RU2587966C2 - Physiotherapy apparatus - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment, namely to devices for dynamic physiotherapy. Device comprises support for at least partial support and retain patient's limb, manipulator connected thereto, which includes mechanism with parallel links, first and second parts, first part comprises multiple sources of radiation signal, and second part includes plurality of detectors for detecting at least part of the signal and/or first or second part includes an emitter signal and at least one inclinometer and/or gyroscope each signal is emitted and detected by detector has time signal between appropriate source and detector. Device also includes controller configured to determine plurality of times of signal passage between at least some of sources and at least some of detectors and determination of spatial position and orientation of first and second parts relative to each other on basis of multiple certain time and measurement data inclinometer and/or gyroscope. Device also has possibility of storage in memory of plurality of certain spatial positions and orientations of first and second parts relative to each other, and controller is configured to read at least part of stored in memory certain spatial positions and orientations of first and second parts relative to each other, determine at least one sequence of maneuvering body part as function of stored in memory of plurality of certain spatial positions and orientations of first and second parts relative to each other, and control device for actuation of manipulator to maneuver support so that part of body, when properly positioned on support, performs maneuvers according to at least above sequence of maneuvering. Method of operation and data medium containing part of software code, providing device.

EFFECT: invention increases accuracy of maneuvering due to training sequence.

15 cl, 14 dwg

Description

FIELD OF THE INVENTION

The present description relates to the field of physiotherapeutic devices and, in particular, to a device for dynamic physiotherapy, and more particularly to a device for dynamic physiotherapy of the head, neck and / or shoulders. In another aspect, the present description relates to determining the position and / or displacement of a body part.

BACKGROUND OF THE INVENTION

In physiotherapy, in particular in orthopedic physiotherapy, there is a difference between active therapies and passive therapies. With active therapy, preset movements are performed by the patient during training and learning sessions. In passive or rendered therapy, a patient is treated by manipulating one or more parts of the body. There are two different types of treatment used: static therapies and dynamic therapies.

In static therapy, a part of a patient’s body is brought into a predetermined position and a predetermined force is applied to a part of the body for a predetermined time to maintain a part of the body in that position. Such static treatment facilitates the use of the device to provide an adjustable predetermined force (in magnitude and direction) for the required period of time. For example, there are various pulling devices that can be made in the form of a simple pulley. A more sophisticated robotic pulling device is disclosed in DE 20 2008015138.

In dynamic therapy, a part of the body being treated is maneuvered along a predetermined path, usually at a given speed and / or force. This requires delicate motion control so as not to hurt or harm the patient. Maneuvering a part of the body means moving, continuously or intermittently, parts of the body by external forces, for example, by another person, such as a doctor.

For applying dynamic therapy to the patient’s head and neck according to various methods, WO 2008/059497 discloses a device for treating a patient’s body or organ, in particular his head and neck, by controlled maneuvering of the organ to be treated, comprising: a support pad adapted for stable and convenient retention of the organ to be treated; and a maneuverable platform on which the cushion is supported, including maneuvering means adapted to rotate the platform in the sagittal, coronal, horizontal planes or in any combination of these planes for a given period of time; moreover, the maneuvering by the said body is characterized by parameters selected from the set of permissible movements, which is defined in the document, while the duration of the movement in all cases is up to approximately 90 seconds.

Due to the structure of the joint being treated, and / or due to the patient’s limitations (in terms of flexibility, illness, pain, etc.), the trajectory of therapeutic maneuvering can be complex. This is particularly the case for moving the head, neck and shoulders, which includes changing and moving centers of rotation and / or relative translational movements. To enable neck treatment, the device disclosed in document WO 2008/059497 relies on the serial connection of the engines as well as on the biological feedback (muscle tension, etc.), thus the device suffers from a large size and complexity, as well as from accumulation errors in position and orientation from one engine to the next, reducing the accuracy of the position and orientation of the pillow. In addition, such a device tends to be expensive and can be frightening for patients, preventing them from relaxing during treatment, which reduces its effectiveness.

The purpose of the present description is to provide an improved device for the implementation of dynamically applied physiotherapeutic treatment. Another goal is to create a device for improving the determination of spatial position, orientation of a body part and determination of displacement.

SUMMARY OF THE INVENTION

According to a first aspect, there is provided a device configured to treat a portion of a patient’s body. The device comprises a support for at least partially supporting and holding a part of the body and a manipulator connected to the support for supporting the support and maneuvering it.

The manipulator contains a mechanism with parallel connections, such as a double tripod, pentapod or Stuart platform or hexapod, which provides better accuracy and much higher rigidity for a given structural mass than a mechanism with serial bonds, and vice versa, which may have a reduced mass for a given desired stiffness. Reduced mass leads to lower power consumption and increased accuracy during handling and maneuvering. The manipulator, which provides controlled positioning of the support with six degrees of freedom (three mutually perpendicular directions of translational movement (X, Y, Z) and three rotational movements around the directions of translational movement (rotation, tilt, rotation in the horizontal plane)), allows for complex movements and trajectories using the support. A solid angle made up by flat angles (θ, ϕ, ρ) in mutually perpendicular directions of approximately (45 °, 45 °, 45 °) makes it possible to access the range of head movement of a normal, healthy person and a person without pain for about 90 years and helps to prevent asymmetric treatment. Translational degrees of freedom make it possible to take into account changes and displacements of centers of rotation and / or relative translational displacements during neck movement.

In a preferred embodiment of the device (mechanism with parallel connections), the manipulator comprises a Stuart platform having six linear actuators connected to two supporting elements via hinges. The Stuart platform may occupy a small volume relative to its attainable range of motion. In addition, the Stuart platforms are generally reliable and provide a low probability of kinematic singular points, that is, points at which the position, movement and / or direction of two support elements relative to each other are ambiguous or where the degree of movement has become unattainable or “crowded out”, for example, in a state known as folding gimbal frames. The Stuart platform can even be designed to be essentially free of singular points. Thus, the security of the device is increased.

One or more hinges, preferably all hinges of the device with parallel connections can be made in the form of a magnetic ball connection. This reduces the number of parts and reduces friction and maintenance compared to biaxial universal joints (cardan joints). The magnetic ball joint also does not contain a housing for holding the ball of a non-magnetic ball joint, which also reduces friction and the number of parts. In addition, the range of motion of the joint and thus the manipulator is increased, facilitating the achievement of a solid angle made up by flat angles (θ, ϕ, ρ) in mutually perpendicular directions of approximately (45 °, 45 °, 45 °) described above. The magnetic ball joint may be enclosed at least partially by a flexible tube to help prevent the joint from being disconnected.

One or more hinges, preferably all hinges, of the mechanism with parallel connections can be made in the form of a flexible connection (tendon joint). In this text, a flexible connection is any type of connection in which two objects are movably connected by a third flexible element, which is flexible in at least two perpendicular directions, such as a rod or pipe made of plastic, natural and / or synthetic rubber, a coil spring or spring another type, part of a cable, for example, a steel cable, etc. Typically, the flexibility of the flexible joint is such that, in a weakened and unloaded state, the flexible member is oriented essentially straight, like a rod, rod or rod, without sagging down under its own weight in a horizontal position. Flexible joints can allow a range of motion in a wide solid angle, making it easier to achieve the solid angle described above. The range of motion of the flexible joint can be determined by the choice of material, diameter, length and / or shape of the joint, for example, from a substantially cylindrical rod to a substantially hourglass rod. A flexible connection provides a direct connection between the parts of the hinge connected by this connection, preventing the connection from being disconnected. Rubber universal joints and coil springs with various characteristics are available on the market, in general, at a significantly lower price than cardan joints or (magnetic) ball joints.

Magnetic ball joints and in particular flexible joints require a small housing, up to the complete absence of a housing, for connection and, thus, can take up a small volume. Thus, the joints of the manipulator can be located close to each other. This increases the freedom of movement of the manipulator.

It has been found that a parallel-link mechanism, in particular a Stuart platform, containing a plurality of linearly coupled linear drives with universal joints or non-magnetic ball joints, typically has a range of motion in solid angle that is limited to approximately 30 degrees in the direction of rotation (rotation, tilt) rotation in the horizontal plane), and which can limit the range of translational motion. In order to reduce the likelihood of singular points of such a mechanism, in particular in the case of Stuart platforms, one or more universal universal joints can be rigidly attached to the base or platform. However, this reduces the range of motion of the device and may affect the symmetry of the remaining range of motion. When using magnetic ball joints and / or flexible joints, the range of rotational motion (rotation, tilt, rotation in the horizontal plane) of the device, in particular, the Stuart platform, as well as the range of translational motion can be significantly increased for the same drives. The improved therapeutic device disclosed in this text illustrates this.

To take advantage of one or more of the advantages described above in an existing Stuart platform or in any mechanism with parallel connections, it can be improved by modifying one or more of its existing joints with flexible joints.

An elastic hinge, in particular an elastic flexible joint, provides restoring force to the manipulator to help restore the default position. In addition, it can function as a shock absorber and can reduce the shocks of the manipulator (push 1 is the time derivative of the acceleration a or, equivalently, the second derivative of the velocity v and the third derivative of the position s : i = d a / dt = d ² v / dt ² = d ³ s / dt ³ ). This ensures a smoother movement of the object supported by the manipulator, therefore, a smoother movement of the body part. This advantage does not depend on the degree of translational or rotational mobility and / or the range of motion of the manipulator and, therefore, the device containing the manipulator.

The advantages of flexible coupling, in particular elastic flexible coupling, for a parallel coupling mechanism with linear drive mechanisms may benefit other parallel coupling mechanisms that use them.

Flexible rubber couplings with various characteristics are usually available on the market at a significantly lower price than gimbal joints or (magnetic) ball joints.

In the case of the present device, including elastic flexible joints, the movements (parts of the body) of the patient can be compensated to some extent, determined by the elasticity of the joints. The patient can thus resist to some extent the amplitude of movement of the support. Comfort and safety (a sense of security) in patients therefore increase significantly.

At least one of said linear actuators may include at least one lead screw drive. A drive with a lead screw can be lightweight and provide a large stroke of the drive compared to a hydraulic or pneumatic cylinder of equal force and equal length with minimal elongation. In addition, the lead screw is self-braking, thus increasing the safety of the device. Further, the drive with a lead screw may have a small diameter relative to its force compared to other types of drives, allowing close placement of the drives, which provides an advantage in the degree of mobility of the manipulator.

The device may include a servomotor and / or stepper motor for actuating one or more of the aforementioned linear drives accurately and reliably. Servo motors or stepper motors are generally reliable for setting both absolute and relative adjustments.

A servo motor and / or a stepper motor in combination with a drive with a lead screw allow constant accuracy along the entire stroke of the drive, as well as high speed operation. This allows movements to be performed for complex paths. By selecting the pitch of the lead screw and the pitch of the motor, the accuracy of the positioning of the drive is ensured, and therefore the accuracy of the position and orientation of the device.

To improve the reliable assignment of movements of one part of the body relative to the second part of the body, the device may further include a second support for supporting, such as a stand, chair, couch or bed, to keep the other part of the body stationary.

Physiotherapeutic device may contain the first part and the second part: the first part contains many sources for emitting a signal, and the second part contains many detectors for detecting at least part of the signal. Each signal emitted by the source and detected by the detector has a signal transit time between the corresponding source and the detector. A device comprising a controller configured to determine a plurality of signal propagation times between at least some of the sources and at least some of the detectors, allows to determine, mainly using a controller, based on a plurality of signal propagation times determined, the spatial position and orientation of the first and second parts relative to each other.

The first part may include a support, and the second part of the device may be a second support or other object. Preferably, the first part of the device includes an object that is easily attached to a part of the body, for example, suitable for putting on it, such as a helmet, eyeglass frame, headband, bracelet, etc. This allows you to determine the position and movement of the body part, regardless of the position of the support and / or the manipulator relative to the body part, for example, during maneuvering part of the body by a doctor.

Preferably, the signal is an ultrasonic signal, this reduces electromagnetic interference, and it is not noticed by people.

In addition, the source may be configured to simultaneously emit a first signal and a second signal; the first signal is a relatively slow signal, preferably an ultrasonic signal, and the second signal is a relatively fast signal, for example, an electrical, radiographic, and / or optical signal. If the transit time for the second signal is negligible compared to the first signal, then the second signal can be effectively used to start measuring the transit time of the first signal. This makes it easy to measure and collect data.

In order to record at least part of a maneuvering sequence or trajectory, the device can be arranged to store in the memory device a plurality of determined spatial positions and orientations of the first and second parts relative to each other. In addition, time stamps corresponding to at least some of the determined spatial positions and orientations may be stored to provide information about speed and acceleration.

The storage device may be integrated in the device, be removable and / or remote, for example, a disk, a solid state storage device and / or a remote computer.

The device may further include a controller configured to read at least a portion of the information stored in the storage device in order to determine at least a first sequence of maneuvering with a part of the body as a function of the information stored in the storage device and with the ability to control the device to actuate by at least part of the manipulator, for example, one or more drives for maneuvering the support so that the part of the body when it is properly positioned on a support and is retained by it possible, according to the maneuvers performed at least a first sequence of maneuvers.

This allows you to recreate the registered trajectory, in particular the trajectory of the actual part of the body.

In yet another aspect, a method is provided for determining the spatial position and orientation of a first object relative to a second object; the first object contains many sources of ultrasonic signals, and the second object contains many detectors of ultrasonic signals for detecting signals from signal sources. The method includes the steps of emitting a signal from at least one source from a plurality of signal sources and detecting a signal from at least one detector from a plurality of signal detectors so that each signal emitted from one of the sources and received by one of the detectors has a signal propagation time between the respective source and detector; determining a plurality of transit times of a given signal from one source to multiple detectors and / or a given signal from multiple sources to one detector; determination, based on certain numerous travel times. the signal of at least one of the position of one source relative to multiple detectors, and accordingly the position of one detector relative to multiple sources; and repeating the steps of the method of emitting and detecting the signal, determining the signal transit times and determining relative positions with various combinations of sources and detectors, and determining from the determined relative positions the spatial position and orientation of the first and second objects with respect to each other.

Using the aforementioned method, the position and orientation of the first and second objects relative to each other are easily and reliably determined using triangulation with multiple positions. One source and three detectors or three sources and one detector are sufficient to determine the relative positions of two objects. Using three sources and three detectors, the relative position and orientation of three-dimensional objects can be uniquely determined using a minimum number of sources and detectors.

By repeating the steps of the method and storing in the storage device certain spatial positions and orientations of the first and second objects relative to each other, the trajectory of the first and second objects relative to each other can be recorded. In addition, time stamps corresponding to at least some of the determined spatial positions and orientations can be stored to provide information about speed and acceleration for the path.

If the first or second object is a solid motionless body, for example, a building structure, such as a wall, this object can accordingly serve as a reference base.

The above aspects are explained below with additional details and advantages with reference to the drawings, in which, by way of example, embodiments of the invention are shown.

BRIEF DESCRIPTION OF THE DRAWINGS

1 illustrates a device for treating a patient's head.

2A-4C explain the basic movements of the human head.

5 shows an alternative embodiment of a device for treating a patient’s head.

6 and 7 explain the use of the device depicted in figure 5.

FIG. 8 illustrates an example embodiment of a device for treating a patient’s head.

9-10B show various ball joints. 11A-14 show various flexible joints.

DETAILED DESCRIPTION OF EMBODIMENTS

It should be noted that the drawings are schematic, not necessarily to scale, and that details that are not required to understand the present invention may have been omitted. The terms “up,” “down,” “below,” “above,” and the like, refer to embodiments as they are oriented in the drawings, unless otherwise indicated. In addition, elements that are at least substantially identical or that perform at least a substantially identical function are denoted by the same numeric position where this is useful with an individualized letter suffix.

Figure 1 shows a device 1 configured to treat a patient 3 by controlled maneuvering at least a part of the body, in the present example, the head 5 relative to the torso 6 of the patient 3. The device 1 contains a support 7 for supporting the head 5 and a second support 9 in the form of a bench to support the torso and limbs of the patient 3. The second support 9 may contain numerous parts that can be movable relative to each other, for example, for the comfort of the patient (not shown). The manipulator 11 is connected to the support 7 to support and maneuver it. The support 7 may include a support cushion, a cradle and / or means for providing and maintaining a specific position of the head relative to the support 7.

The shown manipulator 11 contains a mechanism 13 with parallel connections, here in the form of a Stuart platform or hexapod 13 having a base 15, a platform 17 and six linear actuators 19 connected by hinges 21 to the base 15 and platform 17. Each linear actuator 19 includes a lead screw 23 with threaded and rotatable, placed in the threaded part inside the pipe 25. Other types of drives, for example, hydraulic or pneumatic drives, drives with pulleys, rack and pinion drives without a pipe, etc. are possible. However, a lead screw drive is generally preferred over other drive types, being less expensive, requiring less maintenance and less weight. Each drive 19 is rotated by a servomotor or a stepper motor (not shown) to change the length of the corresponding drive 19. The combination of the lengths of each drive 19 determines the relative position and orientation of the base 15 and platform 17 of the Stuart platform 13. Since the support 7 is connected to the (platform 17) by the manipulator 11, the relative position and orientation of the support 17 are determined by the regulation of the drives 19. The controller 27 is connected to the manipulator 11 to control the drives 19 of the device 1 for maneuvering the support 7. Thus, it is possible to maneuver the head 5 when it is respectively positioned on the support 7 or in it.

In addition, an additional bearing 28 is provided in order to allow the movement of the support 7 relative to the platform 17 to increase the degree of mobility when moving the neck in one or more directions relative to the platform 17. The movement in a specific direction may be determined by needle bearings and / or a guide; Ball bearings can be used to move in a variety of directions. The advantage is increased flexibility and comfort for the patient 3, however, due to the reduced controllability of the position and / or trajectory of the head 5 relative to the platform 17.

FIGS. 2A-2C, 3 and 4A-4C explain the main movements of the head 5 of patient 3, three essentially perpendicular movements of the sagittal flexion-extension within the angle 9 defined in the sagittal plane (FIGS. 2A-2C), coronal inclinations within the angle ρ defined in the coronal plane (FIG. 3) and horizontal rotation within the angle φ defined in the transverse plane (FIGS. 4A-4C). The orientation (θ, ϕ, ρ) of the head is determined relative to the anatomical longitudinal axis A. Since the human neck contains seven vertebrae, only theoretically perfect horizontal rotation leads to rotation around a fixed axis of rotation, sagittal flexion-extension and coronal tilts lead both to rotation, so and translational movement of the center of rotation. Combined movements in numerous directions outside the planes are also possible, so that the head 5 can move in a solid angle Ω, which is generally covered by an achievable range of angles (θ, ϕ, ρ) (not shown).

Similar considerations apply to other joints that can reach large (e.g., shoulders) or smaller (e.g., knees) solid angles.

The main goal of physiotherapy is to achieve normal mobility (speed and range of motion) for the patient, or at least as close as possible and as convenient as possible for a particular patient.

The range of motion found for normal healthy people between 10 and 90 years is shown in the following table 1, showing the movement (see figa-4C: sagittal extension (not shown) is the extension of the face forward with the head parallel to the torso, while measured the angle of the neck relative to the torso), the maximum angle achieved by this movement, and the full range of motion during this movement.

Table 1 Range of motion Moving Max. [°] Overall [°] Angle θ of sagittal flexion Sagittal extension 45-60 90-130 55-70 Corner ρ of the coronal inclination 45 90 Horizontal angle ϕ 60-80 120-160

In humans, the range of motion tends to decrease with age. Flexible people and younger people can achieve higher listed values, for example, adolescents can reach a bending range of approximately 130 ° -135 °, with θ between -70 ° and 70 °, tilt range of approximately 90 °, with ρ between -45 ° and 45 °, and horizontal rotation in the range of approximately 160 °, with ϕ between -80 ° and 80 °. For treating an elderly patient, it is preferable to have a smaller range of motion. To make possible the treatment of most patients, taking into account differences in growth and physical disabilities, manipulation of the head to an angle of 9 sagittal flexion of approximately -70 ° (back) and 70 ° (forward), to an angle ρ of the coronal inclination of approximately -50 ° (may be provided) to the left) and 50 ° (to the right), and to an angle ϕ of horizontal rotation of approximately -45 ° (to the left) and 45 ° (to the right), since the restriction during horizontal rotation can be easily compensated by the patient by turning the shoulders or part of the torso. A horizontal rotation angle ϕ up to approximately −90 ° (left) and 90 ° (right) may be preferred for treating the neck itself, which does not require a torso or shoulder rotation.

Translational movement in the coronal direction of approximately 15-20 cm is desirable in order to take into account the curvature of the vertebrae of the neck and / or the displacement of the skull of middle adults in the treatment of coronal tilt. A similar translational movement is desirable in the sagittal direction in the treatment of flexion. Large ranges of translational motion, for example, up to 30 or 40 cm, at least in the coronal direction, are preferred to facilitate the treatment of higher patients. Preferably, the range of translational motion is substantially equal in two dimensions parallel to the coronal plane (e.g., horizontal), and it can be substantially equal in the third dimension, in the sagittal plane.

Thus, the manipulator 11 can maneuver part 5 of the body in a volume covered by a combination of the range of translational motion and rotation. While static physiotherapy usually only refers to maintaining the relative position and orientation of the body part being treated, in dynamic physiotherapy therapeutic maneuvers are known for various diseases. A maneuver can be carried out with the necessary duration corresponding to a specific speed of movement. A typical sequence of maneuvering steps for physiotherapeutic treatment of the head and neck is defined in Table 2, with each step taking approximately 30 to 90 seconds.

table 2 Therapeutic Maneuvering Sequence Step Traffic Starting angle End angle one Sagittal forward flexion (0 °, 0 °, 0 °) (70 °, 0 °, 0 °) 2 Sagittal return (70 °, 0 °, 0 °) (0 °, 0 °, 0 °) 3 Coronal tilt to the right (0 °, 0 °, 0 °) (0 °, 45 °, 0 °) four Coronal Return Right (0 °, 45 °, 0 °) (0 °, 0 °, 0 °) 5 Coronal slope to the left (0 °, 0 °, 0 °) (0 °, -45 °, 0 °) 6 Coronal Return Left (0 °, -45 °, 0 °) (0 °, 0 °, 0 °) 7 Horizontal rotation to the right (0 °, 0 °, 0 °) (0 °, 0 °, 45 °) 8 Right horizontal return (0 °, 0 °, 45 °) (0 °, 0 °, 0 °) 9 Left horizontal rotation (0 °, 0 °, 0 °) (0 °, 0 °, -45 °) 10 Left horizontal return (0 °, 0 °, -45 °) (0 °, 0 °, 0 °)

The endpoints of each movement can vary from one patient to another and / or from one therapy procedure to another. Alternative sequences of maneuvering steps are also possible.

Preferably, the device is arranged so that the angles (θ, ϕ, ρ) of the patient correspond to the angles of substantially pure rotation, tilt and rotation in the horizontal plane of the manipulator 11. This facilitates the control and / or programming of the device and can optimize the use of the range of movement available with the manipulator . Starting positions and final positions of the head and, therefore, supports can also be determined for complex movements depending on the size of the patient 3.

Fig. 5 shows a second embodiment of the device 1. The device 1 comprises an object worn by the patient, here is a device 29 for wearing on the head in the form of spectacle frames 29 worn by the patient 3 and provided with three signal sources in the form of emitters 31A-31C for emitting ultrasonic pulses and radio pulses. In addition, device 1 comprises three signal detectors in the form of ultrasonic detectors 33A-33C and at least one radio signal detector (not shown) for detecting ultrasonic pulses and radio pulses of emitters 31A-31C, respectively. All receivers 33A-33C are connected to the controller. A radio signal detector may be included with an ultrasonic detector. Each detector 33A-33C is attached to the frame 35, or optionally to some other element, such as a wall, a second support 9, etc., provided that it can detect the signals emitted by the emitters 31A-31C. In particular, in the case of ultrasonic signals or. optical signals between sources 31A-31C and detectors 33A-33C should be essentially transparent and without obstruction line of sight to prevent possible signal deterioration or loss. In addition, the device 1 contains a clock (not shown) and a storage device 37 for storing data.

The emitters 31A-31C are located to determine the first plane through the emitters 31A-31C. Detectors 33A-33C are located to determine the second plane by means of receivers 33A-33C.

In operation, the first emitter 31A produces a radio signal and an ultrasonic signal. The signals may include one or more pulses or pulse sequences, and possibly include information for identifying the emitter 31A-31C. A radio signal is detected by a radio signal detector. Ultrasonic signals are detected by each of the detectors 33A-33C and the detection (its moment) is signaled to the controller 27. Since the radio signal was detected by the radio signal detector, the detectors 33A-33C and the controller 27 measure the time of arrival of the ultrasonic signal to each detector 33A-33C to determine the corresponding transit times signals T (31A, 33A), T (31A, 33B) and T (31A, 33C). Differences between the travel times of the signals T (31A, 33A), T (31A, 33B) and T (31A, 33C) as a result of different travel distances allow you to determine the position of the signal source relative to the detectors. Determination of all combinations of signal transit times T (31A, 33A), T (31A, 33B) and T (31A, 33C); T (31B, 33A), T (31B, 33B) and T (31B, 33C); T (31C, 33A), T (31C, 33B) and T (31C, 33C) allows you to determine the mutual orientations of the first and second planes, blocked by emitters 31A-31C and detectors 33A-33C. This leads to a complete determination from the determined relative positions of the spatial position and orientation of the device 29 for wearing on the head, and thus the patient's head 5 and frame 35 relative to each other.

Also or alternatively, the support 7 may be provided with emitters. The presence on the patient side (device 29 for wearing on the head and / or support 7, etc.) of emitters 31 and on the controller side or the far side (frame 35, etc.) of the detectors 33 facilitates the processing of signals:

the head wearing device 29 may include a low power battery supplying signal sources 31 for emitting radio-transmitted signals, while the detectors 33 may be wired and / or combined with a controller 27.

To increase the reliability of the measurements, it is preferable that the ultrasound sources are arranged with mutual spacing of approximately 15 cm or more. Greater diversity increases the reliability of triangulation, since with increasing diversity a constant absolute error will lead to a smaller relative error. This also applies to ultrasonic detectors.

Another way to determine the orientation (deviations in orientation) of a body part involves the use of one or more gyroscopes and / or one or more inclinometers attached to the body part and / or support. The inclinometer can detect orientation (deviations in orientation) relative to the gravitational field and / or other reference system, for example, a magnetic field, preferably a magnetic field of the Earth. One inclinometer can be used to determine the orientation (deviations in orientation) in one plane, and can thus provide essentially the same information as two signal sources (or detectors) and three detectors (or sources, respectively).

Preferably, at least two inclinometers are used to determine the orientation (deviation in orientation) in two spatial directions at an angle to each other, preferably mutually perpendicularly, which allows you to determine the three-dimensional inclination of the controlled object (body parts and / or supports). The gyroscope facilitates control of speed and / or acceleration and, in particular, angular velocity and / or acceleration, and allows you to determine the angle of rotation by integration. measured angular velocity for a certain time.

In a preferred embodiment, the two inclinometers are substantially mutually perpendicular and are configured to measure inclination angles of a relative local horizon (local earth plane), for example, inclination and rotation angles, which may correspond to a sagittal flexion-extension (inclination) angle θ and a horizontal rotation angle ϕ (rotation). In addition, a gyroscope is provided for measuring substantially perpendicular to the measurement planes of the inclinometers in order to measure a rotation angle in the horizontal plane (ρ), which may correspond to a coronal rotation angle. Magnetic inclinometers and gyroscopes can be combined into one integrated circuit.

In a particularly preferred embodiment of the therapeutic device, the support is provided with two or three signal sources and / or detectors, respectively, and the headgear comprises at least one signal source or detector, respectively, and one or two inclinometers and one or more gyroscopes . Sources and / or signal detectors preferably include ultrasonic sources and / or detectors, as before. Thus, the position and orientation of the support can be reliably determined, the size of the support is relatively unimportant and therefore allows a spacing of sources and / or signal detectors of more than 15 cm. In addition, the position and / or displacement of the wearing device on the head can be determined from the source and / or detector and (changes in) its orientation from inclinometers and gyroscope (s), which can be combined in a small-volume device, for example, one integrated circuit.

Doctors usually use the maneuvering part of the body to be treated, both for diagnostic and therapeutic purposes, possibly in combination in one trajectory.

As shown in FIGS. 6 and 7, in a typical therapeutic treatment procedure, patient 3 is positioned on the first and / or second support 7, 9 and the doctor 39 maneuvers the part of the body being treated, in this case the head 5. During this, the doctor 39 can hold directly body part 5 and / or support 7 with body part 5 attached thereto. With the direct retention of body part 5, the doctor 39 maneuvers and treats the patient 3 in the usual way and at the same time receives hard feedback from the patient’s body, which facilitates the diagnosis and monitoring of the course of treatment.

During treatment and / or diagnosis, the position and orientation of the body part 5 are repeatedly determined by the emitters 31A-31C, the detectors 33A-33C and the controller 27, and this data is stored with the appropriate time stamps in the memory 37. In this way, the actual movements and trajectory of the part 5 are recorded body (and / or, in a suitable case, displacement and the trajectory of the support 7).

When maneuvering with a body part 5 provided with emitters 31A-31C, the support 7 and / or the manipulator 11 can be at least partially lowered, moved away and / or removed altogether to provide freedom of choice for body position and / or movement for the doctor 39.

For automated treatment with device 1, the manipulator 11 is placed in the required position, possibly connected to the connecting part on the floor of the treatment room and / or attached to the second support 9. Then, part 5 of the body and support 7 are placed in the desired position, for example, by a doctor 39. Location (drives 19) the manipulator 11 and the position of the support 7 are determined by the controller and the position and orientation of the body part 5 are determined relative to the (frame 35) of the device, for example, using signals from sources 31 and signal detectors 33. Then, treatment is applied with the device 1 by actuating one or more drives 19 under the control of the controller 27 so as to maneuver the support 7 in such a way that the body part 5 is maneuvered according to the path defined by the doctor’s maneuvering sequence.

The trajectory can be stored in or read from memory 37 or another storage medium as part of a software code that, when executed by controller 27, drives at least a portion of manipulator 11, for example at least one of the drives 19, in a predetermined a sequence of steps so as to maneuver the support 7 according to the desired maneuvering sequence for treating part 5 of the patient’s body 3; this allows you to store and transfer treatment data to another treatment device 1, to a patient file for further reference, etc.

In the device 1 shown in FIGS. 1 and 5-7, the Stuart platform 13 is mounted to the right with the platform 17 supported by the drives 19 above the base 15. In an alternative embodiment, see FIG. 8, the manipulator 11 comprises a Stuart platform 13, which is located essentially horizontal, and the support 7 in the form of a console protrudes from the platform 17. This allows the seated doctor to maneuver his head 5. However, the load on the Stuart platform 13 is less favorable than in the vertical case, and the manipulator 11 requires a more stable Stuart platform 13, which has t tend to be heavier, more expensive and possibly less accurate. It may also impede the use of magnetic ball joints (which may have too little attractive force within acceptable financial and / or spatial constraints), but suitable flexible joints can be provided and successfully used.

In the embodiment depicted in FIG. 8, another construction of a flat frame 35 with a detector 33 is also shown. In addition, the plane of the emitters 31 can be seen on the head wear device 29.

Fig. 9 is a cross-sectional view of a standard ball joint 41 comprising a ball 43 that is housed in a mating body 45. The ball 43 is connected or can be connected to another object using a threaded axis 47. The ball 43 is held in position in the housing 45 by a ring 49.

FIGS. 10A and 10B are perspective views (FIG. 10A) and cross-sectional views (FIG. 10B) of exemplary magnetic ball joints 51 for use as an improved hinge 21 comprising a ball 53 that is placed in conjugate case 55. Ball 53 is connected or can be connected to another object, for example, with a threaded axis 57. The ball 53 is held in position in the housing 55 by a magnetic part 59 attracting the ball 53.

From the comparison of FIGS. 9 and 10B, it is evident that the magnetic ball joint 51 has a significantly greater degree of movement mobility between the threaded body 55 and the threaded shaft 57 than the standard ball joint 41 between the threaded body 45 and the threaded shaft 47.

11A-14 show various flexible joints 61 for use as an improved hinge 21, comprising a flexible member 63 attached to a first object 65, such as a base 15, and to a second member 67, such as a drive 19, and connecting these elements . The flexible member 63 may be attached in any suitable manner, for example, a support 69 with a clamping ring. Industrial rubber flexible members 63 of the flexible joint may comprise a threaded nut for attaching the flexible member to another object. 11B illustrates this, a sufficiently long and resilient flexible element, if this also allows the shape of the first and second objects 65, 67, can be easily bent by approximately 90 ° in any direction from a straight position, assuming a degree of mobility of movement in solid angle essentially 2π steradian.

12 schematically illustrates an elastic flexible joint 61 with a flexible member 63 between two objects 65, 67 in the form of a coil spring. 13 schematically illustrates an elastic flexible joint 61 with a flexible member 63 formed by a rod 71 having periodic tangential or radial cuts 73 in different directions in the direction of extension of the rod 71. Here, the cuts 73 alternate in directions that are perpendicular to each other. Fig. 14 illustrates a flexible connection similar to Fig. 13, but with a tubular flexible element 63 having through cutouts 73 in the wall of the tubular flexible element 63. Another embodiment (not shown) comprises a hollow flexible element having a flexible accordion-shaped flexible wall with a periodically changing diameter in the direction of the length of the flexible element to give flexibility and elasticity to the pipe.

A flexible joint 21, attached at one end to a base 15 or platform 17, and at the other end to a drive 19 with a threaded spindle, may experience some rotation, depending on the design and / or material of the flexible element, but will sufficiently prevent the drive from rotating 19 s with a lead screw relative to the base 15 or platform 17 so as to eliminate additional measures to prevent unwanted rotation of the drive 19 with the lead screw relative to the base 15 or platform 17 and / or lead screw 23 and the pipe 25 relative to each other.

The invention is not limited to the embodiments described above, which can be modified in a variety of ways within the scope of the claims. For example, a device may include one or more connectors, readers, recording devices and / or receivers for one or more storage media (not shown) (for connecting to them) and a storage device to provide and / or store data and / or program for use by the controller and / or for programming it.

The device may include a user interface with which the user, for example, a doctor, can adapt and / or program the maneuvering sequence and write it to a storage device. For example, when arranging the stored maneuvering sequences into the desired trajectory or program, a periodically repeating trajectory with increasing amplitude of movement (for example, bending angle, coronal translational motion, etc.) and / or speed with each repetition. Data from registered treatment maneuvers and trajectories and / or parts of the software code for their execution by device 1 can be delivered and / or sold on suitable data carriers.

Various objects worn by the patient may be delivered separately or complete with a manipulator and / or support, for example, devices for wearing on the head, appropriate to the patient’s size, diseases and / or preferences of the user, and / or for replacement.

The first support and at least part of the second support can be connected movably, as shown in Fig.7.

The method may include positioning and / or orientation of a part of the body and / or part of the device, for example, the support, in one or more default positions and / or orientations for installation in the initial position, increasing the reliability of the installation and / or maneuvering. This may include multiple resetting.

Elements and aspects considered for or in connection with a particular embodiment may be suitably combined with elements and aspects of other embodiments, unless expressly indicated otherwise.

Claims (15)

1. A device (1) for treating a part (5) of a patient’s body (3), comprising:
a support (7) for at least partial support and retention of a part of the patient’s body (3); and
a manipulator (11) connected to the support, to maintain the support and maneuver it,
wherein the manipulator includes a mechanism (13) with parallel connections;
the first part (29) and the second part (35), the first part including many sources (31A, 31B, 31C) for signal emission, and the second part includes many detectors (33A, 33B, 33C) for detecting at least part of the signal, and / or the first or second part comprises a signal emitter and at least one inclinometer and / or gyroscope,
wherein each signal emitted by the source and detected by the detector has a signal transit time between the corresponding source and the detector,
moreover, the device includes a controller (27), configured to determine the set of signal travel times between at least some of the sources and at least some of the detectors and determine the spatial position and orientation of the first and second parts relative to each other based on the set of certain signal travel times and measurement data of an inclinometer and / or gyroscope, when applicable,
however, the device is also configured to store in the storage device (37) a plurality of the aforementioned specific spatial positions and orientations of the first part (29) and the second part (35) relative to each other,
and the controller (27) is configured to
to read at least a part of the plurality of said defined spatial positions and orientations of the first part (29) and the second part (35) stored in the storage device (37) relative to each other,
determine at least one maneuvering sequence with a part of the body (5) as a function of the plurality of the aforementioned specific spatial positions and orientations of the first part (29) and the second part (35) stored in the memory device (37) relative to each other; and
control the device (1) for actuating the manipulator (11) in order to maneuver the support (7) so that the part of the body, when it is properly positioned on the support, performs maneuvers according to at least the mentioned maneuvering sequence. 2. The device (1) according to claim 1, characterized in that at least one of the plurality of sources or said signal emitter, respectively, is configured to simultaneously emit a first signal and a second signal, the first signal having a lower speed compared to the second a signal, wherein the first signal is preferably an ultrasonic signal, and the second signal is, for example, an electrical, radiographic and / or optical signal. 3. The device (1) according to claim 1 or 2, characterized in that the first part (29) contains an object (29) that is intended to be worn on a body part, such as a helmet, eyeglass frame, headband, bracelet, etc. d. 4. The device (1) according to claim 3, in which the first part (29) contains a device (29) for wearing on the head, containing at least one of the following: an ultrasonic signal source, inclinometer, gyroscope, many sources (31A, 31B , 31C) an ultrasonic signal. 5. The device (1) according to claim 1 or 2, comprising a storage device (37) for storing therein a plurality of said specific spatial positions and orientations of the first part (29) and the second part (35) relative to each other. 6. The device (1) according to claim 1, in which
the manipulator includes a mechanism (13) with parallel connections containing a plurality of linear drives pivotally connected to each other (19);
moreover, the parallel linkage mechanism (13) comprises at least one hinge (21) comprising a flexible joint (61), preferably an elastic or magnetic ball joint (51). 7. The device (1) according to claim 1, in which
the manipulator includes a mechanism (13) with parallel connections containing a plurality of linear drives pivotally connected to each other (19);
moreover, the mechanism (13) with parallel connections contains the platform (13) Stuart. 8. The device (1) according to claim 6 or 7, characterized in that at least one of the aforementioned linear drives (19) contains at least one drive with a lead screw. 9. The device (1) according to claim 1 or 2, characterized in that it includes at least one of a servomotor or a stepper motor configured to actuate at least one of the linear actuators (19). 10. Device (1) according to claim 1 or 2, characterized in that it is made with the possibility of controlled maneuvering by a support with six degrees of freedom and in a solid angle overlapped by flat angles (θ, ϕ, ρ) in mutually perpendicular directions approximately (45 °, 45 ° 45 °). 11. The device (1) according to claim 1 or 2, further comprising a second support (9) for supporting at least one more part (6) of the patient’s body. 12. The device (1) according to claim 1 or 2, characterized in that it is configured to save time stamps corresponding to at least some of the determined spatial positions and orientations in the storage device (37). 13. The method of operation of the physiotherapeutic device (1), for example, the device (1) according to any one of paragraphs. 1-12, which includes a first part (29) containing a plurality of ultrasonic signal sources (31A, 31B, 31C), and a second part (35) containing a plurality of ultrasonic signal detectors (33A, 33B, 33C) for detecting a signal from signal sources and / or the first or second part comprises a signal emitter and at least one inclinometer and / or gyroscope;
wherein the method includes the following steps:
a) emission of an ultrasonic signal by at least one source from a plurality of signal sources; and
b) detecting an ultrasonic signal by at least one detector from a plurality of signal detectors so as to determine a signal transit time between a respective source and a detector for each ultrasonic signal emitted by one of the sources and detected by one of the detectors;
c) determining a plurality of signal travel times for a given ultrasonic signal to travel from one source to many detectors and / or a given ultrasonic signal to travel from multiple sources to one detector;
d) determining, on the basis of said plurality of determined signal travel times, the position of one source with respect to multiple detectors and / or, respectively, the position of one detector with respect to multiple sources;
e) repeating the steps of emitting and detecting the signal, determining the propagation times of the signal and determining the relative positions with various combinations of sources and detectors, or determining the angle of rotation and / or tilt using an inclinometer and / or gyroscope, when applicable; and
f) determining the spatial position and orientation of the first and second parts relative to each other using the controller (27) according to the specified relative positions, as well as the angles of rotation and / or inclination, when applicable;
g) repeating steps af;
h) storing said specific spatial positions and orientations of the first and second parts relative to each other in a storage device (37);
i) determining at least one maneuvering sequence with part (5) of the body as a function of at least part of the aforementioned specific spatial positions and orientations of the first and second parts stored in the storage device (37); and
j) actuating at least a part of the manipulator (11) for maneuvering the support (7) so that the part of the body, when properly supported and held by the support, maneuvers according to at least part of said maneuvering sequence. 14. The method according to p. 13, characterized in that it includes an additional step of maneuvering one of the first and second parts relative to the other of them during step d. 15. A storage medium containing parts of a software code that, when executed by a controller (27), controls a device (1) according to any one of paragraphs. 1-12, implementing the method according to any one of paragraphs. 13-14 and / or actuating at least a part of the manipulator (11) in a predetermined sequence of steps to maneuver the support (7) of the device according to at least the mentioned maneuvering sequence, in particular for treating part (5) of the patient’s body (3 )

Images