RU2735986C1 - Exerciser with biological feedback for joints and muscles of hands and fingers rehabilitation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to exercisers with biological feedback for rehabilitation of joints and muscles of hands and fingers. Exerciser consists of a control module, a module of a step-up voltage converter for feeding step motors, an arm extension / extension module, a module of engine of flexion / extension of fingers, sensors of control of skin-galvanic reaction of an organism, gloves for fixation of a hand and a computer connected to the Internet. Control module is made in the form of hollow plastic housing fixed on patient's forearm. Control module comprises current hand flexion / extension arm current control module, fingers finger flexion / extension motor controller, power supply unit for microcontroller and for external connected sensors - myosensors and sensors for control of galvanic skin reaction. Hand flexure / extension arm module is located at the top in the center of the longitudinal axis of the hand and additionally comprises a cylindrical reduction gear and an absolute encoder. Hand glove comprises a plastic finger retainer with a T-shaped pin and a locking bar for fixing the fingers of the glove on the substrate, as well as bending resistor, sewn into index finger of glove with possibility of its use as absolute encoder for measurement of angle of flexion of fingers. Exerciser also contains a soft fabric brace with two myosensors sewn into it and fixed on the forearm by means of a Velcro tape.

EFFECT: enabling increase in the exerciser operational reliability and usability.

1 cl, 15 dwg

Description

The claimed invention relates to the field of satisfying human vital needs. It can be used in medicine for the rehabilitation (restoration) of physical activity and the range of motion of the joints and muscles of the hands and fingers, impaired as a result of injuries or diseases suffered by a person, for example, a stroke, and in the field of sports - for the purposeful development of the tone and strength of the muscles of the hands and fingers. hands, for example mountaineers, rock climbers.

It is known that the consequence of injuries and / or diseases is very often a violation of motor activity and range of motion in the joints, for example, in the wrist, joints of the fingers of the hands. Violations are in the nature of limited mobility in the joints, limitation of the amplitude of their movements in comparison with their physiological parameters, weakening of the tone and strength of the muscles that set the hands and fingers in motion. These disorders significantly limit the ability to work and worsen the quality of life of the patient who has suffered an injury and / or illness. Due to the dysfunction of the upper limbs, patients experience difficulties in self-care and in carrying out daily activities. In this regard, the selection of the most effective means of rehabilitation of patients with this pathology is of particular relevance.

Further in the text, the applicant provides the terms that are necessary to facilitate an unambiguous understanding of the essence of the declared materials and to exclude contradictions and / or controversial interpretations when performing an examination on the merits.

An absolute encoder is a position sensor that counts the number of unique digital codes per unit of disk rotation to measure the main kinematic parameters of an electric drive: speed and shaft position. [http://www.servotechnica.ru/catalog/type/index.pl?id=139#:~:text=%D0%90%D0%B1%D1%81%D0%BE%D0%BB%D1 % 8E% D1% 82% D0% BD% D1% 8B% D0% B5% 20% D1% 8D% D0% BD% D0% BA% D0% BE% D0% B4% D0% B5% D1% 80% D1 % 8B,% D1% 8D% D0% BB% D0% B5% D0% BA% D1% 82% D1% 80% D0% BE% D0% BF% D1% 80% D0% B8% D0% B2% D0% BE% D0% B4% D0% B0% 3A% 20% D1% 81% D0% BA% D0% BE% D1% 80% D0% BE% D1% 81% D1% 82% D0% B8% 20% D0% B8% 20% D0% BF% D0% BE% D0% BB% D0% BE% D0% B6% D0% B5% D0% BD% D0% B8% D1% 8F% 20% D0% B2% D0% B0% D0% BB% D0% B0.]

Galvanic skin response (GSR) is a bioelectric activity recorded on the surface of the skin, caused by the activity of sweat glands and serving as a component of the orienting reflex, emotional reactions of the body associated with the work of the sympathetic nervous system. Can be recorded from any area of the skin, but usually fingers and hands or soles of the feet are used. Serves to analyze the state of a person, his emotional-volitional and intellectual processes.

A myosignal (or electromyogram (EMG)) is an electrical signal characterizing the bioelectric activity of muscles, which is recorded by electrodes of various types: intramuscular (needle electrodes), surface electrodes, unipolar or bipolar. In the claimed technical solution, surface electrodes are used.

A patient is a person with impaired natural mobility of the joints of the hands and / or fingers and / or a person who develops strength, tone, endurance of the muscles of the hands under the guidance of medical personnel or a trainer, for which purpose he is undergoing the process of rehabilitation of joints and muscles of the hands and fingers.

Paresis is a decrease in muscle strength with limited range of voluntary movements.

A session is a period of time during which an action is performed to rehabilitate the hand and / or fingers, some work or part of it.

Muscle tone is the elastic-viscous properties of a muscle, a known degree of involuntary constant muscle tension. There are three different understandings of the term muscle tone:

1) resistance of the muscle to its stretching forces (Rieger, Spiegel),

2) the ability of a muscle to hold one or another degree of contraction for a long time (Foix),

3) muscle tone is taken as the criterion of muscle tone [https://big_medicine.academic.ru/7854/%D0%A2%D0%9E%D0%9D%D0%A3%D0%A1].

DAC is a device for converting a digital (usually binary) code into an analog signal (current, voltage or charge). D / A converters are the interface between the discrete digital world and analog signals.

CPM (Continuous Passive Motion) therapy is a modern trauma treatment method related to mechanotherapy. Continuous Passive Motion in Russian means “continuous passive movement” (“continuous passive mobilization”).

Static mode - in the context of the present description, under this term, the applicant understands the use of a static method of recovery - a long, up to 40 minutes, fixation and holding in a motionless position of the hand or fingers in the claimed simulator during the rehabilitation process.

The static recovery method is based on a scientific discovery made in 2007. The essence of the discovery is that “under the influence of long-term, repetitive and dosed physical, mental and speech loads, on the verge of their tolerance by the human body, the elimination of defects of the nervous system occurs” (Ph.D. Myshlyaev S.Yu.) [https : //xn--b1afrd4dr4a.xn--p1ai/nauka/scientific-publications/novaya-metodika-i-robotizirovannyy-kompleks-dlya-sportivnoy-reabilitatsii-i-vosstanovleniya-narushen/]. Using prolonged physical static loads, it is possible to restart the regeneration process in the brain. It is electrical excitation in the brain that allows the restoration of unformed or damaged neurons and the connections between them. An electrical signal from the "periphery" of the motor, visual or auditory analyzer (electrical regeneration) in the process of rehabilitation triggers biological regeneration in the "center", i.e. - plasticity of the brain or its structural and functional restructuring. Within the framework of rehabilitation or correction, dosed loads (stretching physical exercises with weights in the form of a load), long-term physical static loads are needed.

From the investigated prior art, the applicant identified analogues of the claimed technical solution.

Known useful model for patent RU 147759 "Exercise machine for restoring the mobility of the fingers". The essence is a simulator for restoring the mobility of fingers, containing a hand exoskeleton with drives for moving the fingers of the exoskeleton and a control unit for them, characterized in that the drive for movement of each of the fingers is individual, and the fingers are equipped with a means of attracting the patient's attention, while the control unit for the drives of the fingers is made with the ability to connect to an encephalographic helmet and contains a serially connected unit for recording encephalograms, an analysis unit for encephalograms and a unit for generating commands for finger drives.

The disadvantage of the known utility model is the inability to provide flexion / extension of the fingers in a predetermined (according to the diagnostic results) angular range in the passive mode, i.e. the inability to controllably dose the load on the fingers by setting the angle of flexion of the fingers, the inability to monitor the dynamics of recovery, the inability to correct the course of the rehabilitation process, for example, using biofeedback, the scope of application is limited - only for the fingers. Another disadvantage of the known useful model is also significant complexity in application due to the need to use an electroencephalographic helmet, which has very limited application - only in medical institutions, as a result of which the model is practically not applicable at home and / or by the patient being treated, including because that the installation and operation of the electroencephalographic helmet requires the participation of a second specialist, in addition to the attending physician involved in the rehabilitation.

A device for continuous passive movement is known according to US patent 5327882A [filing date 05.05.1993, published 12.07.1994]. The essence is a device for continuous passive movement for therapy of a patient's hand, comprising a tire adapted to be attached to the patient's forearm and hand, a drive attached to said tire, and containing a motor for driving a gear transmission mounted in a housing mounted with the possibility of rotation of a gear transmission along the first axes, means for attaching fingers, extending from said body and adapted to rotate about it about a second axis spaced from the first axis and parallel to it, and said means for attaching fingers is adapted to attach to at least one of the patient's fingers, and said transmission means upon actuation of said motor means, causing said finger holding means to rotate in the opposite direction around said second axis and relative to rotation of said housing about said first axis, whereby said, along at least one finger is driven along a return path corresponding to at least part of a complex spiral.

The disadvantages of the known device are the low efficiency (unsatisfactory efficiency) of therapy, which is expressed in the form of incomplete restoration of the work of the fingers due to the fact that physiological flexion on this device is performed in an incomplete (compared to natural) volume, since the design of the simulator does not provide (does not provide) interphalangeal flexion. joint of the distal and middle phalanx, there is no possibility of monitoring the dynamics of recovery using biofeedback, the scope of application is limited - only for fingers. The lack of instrumental monitoring of the rehabilitation session makes it impossible to quickly adjust the parameters, for example, the angles of flexion of the fingers, during the process.

Known utility model under the patent RU 175324 "Trainer". The essence is a trainer containing a block of attachment to the arm in the form of a base, made with the possibility of attachment to the outer side of the forearm and hand, a movable part and a drive unit and means for fastening fingers connected to it, while the drive unit contains a motor and consoles installed on the sides of the drive unit and directed towards the hand, while the movable part of the simulator is made in the form of two pairs of levers located on both sides of the longitudinal axis of the drive unit and pivotally connected to the consoles, and the first levers of the pair are made with the ability to move by means of the first gear transmission relative to the axis connecting them with the ends of the consoles, and the second levers of the pair are made with the possibility of movement by means of the second gear transmission relative to the axis connecting them with the ends of the first levers, while between the free ends of the second levers the axis is rigidly mounted on which smo Means for fastening the fingers are mounted, made in the form of four chains of pivotally connected links, and finger holders are installed on the free ends of the chains, and the links are made with holes with the possibility of placing at least two cables in them, while the length of the cable placed closer to the finger is less than the length of the cable located at a greater distance from the finger, according to the utility model, the drive unit is movable over the base along a guide rigidly installed in its front part, and the drive unit motor is connected to a rotatable shaft by means of a third gear train and a sensor the position angle of the simulator by means of the fourth gear transmission. In this case, according to the description of the utility model, the position angle sensor of the simulator can be made in the form of a sensor based on the Hall effect.

The disadvantage of the known technical solution is the inability to provide flexion / extension of the fingers in a predetermined (according to the diagnostic results) angular range in the passive mode, that is, the inability to dose the load on the fingers - thereby restore the strength of the muscles of the fingers - by setting the angle of flexion of the fingers, the inability monitoring the dynamics of recovery and correction of the recovery process using biofeedback, limited scope - only for the joints of the fingers (but not the hands!).

The closest in terms of the number of common features and the claimed technical result, selected by the applicant as a prototype, is the invention of the authors of the claimed technical solution under the patent RU 2720323 "Trainer with biofeedback for the rehabilitation of hands and fingers."

The essence of the prototype is a simulator consisting of a control module made in the form of a hollow plastic body fixed on the patient's forearm, a flexion / extension motor module of the hand, characterized in that it is additionally equipped with a stepper motor for flexion / extension of the hand, a control module located in a microcontroller control module, a stepper motor controller for flexion / extension of the hand and a controller for servo control, a Bluetooth communication module with the computer supplied with the simulator, a galvanic skin response sensor module of the patient's body, two myosensor modules, a power voltage converter module for a stepper motor, autonomous, independent from the mains power supply for powering all electronic components and modules of the simulator, a computer connected to the Internet with specially developed software installed on it, a motor module for flexion / extension of the finger in the hand with a servo-drive that provides controlled forced flexion / extension of the fingers of the hand, a glove for fixing the hand on the flexion module of the hand, equipped with finger pressure sensors located inside the fingers of the glove.

The disadvantages of the prototype in comparison with the declared technical solution are:

1 - impossibility of carrying out rehabilitation in a static mode without reducing the load on the patient's hand for a long time due to the absence of a module for controlling the current of the hand flexion / extension stepper motor and the absence of an absolute encoder in the feedback circuit.

2 - ineffective rehabilitation in a dynamic mode due to the absence of a module for controlling the current of a stepper motor for flexion / extension of the hand and the absence of an absolute encoder in the feedback circuit, since there is no constant operational feedback on the load on the patient's hand and fingers, which does not allow prompt and control the movement of the hand and fingers with high precision.

3 - overheating of the stepper motor when operating in a static mode. Test operation of the prototype, the authors of which are the authors of the claimed technical solution, showed that during the course of rehabilitation sessions in a static mode, after bringing the palm to the required position (angle), the hand should be fixed in this position for up to 40 minutes, depending on the doctor's appointment ... However, after 10 minutes, the stepper motor heats up to 80 degrees and more, since the stepper motor control current remains unchanged and high enough, which leads to overheating of both the stepper motor and the stepper motor controller. Further holding the hand in this mode becomes difficult, and, accordingly, the use of the prototype for performing rehabilitation sessions in a static mode becomes difficult.

4 - ineffective, not economical use of autonomous power supplies, since the current consumption by the stepper motor of the motor module for flexion / extension of the hand does not depend on the real load and is always constant;

5 - a motor module for flexion / extension of the hand, containing a stepper motor with a metal gearbox, is placed on the outside behind the longitudinal axis of the forearm, as a result of which the forearm is outweighed and "everted" to the outside under the weight of the motor and the patient has to apply significant, quickly a tiring effort to keep the forearm in a horizontal position, which makes the patient tired;

6 - application of additional efforts to keep the forearm in a horizontal position due to the peculiarity of the location of the motor module (and servo drive) - on the outside of the end of the outstretched palm of the hand;

7 - additional costs of time in the process of preparing the patient for the rehabilitation session, since the fixation of the glove fingers on the substrate for fixing the glove fingers is carried out with the help of fastening screws, in contrast to the T-shaped pin in the plastic finger retainer and the striker plate for fixing the glove fingers on the substrate in the declared technical solution;

8 - less contact of myosensors with the skin surface of the forearm in comparison with the claimed technical solution, since the sensitive elements of the myosensors are fixed on the inner side of the control module, which, in turn, leads to weak (non-optimal) contact of the myosensors with the skin surface of the forearm, which reduces the level an electrical signal of muscle activity taken from the surface of the skin of the forearm, and, accordingly, a less accurate determination of the degree of improvement / deterioration of the rehabilitation process in the direction of increasing / decreasing the rehabilitation time;

9 - uneven distribution of the load on the support, unreliable operation of the simulator, since the support for fixing the fingers is located only on one side (to the motor module for flexion of the fingers), and "hangs freely" on the other side during a passive finger rehabilitation session and semi-active modes, which can lead to clamping at the place of attachment of the substrate to the motor module of the flexion of the fingers and, as a consequence, to a significant increase in resistance during rotation of the substrate, up to a complete stop of rotation of the substrate (jamming);

10 - it is difficult for a patient to hold a hand with a simulator fixed on it in a sitting or lying position for 30-40 minutes when performing rehabilitation exercises due to the lack of support.

The purpose of creating the claimed technical solution is to increase the operational reliability, improve the ergonomic properties of the simulator, expand the list and scope of rehabilitation means for the natural mobility of the joints of the hands, joints of the hands and fingers / or an individual finger, the tone and strength of the muscles of the hands, hands and fingers lost due to illness and / or injury, increased ease of use of the simulator.

The technical result of the claimed technical solution is to eliminate the shortcomings of the prototype, namely:

1 - the possibility of carrying out rehabilitation in a static mode without reducing the load on the patient's hand for a long time as a result of the additional introduction of the module for controlling the current of a stepping motor for flexion / extension of the hand and the use of an absolute encoder in the feedback circuit, which (an absolute encoder) makes it possible to detect signs braking a stepper motor when the load increases by detecting the missing steps of the stepping motor, and the written software, by analyzing the data obtained from the absolute encoder, generates a microcontroller signal that goes to the stepper motor current control module, increasing its power, which allows it to quickly and accurately align static load on the patient's hand through the stepper motor current control module.

2 - the possibility of more effective rehabilitation in a dynamic mode, since as a result of the introduction of a control module for the current of a stepper motor for flexion / extension of the hand and the use of an absolute encoder in the feedback circuit, constant operational feedback on the load on the patient's hand and fingers is provided, which allows prompt and with high precision control the movement of the hand and fingers.

3 - elimination of overheating of the stepper motor in static mode as a result of the introduction of the module for controlling the current of the stepping motor for flexion / extension of the hand, which in the static mode, upon reaching the position of the hand specified by the software, automatically sets the minimum current of the stepper motor required for holding, which, in turn, protects the stepper motor from overheating and thus allows long-term rehabilitation;

4 - more efficient use of autonomous power supplies as a result of the introduction of a module for controlling the current of a stepper motor flexion / extension of the hand, as a result of which:

- in static mode, when the position of the hand specified by the software is reached, the minimum current of the stepper motor necessary for holding is automatically set, while with the reverse movement of the hand downward, the current is reduced to a minimum due to the absence of resistance to the movement of the hand during its downward movement;

- in the dynamic mode, the dependence of the current consumption by the stepper motor of the motor module for flexion / extension of the hand on the real load is provided - the current decreases in the case of a decrease in the load and, accordingly, increases in the case of large resistance to movement;

5 - reduction of overweight and "eversion" of the patient's forearm to the outside under the weight of the motor by optimally placing the motor module for flexion / extension of the hand, containing a stepper motor with a metal gearbox, on the outside in the middle of the longitudinal axis of the forearm, in addition, thanks to an additional gearbox the weight of the motor is reduced, since a less powerful stepper motor of a smaller size and a planetary gearbox are used while maintaining the same technical characteristics (torque force)

6 - additional stability of the patient's forearm position due to the use of a second stepper motor in the motor module for flexion / extension of the fingers of the hand, located almost on the forearm, instead of the servo used in the prototype, located at the end of the extended palm of the hand, which reduces the weight of the load and increases the torque moment on the axis of the gear, to which the substrate for fixing the fingers of the glove is fixed;

7 - acceleration and convenience of the process of preparing a patient for a rehabilitation session by using a T-shaped pin in a plastic finger retainer and a striker plate for fixing the glove fingers on a substrate, instead of fixing screws in the prototype;

8 - ensuring better contact of the myosensors with the skin surface of the patient's forearm due to the use of a soft tissue bracelet encircling the patient's forearm just above the simulator module located on the patient's forearm, fixed (bracelet) with Velcro tape, which (better contact of the myosensors with the skin surface) in ultimately leads to a more accurate determination of the degree of improvement / deterioration of the rehabilitation process in the direction of increasing / decreasing the rehabilitation time;

9 - even distribution of the load on the support for fixing the fingers, ensuring reliable operation of the simulator by using a U-shaped structure for attaching the support for fixing the fingers using an additional support module for the support for fixing the fingers;

10 - ensuring the ability not to hold the hand with the simulator fixed on it on weight in a sitting or lying position for 30-40 minutes when performing rehabilitation exercises due to the development of a retractable (installed), if necessary, support of the simulator on a table / bed, made, for example, made of thick metal wire.

At the same time, when using the claimed simulator, just as in the prototype, remote (at a distance) control of the rehabilitation process by the attending specialist is provided, which makes it possible for one attending specialist, after preliminary diagnostics, to simultaneously manage the rehabilitation processes of several patients, which will significantly increase the labor productivity of the attending specialists ...

The essence of the claimed technical solution is a biofeedback simulator for the rehabilitation of joints and muscles of the hands and fingers, consisting of:

a control module made in the form of a hollow plastic body fixed to the patient's forearm, which contains a control microcontroller, a stepper motor controller for flexion / extension of the hand, a Bluetooth communication module with a computer supplied with the simulator;

a voltage boost converter module for powering stepper motors, autonomous power supplies independent of the mains power supply for powering all electronic components and modules of the simulator;

a hand flexion / extension motor module equipped with a stepper motor;

finger flexion / extension motor module;

sensors for monitoring the galvanic skin response of the body;

gloves for fixing the hand on the finger flexion / extension module, equipped with finger pressure sensors located inside the fingers;

a computer connected to the Internet with developed software installed on it,

characterized by the fact that

the control module additionally contains a module for controlling the current of a stepping motor for flexion / extension of the hand, a controller for a stepper motor for flexion / extension of the fingers of the hand, a power supply for the microcontroller and for external plug-in sensors - myosensors, sensors for monitoring the skin-galvanic reaction of the body;

the hand flexion / extension motor module is located above the center of the longitudinal axis of the hand and additionally contains a cylindrical gearbox and an absolute encoder;

the finger flexion / extension motor module further comprises a second stepper motor and an additional attachment module for the finger fixation substrate;

the glove for fixing the hand contains a plastic finger retainer with a T-shaped pin and a striker plate for fixing the glove fingers on the substrate, as well as a bending resistor sewn into the index finger of the glove with the possibility of using it as an absolute encoder for measuring the angle of flexion of the fingers;

at the same time, the simulator additionally contains a bracelet made of soft fabric with two myosensors sewn into it, fixed on the forearm with a Velcro tape,

and the support of the simulator on the table / bed while the patient is sitting / lying down.

The claimed technical solution is illustrated in Fig.1 - Fig.15.

Figure 1 shows the electronic-mechanical unit of the claimed simulator assembly, left side view.

Figure 2 shows the electronic-mechanical unit of the claimed simulator assembly, right side view.

Figure 3 shows the electronic-mechanical unit of the claimed simulator in assembly, with the stop removed;

Figure 4 shows the module of the hand flexion / extension motor;

Figure 5 shows the mechanism of the additional cylindrical gear 4 of the motor module for flexion / extension of the hand 3 (Figure 1);

Fig. 6 shows a method for attaching a hand flexion / extension motor module to a control module 1 (Fig. 1);

Fig. 7 shows the design of a hand flexion / extension motor module;

Fig. 8 shows a mechanism for transmitting the rotational movement of the axis of the stepper motor 20 (Fig. 7) into the rotational movement of the gear 22 of the flexion / extension motor module of the fingers;

Fig. 9 shows the principle of transferring the rotational motion to the transverse substrate for fixing the fingers 7 of the glove 9 (Fig. 1) of the flexion / extension motor module;

FIG. 10 shows a glove fixed on the finger fixing substrate (for example, one fixed index finger is shown);

FIG. 11 shows a glove fixed on the finger fixing substrate (top view);

FIG. 12 shows a plastic finger retainer;

FIG. 13 shows a replaceable right / left hand flexion module;

FIG. 14 is a block diagram of the connection of the wrist flexion / extension stepper motor current control module to the control microcontroller board with the microcontroller;

FIG. 15 shows a bracelet made of soft fabric, fixed on the forearm using a Velcro strap with two myosensors sewn into it.

Positions in Fig. 1 to Fig. 15 denote:

1 - control module,

2 - ears for the straps for attaching the simulator to the forearm,

3 - hand flexion / extension motor module,

4 - spur gear unit 3,

5 - absolute encoder for measuring the angle of flexion of the hand,

6 - motor module for flexion / extension of the fingers,

7 - pad for fixing the fingers of the glove worn on the hand,

8 - hand support,

9 - a glove for fixing the fingers of the hand on the substrate,

10 - module for additional fastening of the substrate for fixing the fingers,

10а - transverse bar of the additional support module for fixing fingers,

11 - emphasis on the table / bed in a sitting / lying position of the patient, attached and extended if necessary,

12 - hand flexion / extension stepper motor,

13 - planetary gearbox,

14 - bearings for each of the two gears of the gearbox,

15 - gears of the gearbox 4 of the module 3 for transmitting the torque from the stepping motor 12 to the bar 16 with the flexion / extension motor module of the hand 6 and the substrate 7 for fixing the fingers of the glove worn on the hand, fixed on it,

16 - strap (provides adjustment in length, depending on the size of the palm), with module 6 fixed on it,

16a - knurled screw fixing the length adjustment,

17 - plastic case of a stepper motor with a planetary gearbox,

18 - grooves in a plastic case 17 of a stepper motor with a planetary gear,

19 - screws for fastening the flexion / extension motor module of the hand on the support of the simulator,

20 - stepper motor of the module of flexion / extension of the fingers,

21 - axis of a stepper motor with a trapezoidal profile thread - a guide lead screw,

22 - gear wheel of the substrate drive for fixing the fingers of the glove worn on the hand,

23 - block nut for gear mounting,

24 - rack-pinion,

25 - pinion axle 22 for fastening the caliper-retainer of the hand,

26 - finger retainer made in the form of a plastic tip inserted into the end of the glove fingers,

27 - grooves for installing the finger retainer,

28 - T-shaped pin for fastening the finger retainer,

29 - striker plate for fixing the fingers of the glove on the substrate,

30 - eyelet for Velcro tape to fix the striker plate,

31 and 32 - screws for fastening the strap for fixing the glove fingers on the backing,

33 - bending resistor sewn into the index finger of the glove and used as an absolute encoder for measuring the angle of flexion of the fingers of the hand,

34 - depression for the pressure sensor,

35 - replaceable module of flexion of the hand to the right / left,

36 - board of the controlling microcontroller with a microcontroller,

37 - module for controlling the current of the stepper motor flexion / extension of the hand,

38 - hand flexion / extension stepper motor controller,

39 - a bracelet with two myosensors sewn into it.

The sensors of surface electromyography (EMG) and the sensor for monitoring the galvanic skin response of the body (GSR) are connected by cables and in Fig. not specified.

Next, the applicant presents a description of the claimed technical solution.

The functionally declared simulator consists of two main parts installed by the patient and the attending physician, respectively:

1. Equipment with pre-installed software (software) at the patient, which includes:

• electronic and mechanical unit, including:

- a control module based on a microcontroller for controlling an electronic-mechanical module and performing collection, processing of objective patient data received from sensors and transferring this data via Bluetooth to the patient's computer;

- hand flexion / extension motor module with an absolute encoder installed on it;

- motor module for flexion / extension of the fingers;

• a glove for fixing the hand on the finger flexion module, equipped with finger pressure sensors located inside the glove fingers;

• a set of sensor sensors to provide feedback:

- sensors of surface electromyography - myosensors (EMG);

- sensor for control of galvanic skin response of the body (GSR);

- finger pressure force sensors, for example - strain gauges, located in a glove;

- a bending resistor sewn into the index finger of the glove and used as an absolute encoder for measuring the angle of flexion of the fingers;

• support of the simulator on the table / bed in the sitting / lying position of the patient, attached and extended if necessary;

• a bracelet made of soft fabric with two myosensors sewn into it, fixed on the forearm with a Velcro strap;

• a computer with pre-installed software on it and according to a given program via the Bluetooth channel controls the simulator, as well as (computer) via the Internet (via Wi-Fi) transmits the patient's objective data to the medical staff managing the rehabilitation process, who controls, analyzes and corrects the process rehabilitation.

1. Equipment on the side of the attending physician, including a computer with a patient database.

Further, the applicant describes in more detail the above equipment.

The control module 1 on the basis of the microcontroller is made in the form of a hollow plastic case, fixed on the patient's forearm. In this case, the control module 1 is fixed on the outer side of the forearm using Velcro straps, tightly covering the bottom of the forearm. The straps are sewn to the four ears 2 at the bottom of the control module 1.

Inside the control module 1 (Fig. 1-3) are located (not shown in the Fig.):

- board for controlling microcontroller with microcontroller;

- two stepper motor controllers - one for the hand flexion / extension motor, the other for the finger flexion / extension motor;

- Bluetooth-module for communication with a computer;

- a power supply unit for the microcontroller and for external connected sensors - myosensors, sensors for monitoring the skin-galvanic reaction of the body;

- module of the step-up voltage converter for power supply of stepper motors;

- the module for controlling the current of the hand flexion / extension stepper motor, assembled on the control microcontroller board. The stepper motor current control module includes a microcontroller DAC, which is an integral part of the microcontroller located on the control microcontroller board with a microcontroller 36 (Fig. 14), connected to the input of the current control circuit of the stepper motor controller 38 (Fig. 14);

- autonomous power supplies independent of the mains for powering all electronic components and modules of the simulator, for example, rechargeable batteries.

The hand flexion / extension motor module 3 (Figs. 1 - 6) is fixed on the control module 1 in an optimal way, namely, from the top in the center of the forearm longitudinal axis, so that the forearm does not "twist" to the outside under the weight of the motor, which indicates achievement the declared technical result.

Hand flexion / extension motor module 3 consists of:

- a plastic case 17 (Fig. 4), having grooves 18 (Fig. 6), making it possible to insert the plastic case 17 (Fig. 4) into the base of the control module 1 (Fig. 1) and fix it with screws 19 (Fig. 6) ;

- stepper motor 12 (Fig. 5);

- planetary gear 13 (Fig. 5) with a gear ratio of 1:99;

- a cylindrical gear 4 (Fig. 5), which, in turn, consists of 2 gears 15 mounted on axles with bearings 14 (Fig. 5), providing a gear ratio of 1: 2;

- the plate 16 of the gearbox, fixed with screws on the gear 15 (Fig. 5), made, for example, of duralumin, with the module of the motor flexion / extension of the hand 6 (Fig. 1) and the substrate 7 (Fig. 1) fixed on it for fixing the fingers of the glove worn on the hand; the bar 16 provides length adjustment, depending on the size of the palm, and fixes the length adjustment by means of knurled screws 16a (Fig. 5);

- an absolute encoder 5 (Fig. 5) located in the feedback circuit of the stepper motor current control module, which (an absolute encoder) allows determining the flexion / extension angle of the hand and, therefore, allows detecting signs of stepping motor braking with increasing load by detecting gaps steps of a stepper motor, and also allows you to quickly and accurately control the movement of the hand and fingers;

- hand support-retainer 8 (Figs. 1, 2), fixed on one side to the flexion / extension motor module of the fingers 6 and on the other side to the module for additional fastening of the substrate for fixing the fingers 10, connected to the flexion / extension motor module arms 6, for example, using the screw-nut method, with a transverse bar 10a (Fig. 2), and fixed with a screw (not shown in Fig.);

- pad for fixing the fingers of the glove 7 (Fig. 1, 2), which serves to fix the hand (fingertips) in the simulator.

The module of the motor for flexion / extension of the fingers of the hand 6 (Fig. 1) with the help of the sliding helical gear mechanism moves the gear 22 (Fig. 7) linearly along the wrist with the gear wheel 7 (Fig. 1, 2) fixed to the gear axis of the substrate for fixing the fingers of the glove 7 (Figs. 22 is fastened with a block nut 23 and rotates due to contact with the rack-pinion 24 (Fig. 8).

The motor module for flexion / extension of fingers 6 (Fig. 1) consists of:

- the second stepper motor 20 (Fig. 7), fixed on the duralumin strip 16 (Fig. 7),

- the axle 21 of the stepper motor 20 (guide lead screw) (Fig. 7) with a trapezoidal thread, which is part of the sliding screw transmission mechanism. When the axis 21 of the stepper motor 20 rotates, the block-nut 23 (Fig. 8) with the gear 22 (Fig. 8) fixed on it in the guide grooves (not shown in Fig. 8) moves linearly. Thus, the stepping motor 20 of the module 6 (Fig. 1) is located practically on the forearm of the hand, instead of the servo used in the prototype, located at the end of the outstretched palm of the hand. In this case, the weight of the module 6 (Fig. 1) is distributed along the entire hand, which provides additional stability of the position of the patient's forearm, reduces the weight of the load, and, in addition, the use of the sliding screw transmission mechanism increases the torque force on the pinion axis to which the fixation substrate is fixed glove fingers, which, in turn, proves the achievement of the claimed technical result;

- rack-pinion 24 (Fig. 8), fixed in such a way as to ensure abutment to the pinion gear 22 (Fig. 8) and thus ensure the rotation of the pinion gear 22 (Fig. 8) during linear movement along the axis of the stepping motor.

- the axis 25 (Fig. 9) of the gear 22 (Fig. 9) of the reverse side of the plate 16 (Fig. 9), on which (the axle 25) the transverse substrate for fixing the fingers 7 (Fig. 9) of the glove 9 (Fig. 1).

- a module for additional fastening of the substrate for fixing the fingers of the hand 10 (Figs. 1, 2);

- the substrate for fixing the fingers of the glove 7 (Figs. 1, 2), which (the substrate) rotates around its transverse axis and allows the glove 9 fixed on it to rotate with plastic finger retainers 26 built into it (the glove) from the inside into the fingertips (Fig. 12), which are attached to the substrate by inserting the T-shaped pins of fastening the finger retainer 28 (Fig. 12) into the grooves for installing the finger retainer 27 (Fig. 10), are "locked" with a striker plate 29 (Fig. 10) for fixing the fingers of the glove on the substrate, which is fastened with screws 31 and 32, and fixed (finger retainers 26) with a Velcro tape threaded into the eyelet for the Velcro tape to fix the striker plate 30 (Fig. 10). In the lower part of the fingers 26 (Fig. 12) in the recess 34 (Fig. 12) pressure sensors, for example, a strain gauge foil sensor, are fixed separately for each of the four fingers. A bending resistor 33 (Fig. 11) is sewn into the index finger of the glove, which is used as an absolute encoder for measuring the flexion angle of the fingers of the hand. The data on the degree of flexion of the index finger is sufficient to judge the degree of flexion of all other fingers.

Thus, rotating its axis 21, the stepper motor 20 (Fig. 7), located in the flexion / extension motor module of the fingers 6 (Fig. 1), provides a rotational-translational movement of the transverse substrate for fixing the fingers 7 (Fig. 9) worn on the hand of the glove 9 (Fig. 1), which ensures the bending of the fingers inward of the hand and the extension of the fingers during the reverse movement.

The length of the rack-pinion 24 (Fig. 8) is made in such a way as to ensure the maximum angles of flexion of the fingers (for example, for the proximal phalanx up to 80 angular degrees, the middle phalanx - up to 80 angular degrees and the distal phalanx - up to 85 angular degrees) - to ensure full flexion / extension of the fingers. A bend resistor 33 (Fig. 11) sewn into the index finger of the glove 9 (Fig. 1) is used as an absolute encoder for measuring the flexion angle of the fingers of the hand.

The glove 9 serves to fix the hand on the finger flexion module, and is equipped with finger pressure sensors located inside the glove fingers (not shown in the figure). Glove 9 is described in detail when describing the hand flexion / extension motor module 3 and the finger flexion / extension motor module 6.

A set of sensor sensors (not shown in the Fig.), In the general case, serves to provide feedback between the input control signal and the output action (measured and controlled using sensors) on a physical parameter of a person, for example, flexion / extension of the hand and fingers, and provides (feedback) change in the input control signal depending on the output parameter according to the algorithm specified in the software, measured using these sensors (skipping steps with a stepper motor when an excessive load on the stepper motor axis appears, the angle of flexion of the hand, fingers, muscle pressure finger joints). A detailed description of the use of touch sensors is given in the description of the hand flexion / extension motor module 3 and the finger flexion / extension motor module 6.

The emphasis of the simulator 11 on the table / bed in the sitting / lying state of the patient, attached and extended if necessary, serves to ensure the possibility not to hold the hand with the simulator fixed on it on the weight in the sitting or lying position for 30-40 minutes when performing rehabilitation exercises ... The stop is made, for example, of thick metal wire.

When carrying out a session of rehabilitation therapy, for example, in a sitting position, the emphasis is extended and set perpendicular to the longitudinal axis of the simulator. The height of the stop is designed so that when you perform downward flexion exercises, your fingertips do not touch the surface on which the simulator is installed (for example, a table surface). Thus, the patient's hand does not strain, the session can last up to 40-50 minutes if necessary, without additional stress on the patient's hand, which indicates the achievement of the claimed technical result.

Bracelet "39 made of soft fabric.

The dynamics of the process of restoring the patient's ability to use muscle functions is determined using myosensors, which are located not in the control module, but are sewn into a separate "bracelet" 39 made of soft tissue (Fig. 15), made in the form of a cloth cuff that encircles the patient's forearm just above the simulator module , and fixed with Velcro tape.

A computer with preinstalled software (not shown in the figure).

The measured signal indicators during direct contact between the patient and the attending physician are monitored at the site of the rehabilitation process on the patient's computer.

When the patient and the attending physician are distant, signal indicators and signals correcting the course of the rehabilitation process are transmitted remotely using Bluetooth and the Internet.

At the same time, during the rehabilitation process, the psychoemotional state of the patient and the analysis of pain sensations are monitored using sensors of the galvanic skin response of the body (GSR), dressed on the index and middle fingers of a healthy hand (GSR sensors are not shown in the Fig.).

Further, the applicant describes the implementation of the claimed simulator.

Example 1. Rehabilitation of the hand by bending up / down.

Rehabilitation of the hand occurs by compulsory flexion / extension up / down, for which:

a) fix the patient's hand:

- adjust the simulator to the length of the patient's palm by moving the flexion / extension motor module of the fingers 6 (Fig. 5) along the bar 16 (Fig. 5) for comfortable placement of the palm in the simulator (placing the patient's fingers on the substrate 7 (Fig. 1), after which the engine module 3 is fixed using a knurled screw 16a (Fig. 5),

- on the strip 16 (Fig. 7) on one side and on the module for additional fastening of the substrate for fixing the fingers 10 (Fig. 1) on the other side, the support-retainer of the hand 8 (Fig. 1) is fixed by means of a screw-nut fastening from below, in the area of the base of the thumb, the hand when the hand is bent upwards - this allows you to apply maximum effort while holding the hand in a static mode.

- the hand is inserted into the glove 9 (Fig. 1), which, for fixing the hand, is made to provide the ability to put it on the patient's hand even with a high degree of contracture of the hand and / or fingers. For this, an incision is made on each finger of the glove on the side, allowing each finger of the patient to be fixed in the glove fingers independently (from other fingers) using a Velcro tape, encircling the glove fingers (with the fingers in them) with Velcro fixing tapes, placing Velcro tapes in the spaces between the joints of the fingers in positions that do not interfere with the movement of the joints.

- in the same way on the support-fixator of the hand 8 (Fig. 1) with the help of Velcro tape fix the rehabilitated hand while maintaining the possibility of performing natural hand movements without hindrances.

- the glove 9 (Fig. 1) is fixed on the hand with a Velcro tape as well. To securely fix each finger in the glove in the region of the base of the little finger and index finger on the glove 9 (Fig. 1), the end of two Velcro strips is fixed, the other end of these Velcro strips is fixed on the Velcro tape wrapping around the hand like a bracelet. In this case, inside the glove, at the end of each finger of the glove, there is a finger retainer 26 (Fig. 10), a finger pressure sensor is attached to the recess 34 (not shown in Fig. 10).

- the same finger retainer 26 is used to attach the fingers of the glove to the substrate, which, unlike the prototype, is attached by inserting the T-shaped pins for fastening the finger retainer 28 (Fig. 12) into the grooves for installing the finger retainer 27 (Fig. 10), Are "locked" with a striker plate 29 (Fig. 10) for fixing the fingers of the glove on the support and are fixed with a Velcro tape threaded into the eyelet 30 for a Velcro strip to fix the striker plate 29 (Fig. 10). This method of fastening simplifies the process of fixing the glove on the substrate and reduces the preparation time for the rehabilitation session in comparison with the prototype, which proves the achievement of the claimed technical result.

b) carry out the rehabilitation of the hands as follows.

After fixing the patient's hand with a glove on the simulator, the signal coming from the patient's computer software to the controller located in the control module 1 (Fig. 1), and from the controller to the stepper motor 12, causes the stepper motor 12 to rotate (Fig. 5 ), located in the module of the motor for flexion / extension of the hand 3, which (stepper motor) through the planetary gear 13 (Fig. 5) and the cylindrical gear 4 (Fig. 5) begins to turn the bar 16 to fix the substrate of the fingers worn on the glove hand ( 5), (and, accordingly, the patient's hand) up or down, depending on the signal supplied from the control module. This provides a constant readout of information from the absolute encoder 5 (Fig. 5) about the angular position of the bar 16 (Fig. 5) (and, accordingly, the hand). Due to the use of a stepper motor with a step, for example, 0.9 angular degrees, a planetary gearbox, for example, with a gear ratio of 1:99 and an additional spur gearbox with a gear ratio of 1: 2, precise positioning of the hand in the required position and a controlled force is ensured. necessary when using a static mode of rehabilitation. At the same time, the absolute encoder 5 makes it possible to detect signs of braking of the stepper motor when the load increases by detecting gaps in the steps of the stepping motor, and the written software, by analyzing the data obtained from the absolute encoder, generates a microcontroller signal that goes to the stepper motor current control module, increasing its power. which allows you to quickly and with high accuracy equalize the static load on the patient's hand through the stepper motor current control module.

In addition, thanks to the additional helical gearbox, it was possible to reduce the weight of the stepper motor, using a less powerful stepper motor of a smaller size and a smaller planetary gearbox while maintaining the same technical characteristics (torque force), which proves the achievement of the claimed technical result.

The mode and parameters of actions for the rehabilitation of the static method or the CPM method are set using the developed software installed on the computer - the required wrist flexion angle, retention time for the static method and the number of up / down flexions for the CPM method, exercise control is performed using feedback carried out using an absolute encoder.

The absolute encoder 5 (Fig. 5) is located on the bar 16 (Fig. 5) and provides the ability to control and controllably set the flexion / extension angle of the hand. When an excessive load occurs, pressing on the support for fixing the fingers of the glove worn on the hand (for example, with a severe paresis of the patient's hand, impaired flexion functions of the hand), leading to deceleration of the stepper motor and skipping steps of the stepper motor, which is shown by the readings of the absolute encoder, s using the module for controlling the current of the stepping motor for flexion / extension of the hand 37 (Fig. 14), using the written program, the current of the control signal of the stepper motor 12 (Fig. 14) is automatically increased by increasing the voltage signal level of the DAC of the microcontroller located on the control board of the microcontroller with microcontroller 36 (Fig. 14) to the input of the current control circuit of the stepper motor controller 38 (Fig. 14) located on the same control microcontroller board with the microcontroller 36 (Fig. 14), until the process of skipping the steps of the stepper motor is stopped. Amplification of the signal occurs within strictly specified limits, it allows to quickly and with high accuracy equalize the static load on the patient's hand and does not lead to damage to the patient's hand joint.

When the hand reaches the preset position (the upper one, because the resistance is most pronounced when the hand moves upward), the voltage signal level of the DAC of the microcontroller is automatically reduced using the software, which means that the current strength of the signal that controls the stepping motor, decreases to the minimum required in the case of a static method of rehabilitation, to keep the hand in the required state, or in the case of the CPM method for moving the hand downward, which eliminates overheating of the stepper motor. Thus, more efficient use of autonomous power supplies is ensured due to the dependence of the stepper motor supply current on the real load - the current decreases in the case of a decrease in the load and, accordingly, increases in the case of a higher resistance, and in the case of a static mode, the hand is fixed in a given position by for a long time, for example, up to 40 minutes, the software reduces the control current of stepper motors to eliminate motor overheating, which proves the achievement of the declared technical result.

Thus, the introduction into the simulator of the current control module of the hand flexion / extension stepper motor and the use of an absolute encoder in its feedback circuit leads to the achievement of a number of the above-described technical results due to the relationship of the supplemented part and the known means (prototype), which corresponds to the condition patentability "inventive step".

Example 2. Rehabilitation of fingers.

The process of rehabilitation of the fingers of the hand consists in the forced flexion of the fingers placed in the glove of the claimed simulator, and differs from the prototype in that the flexion of the fingers is provided by rotating the axis of the additional stepper motor 20 (Fig. 7), which is located in the motor module for flexion / extension of the fingers 6 (Fig. 1).

For the process of bending / unbending the fingers, the support-retainer of the hand 8 (Fig. 1) is not needed, so it can be removed by unscrewing the screw-nut connection.

Hand rehabilitation takes place as follows:

a) fix the patient's hand as in Example 1.

b) the rehabilitation of the fingers by forced flexion of the fingers is carried out as follows.

The signal coming from the software of the patient's computer, after selecting the appropriate operating mode, to the controller located in the control module 1 (Fig. 1), and from the controller to the stepping motor 20 (Fig. 1), causes the stepper motor to rotate (Fig. 7 ). The axis of the stepper motor 20 (Fig. 7) is a trapezoidal screw that is part of the sliding screw transmission mechanism. When the stepper motor axis rotates, the block-nut 23 (Fig. 8) with the gear 22 (Fig. 8) fixed on it moves in the guide slots (not shown in Fig. 8) along the hand. In the upper part of the strap 16 (Fig. 9) with a substrate fixed on it for fixing the fingers of a glove worn on the hand, there is a rack-pinion 24 (Fig. 9), fixed in such a way as to ensure abutment to the pinion 22 (Fig. 9) and thus ensure the rotation of the gear 22 (Fig. 9) with the linear movement of the gear along the axis of the stepping motor 20. On the axis 25 (Fig. 9) of the gear 22 (Fig. 9) from the reverse side of the plate 16 (Fig. 9) a transverse substrate is fixed fixing the fingers 7 (Fig. 9) of the glove 9 worn on the hand (Fig. 1). Thus, rotating its axis, the stepper motor 20 (Fig. 7), located in the module 6 (Fig. 1), provides the translational movement of the block nut 23 (Fig. 8), and the gear 22 (Fig. 9), fixed by the axis to the block-nut 23, due to the adjoining teeth to the rack-pinion 24 (Fig. 9), rotating, provides rotational-translational movement of the transverse substrate fixing the fingers 7 (Fig. 9), fixed to the axis 25 (Fig. 9) of the gear 22 (Fig. .9) from the inner side of the strap 16 (Fig. 9), which leads to the bending of the fingers inward of the hand and the extension of the fingers during the reverse movement.

The use of the module for additional fastening of the substrate for fixing the fingers 10 (Fig. 1) makes it possible to create a U-shaped structure for attaching the substrate to fix the fingers, which provides a more even distribution of the load on the substrate for fixing the fingers. In the same way, more reliable operation of the simulator is ensured, excluding jamming and distortion of the structure, which proves the achievement of the declared technical result

Thus, due to the use of the rack-pinion mechanism 24 (Fig. 9), it is possible to simultaneously perform both rotational and translational movement of the substrate with the glove 9 (Fig. 1) fixed on the substrate, put on the hand, inside the hand when bent and out - to extend the fingers. Data reading occurs from a bending resistor 33 (Fig. 11), sewn into the index finger of the glove, with the possibility of using it as an absolute encoder for measuring the flexion angle of the fingers of the hand, which allows continuous monitoring of the flexion angle of the fingers and correcting the rehabilitation process.

The process of rehabilitation of the motor skills of the fingers of the hand by their forced bending / unbending up / down in the claimed technical solution differs from the prototype in that the process is ensured by the use of a stepper motor 20 that is absent in the prototype (Fig. 7), which, using a sliding screw mechanism and a rack mechanism - the pinion converts the stepping motor rotational moment into the rotational-translational movement of the substrate for fixing the fingers of the glove worn on the hand, which ultimately provides forced, controlled flexion of the patient's fingers.

Thus, the introduction of a second hand flexion / extension stepper motor into the trainer, the use of a U-shaped structure for fastening the support for fixing the fingers using a module for additional fastening of the support for fixing fingers, leads to the achievement of a number of the above-described technical results due to the relationship of the supplemented parts and known means (prototype), which corresponds to the condition of patentability "inventive step".

Example 3. Rehabilitation of the hand by bending to the right / left.

Rehabilitation of the hand by forced flexion of the hand to the right and left is carried out as follows.

- the flexion / extension motor module of the hand 3 (Fig. 13) is fixed on the substrate of the control module 1 (Fig. 13) by means of grooves in the end of the motor module and the substrate and is fixed with the fastening screws 19 (Fig. 6) of the flexion motor module / extension of the hand on the support of the simulator,

- the simulator is adjusted to the length of the patient's palm by moving the replaceable hand flexion module to the right / left 35 (Fig. 13) along the bar 16 (Fig. 13) and fixing it with the knurled screw 16a (Fig. 13),

- the patient's hand is placed on the base of the replaceable module 35 (Fig. 13) and is fixed with a Velcro tape,

- the process of movement of the replaceable module of flexion of the hand to the right / to the left is performed similarly to the process of movement of the motor module of flexion / extension of the hand up / down, only in the horizontal plane.

In the declared simulator, it is possible not to hold the hand with the simulator fixed on it on the weight in a sitting or lying position for 30-40 minutes when performing rehabilitation exercises due to the presence of an extendable (installed), if necessary, support 11 of the simulator on the table / bed, made, for example, thick metal wire.

The process of monitoring the dynamics of the rehabilitation process on the claimed simulator differs from the prototype in that the myosensors, with the help of which the dynamics of the process of restoring the patient's ability to use muscle functions, are located not in the control module, but on a separate "bracelet" 39 (Fig. 15), made in in the form of a cloth cuff that wraps around the patient's forearm just above the simulator module located on the patient's forearm and is fixed with Velcro. This provides a better contact of the myosensor with the skin surface of the patient's forearm, which ultimately leads to a more accurate determination of the degree of improvement / deterioration of the rehabilitation process towards an increase / decrease in the rehabilitation time, which proves the achievement of the claimed technical result.

The measured signal indicators during direct contact between the patient and the attending physician, similarly to the prototype, are tracked at the site of the rehabilitation process on the patient's computer. When the patient and the attending physician are distant, signal indicators and signals correcting the course of the rehabilitation process are transmitted remotely using Bluetooth and the Internet. At the same time, during the rehabilitation process, the psychoemotional state of the patient and the analysis of pain sensations are monitored using sensors of the galvanic skin response of the body (GSR), dressed on the index and middle fingers of a healthy hand (GSR sensors are not shown in the Fig.). To control the dynamics of the rehabilitation process in the muscles of the fingers of the hand, resistive pressure sensors are used, located in the recess - the place of attachment of the pressure sensor of the fingers 34 (Fig. 12) inside the plastic retainers of the fingers 26 (Fig. 12).

Thus, from the above, it can be concluded that the applicant has achieved the set goals and the stated technical results, namely, increased operational reliability, improved ergonomic properties of the simulator, expanded the list and scope of the means of rehabilitation of natural mobility of the joints of hands, joints of hands and fingers / or individual finger, the tone and strength of the muscles of the hands, hands and fingers, lost due to illness and / or injury, increased ease of use of the simulator.

At the same time, the disadvantages of the prototype were eliminated, namely:

1 - it is possible to carry out rehabilitation in a static mode without reducing the load on the patient's hand for a long time as a result of the additional introduction of the module for controlling the current of the stepping motor for flexion / extension of the hand and the use of an absolute encoder in the feedback circuit, which (an absolute encoder) allows detecting signs of deceleration of a stepper motor with increasing load by detecting gaps in steps of a stepper motor, and the written software, by analyzing the data obtained from an absolute encoder, generates a microcontroller signal that goes to the stepper motor current control module, increasing its power, which allows it to quickly and with high accuracy equalize the static load on the patient's hand through the stepper motor current control module.

2 - the possibility of more effective rehabilitation in a dynamic mode is provided, since as a result of the introduction of a control module for the current of a stepper motor for flexion / extension of the hand and the use of an absolute encoder in the feedback circuit, constant operational feedback on the load on the patient's hand and fingers is provided, which allows quickly and accurately control the movement of the hand and fingers.

3 - elimination of overheating of the stepper motor in the static mode is ensured as a result of the introduction of the module for controlling the current of the stepping motor for flexion / extension of the hand, which in the static mode, when the position of the hand specified by the software is reached, the minimum current of the stepper motor necessary for holding is automatically set, which in turn , protects the stepper motor from overheating and, thus, allows for long-term rehabilitation;

4 - more efficient use of autonomous power supplies was ensured as a result of the introduction of a module for controlling the current of a stepper motor flexion / extension of the hand, resulting in:

- in static mode, when the position of the hand specified by the software is reached, the minimum current of the stepper motor necessary for holding is automatically set, while with the reverse movement of the hand downward, the current is reduced to a minimum due to the absence of resistance to the movement of the hand during its downward movement;

- in the dynamic mode, the dependence of the current consumption by the stepper motor of the motor module for flexion / extension of the hand on the real load is provided - the current decreases in the case of a decrease in the load and, accordingly, increases in the case of large resistance to movement;

5 - it is ensured that the patient's forearm is minimized and "everted" to the outside under the weight of the motor by optimal placement of the motor module for flexion / extension of the hand, containing a stepper motor with a metal gearbox, on the outside in the middle of the longitudinal axis of the forearm, in addition, due to the additional the reduction gear reduces the weight of the motor, since a less powerful stepper motor of a smaller size and a planetary gearbox are used while maintaining the same technical characteristics (torque force)

6 - additional stability of the patient's forearm was provided due to the use of a second stepper motor in the motor module for flexion / extension of the fingers of the hand, located almost on the forearm, instead of the servo used in the prototype, located at the end of the outstretched palm of the hand, which reduces the weight of the load and increases the force torque on the pinion shaft to which the glove finger fixing substrate is attached;

7 - provided acceleration and convenience of the process of preparing a patient for a rehabilitation session by using a T-shaped pin in a plastic finger retainer and a striker plate for fixing the glove fingers on the substrate, instead of fixing screws in the prototype;

8 - better contact of the myosensors with the skin surface of the patient's forearm is ensured due to the use of a soft tissue bracelet that encircles the patient's forearm just above the simulator module located on the patient's forearm, fixed (bracelet) with Velcro tape, which (better contact of the myosensors with the skin surface) in ultimately leads to a more accurate determination of the degree of improvement / deterioration of the rehabilitation process in the direction of increasing / decreasing the rehabilitation time;

9 - uniform distribution of the load on the support for fixing the fingers is provided, ensuring reliable operation of the simulator by using a U-shaped structure for attaching the support for fixing the fingers using a module for additional fastening of the support for fixing the fingers;

10 - it is possible not to hold the hand with the simulator fixed on it on the weight in a sitting or lying position for 30-40 minutes when performing rehabilitation exercises due to the development of a retractable (installed), if necessary, support of the simulator on the table / bed, made, for example, made of thick metal wire.

The claimed technical solution complies with the "novelty" requirement of patentability for inventions, since the study of the prior art did not reveal a device that has features identical (that is, coinciding in the function they perform and the form of these features) of the set of features listed in the claims , including the description of the purpose.

The claimed technical solution complies with the patentability condition "inventive step" for inventions, since the study of the prior art did not reveal technical solutions having features that coincide with the distinctive features of the claimed invention, and the influence of the distinctive features on the technical result indicated by the applicant was not established.

At the same time, the claimed technical does not follow explicitly from the state of the art due to the fact that the applicant has not identified simulators having the claimed set of features that ensure the achievement of the total technical result achieved by the applicant, namely, the possibility of carrying out rehabilitation in a static mode without reducing the load on the patient's hand for a long time, reliable operation in long-term static mode without overheating of the motor, with the possibility of ensuring the dependence of the supply current on the real load, with an additional solution to the problems of improving ergonomic parameters, such as the convenience of placing the patient's hand, better contact of the sensors with the patient's hand, acceleration and convenience of preparing a patient for a rehabilitation session, etc., which, according to the applicant, indicates the compliance of the claimed technical solution with the patentability condition “inventive step”.

The claimed technical solution meets the condition of patentability "industrial applicability" for inventions, since it can be manufactured using freely available known tools, materials, components and assemblies, while it can be put into industrial production in a short time.

Claims (15)

Biofeedback trainer for the rehabilitation of joints and muscles of the hands and fingers, consisting of: a control module made in the form of a hollow plastic case, fixed on the patient's forearm, which contains a control microcontroller, a stepper motor controller for flexion / extension of the hand, Bluetooth - a communication module with a computer supplied with the simulator; a voltage boost converter module for powering stepper motors, autonomous power supplies independent of the mains power supply for powering all electronic components and modules of the simulator; a hand flexion / extension motor module equipped with a stepper motor; finger flexion / extension motor module; sensors for monitoring the galvanic skin response of the body; gloves for fixing the hand on the finger flexion / extension module, equipped with finger pressure sensors located inside the fingers; a computer connected to the Internet with developed software installed on it, characterized in that the control module additionally contains a module for controlling the current of a stepping motor for flexion / extension of the hand, a controller for a stepper motor for flexion / extension of the fingers of the hand, a power supply for the microcontroller and for external plug-in sensors - myosensors, sensors for monitoring the skin-galvanic reaction of the body; the hand flexion / extension motor module is located above the center of the longitudinal axis of the hand and additionally contains a cylindrical gearbox and an absolute encoder; the finger flexion / extension motor module further comprises a second stepper motor and an additional attachment module for the finger fixation substrate; the glove for fixing the hand contains a plastic finger retainer with a T-shaped pin and a striker plate for fixing the glove fingers on the substrate, as well as a bending resistor sewn into the index finger of the glove with the possibility of using it as an absolute encoder for measuring the angle of flexion of the fingers; at the same time, the simulator additionally contains a bracelet made of soft fabric with two myosensors sewn into it, fixed on the forearm with a Velcro tape, and the support of the simulator on the table / bed while the patient is sitting / lying down.

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