TR2021008881A1 - A ROBOTIC PLATFORM FOR BALANCE CONTROL REHABILITATION AND REACTION TIME MEASUREMENT OF NEUROLOGICAL/NEUROMUSCULAR PATIENTS - Google Patents
A ROBOTIC PLATFORM FOR BALANCE CONTROL REHABILITATION AND REACTION TIME MEASUREMENT OF NEUROLOGICAL/NEUROMUSCULAR PATIENTSInfo
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Abstract
Buluş, hastanın dengeli dikey duruş süresini artırmak, tepkilere karşı verdiği reaksiyon süresini düşürmek ve hastanın denge durumu (hastalık seviyesi hakkında) doktor ve fizyoterapiste ölçülebilir objektif bilgi vermek amacıyla, kullanımı kolay ve istikrarlı tedavi sürecini destekleyen bir platform tasarımını ve platform ile uyumlu sanal gerçeklik uygulamasını kapsamaktadır.The invention aims to design a platform that supports an easy-to-use and stable treatment process and a virtual reality application compatible with the platform, in order to increase the patient's balanced vertical posture time, reduce the reaction time to reactions, and provide measurable objective information to the doctor and physiotherapist about the patient's balance status (disease level). It covers.
Description
TARIFNAME NÖROLOJIK/NÖROMUSKULAR HASTALARIN DENGE KONTROLÜ REHABILITASYONU VE REAKSIYON SÜRESI ÖLÇÜMÜ IÇIN BIR ROBOTIK PLATFORM Teknik Alan Bulus, hastanm dengeli dikey durus süresini artmmak, tepkilere kars Dverdigi reaksiyon süresini düsürmek ve hastanîl denge durumu ve hastalfll seviyesi hakkülda doktor ve fizyoterapiste ölçülebilir objektif bilgi vermek amacgtla, kullanmu kolay ve istikrarlu tedavi sürecini destekleyen bir platform tasarîniü ve platform ile uyumlu sanal gerçeklik uygulamasEl: kapsamaktad r. Teknigin bilinen durumu (Önceki Teknik) Nörolojik hastalüstlarda hem beden fonksiyonlaLhem de zihin fonksiyonlar_etkilenebildiginden kisi, ailesi ve yakîi çevresi için dramatik sonuçlar ortaya çkar. Yeti yitimi ve kgtflültk olusturacak hastalfülar, örnegin inme veya multiple skleroz (MS), kisinin, günlük hareketlerini, fonksiyonel durumunu, is yasantsmu gelirini, sosyal iliskilerini ve yasam kalitesini dogrudan etkiler [1][2]. Bu hastalarn saglkLyasularna klyasla daha yavas yürüdükleri ve istikrarl_bir yürüyüs modeline ulasmalarü için daha uzun süre gerektigi ve düsme öyküsüne sahip Olduklarü gözlenmistir [3] Düsme öyküsü ve buna bagll'blarak olusan düsme korkusu olan hastalar aktivite kletlamalarU bildirmektedir; bunun sonucunda da hareketsiz yasam tarznLtesvik edebilir, topluluk ve sosyal kattllîcnüazaltabilir ve hastanßl yasam kalitesi düsebilir. AyrEa hareketsiz yasam tarzTlobezite, diyabet, kalp hastaltgîlgibi saglkla ilgili diger sorunlar ortaya çkartabilir. Bu yüzden, hastalarîilîl düzenli olarak egzersize girmeleri Önerilir [4][5]. Insan dikey durusunun sabitligini, kütle merkezinin yüksek konumundan, küçük destek alan mdan ve ayaklar ile kütle merkezi aras Iidaki çoklu eklemlerden etkilenerek olusturur [6]. Ayrßa, dikey durusu korunmas Fiçin, merkezi sinir sistemi vücut düzensizlikleri ile ugras lüken gövde ve bacak kaslarlîiîi aktivitesinde iki ana ayarlama türünü kullanlî. Bunlardan birincisi olan öngörülen postüral düzeltmeler, ileri gelen vücut pertürbasyonundan önce gövde ve bacak kaslaanUaktive ederek vücudun kütle merkezinin konumunu kontrol eder. Böylece dengeyi kaybetme tehlikesini en aza indirir. Ikinci olarak telafi edici postural düzeltmeler, duyusal geri besleme sinyalleri tarafßidan baslatlm ve bir bozulma meydana geldikten sonra kütle merkez pozisyonunun yenilemesi için bir mekanizma görevi görür [7]. Öngörülen postüral düzeltmeler sadece tahmin edilebilen durumlarda görünürken, telafi edici postural düzeltmeler tahmin edilemez durumlarda da gözlenebilir. MS hastalarmîi günlük hayatlarîida kars [[astklar: zayEfl denge kontrolü, bozulmus öngörülen postüral düzeltmelerle iliskilidir ve yetersiz öngörülen postüral düzeltmelerin kazara düsmelere neden olabilecegi ve gereken reaksiyon süresinin verilmesinde gecikme yasanabilecegi gösterilmistir [8][9][10]. Öngörülen postüral düzeltmeler kasîlübir motor hareketinden ve harici öngörülebilir bir pertürbasyonun haz Tlanmas @dan önce üretilir ve bu kontrol stratejileri çogunlukla ögrenme yoluyla edinilir ve postüral bozuklugun önceki deneyimlerine dayanarak öngörülen postüral düzeltmeler tepkisini iyilestirebilir ve reaksiyon süresini azaltabilir [4][11][7] . Reaksiyon süresi, uyaranFn baslama zaman @Clan ve yan mîi basladFgl'lzaman aralgîia kadar geçen süredir [12]. Reaksiyon süresi fizyolojik olarak 5 bölüme ayrdabilir. Bunlar sniasyla; reseptör seviyesindeki uyarglügörmek, uyarlgl'ümerkezi sinir sistemine iletmek, uyargzüsinirler yoluyla aktarmak, efektör sinyalini olusturmak, sinyali merkezi sinir sistemi üzerinden kaslara tas &hak ve kasEl yap Iacak mekanik is için uyarüinasîlm [13]. Reaksiyon Süresi, merkezi sinir bozuklugu olan hastalarîi entelektüel fonksiyonlarlrm ve duyusal motor fonksiyon bozukluklaril_ degerlendirmek için sLklüstla kullantlltr [12][l4]. Sanal gerçeklik, bu motor becerilerin iyilestirilmesinde kullanühbilir, Çünkü oyunculara sürekli geri bildirim saglanm, bu, ödül ve basarýarzusuyla birlikte dikkat ve motivasyonu arttmîi. Rehabilitasyonda sanal gerçekligin kullanüdlgiçalLslmalardan elde edilen bulgular, hastalarln duyusal bilgi isleme, ileriye dönük postüral ayarlama, denge ve yürüme becerilerinin iyilesme ve tepki süresini kTslalttFgiilT göstermistir [15][16]. Nörolojik bozukluga sahip hastalklarm düzenli rehabilitasyon tedavisi almalarü önerilir. Hastalfgm takibinde tedavi seklinin etkisini gözlemlemek oldukça önemlidir. Çünkü tedavi edilmeyen hastalar semptomlarîi baslangßlûdan itibaren 20 yT içinde baston ve 30 yi içinde tekerlekli sandalye kullanmak zorunda kalmaktad Liilar veya hareket yetilerini tamamen kaybetmektedirler [17]. HastalarElß günlük yasama daha kolay adapte olabilmeleri için fizik tedavi gereklidir, ancak fizik tedavi gerektiren hasta say|s`ile fizyoterapist sayßîbirbiriyle eslesememektedir [18]. Bir diger yandan, rehabilitasyonun etkinligi terapistin kisisel bilgi ve deneyimine bagldli. Hastanîi iyilesme sürecine ve durum takibine olumlu katk da bulunacak bu süreci robotik platform tasarLle ile saglamak mümkün olabilmektedir [19]. Simdiye dek tasarlanan yük platformlarü hareketsiz durumda olup hastanîi farklü yönlerden gelen dengesizliklere kars Ftepki verme süresini, merkezi bas ile ve ag TUR noktasmmesaplamamaktadm sürelerinin tespitini saglayan, kuvvet ve denge egitiminin birlikte hedeflendigi medikal robotik çal Emas Tbulunmamaktad li. Nörolojik bozukluga sahip hastalEklar, kisinin sinir sisteminin zarar görmesi ile ortaya çEIlar. Bu yüzden sinir boyunca ulastLnlan komutlar yavaslar ve bunun sonucunda denge eksiklikleri ve düsme olas Ifgüolusur. Örnegin, MS (Multipl Skleroz) hastalfgüdünyada 3 milyon, Türkiye°de ise 35 bin insan etkilenmektedir [24]. HastalarîiEi saglllllîlyas lîlarmdan daha yavas yürüdükleri ve istikrarlleir yürüyüs modeline ulasmalarmn daha güç oldugu gözlemlenmistir [3]. Yine bununla birlikte hastalarßîi günlük yasamlarmda karslilhstüglarüzaytfl denge kontrolü, yetersiz öngörülen postüral düzelmeler ile iliskilendirilebilir. Bu düzeltmeler ögrenme yolu ile gelistirilebildigi için hastanEi dikey durusunun sabitligi iyilestirilebilir ve tepkilere kars: verdikleri yavas reaksiyon süresi hzlandillabilir [4][15][25]. Bu yüzden fizik tedavi hastalariilîi günlük hayata daha kolay adapte olabilmeleri için gereklidir. Fakat fizik tedavi ihtiyac _olan hasta sayEElEl fazla olmasüve fizik tedavi uzmanjsayüüdüsük olmasüsebebiyle tüm hastalara esit kaynak saglanamamaktadm, tedavinin gelisimi sübjektif düsüncelere bagldli ve düsme öyküsü olan hastalar fizik tedaviye kattlrnak istememektedir [17]. Bu gibi k`s`Ltl ve olumsuz etkilere çözüm olarak objektif degerlendirmeye dayalü sürekli hizmeti saglayabilen robot temelli terapi uzun ytllardß gündemde yer almaktadî [18]. Rehabilitasyon robotlarü arac [llggila klinik müdahalelerden elde edilen bulgular bu robotlarîzi hastalar& islevlerini düzeltmede etkili oldugunu ve iyilesmeyi hîlandmabildigini göstermektedir. Hastalarii motor iyilesme seviyesi, robot için farm-rehabilitasyon egzersizleri tanlîrhlanarak ölçülebilir böylece objektif, etkili ve güçlü fizik tedavi programlarLlhazrlanabilir [26][27][28]. Fakat MS gibi nörolojik hastalüilartn fizik tedavisi için genellikle el ve bilek gibi üst ekstremite kas gruplarmEl rehabilitasyonu için robotik cihazlarFüretilmektedir [29][30][31]. Hafif ila orta derecede MS hastalarîim haftada dört kez rehabilitasyon destegi almalarÜtavsiye edilmektedir [6]. Ancak rehabilitasyonun hasta üzerindeki verimi, terapistin kisisel bilgi ve deneyimlerine bagllîiî. Diger yandan, terapistin hastanîi durumu hakkmdaki varacagütespiti ise tamamen subjektiftir, diger bir deyisle hastanlîl durumu terapistin kisisel görüslerine göre nitelendirilir. Alt ekstremite gücü ve denge egitimi için tfßbi robotik cihaz tasarînüyaygîi degildir. Bir çalgma, kontrol grubu, düsen ve düsmeyen MS hastalarîaras lîidaki denge bozuklugunu inceledi. Bacak kaslarEiEl elektriksel aktivitesi ve basEiç noktalarîiEi merkezi hesaplandîve düsme öyküsü olan MS hastas ilda öngörücü ve telafi edici postüral ayarlamalarda dengeyi saglamak için gerekenden daha fazla zamanla birlikte daha küçük elektriksel aktivite elde edildi. Bu, düsme öyküsü olan hastanEi reaksiyon süresinin ve kas bozuklugunun saglfklünsanlardan daha yüksek oldugu anlamüia gelir, bu nedenle daha fazla düsme hareketi yasarlar [4]. Baska bir çal Emada, öngörülen postüral düzeltmelerin denge üzerindeki etkisini görmek için özel tedavi gelistirdi. Hasta rastgele bir zamanda atilan topu yakalamaya çalßmken basîiç merkezi, yer degistirme merkezi, 3 boyutlu vücut kinematigi ve kuvvet platformundaki elektriksel aktivite kaydedildi. Çalßma bittikten sonra, bir seanstan sonra bile kütle merkezinde daha küçük bir sapma elde edildiginde, öngürülen postüral ayarlamalarlîi, ögrenme boyunca iyilesebilecegi için gelistigi anlas id `_[9]. Bir diger çal smada ise, ticari olarak temin edilebilen bir kuvvet platformu ve sanal gerçeklik kullanIarak 6 haftalfk bir rehabilitasyon süreci olusturuldu, çal Ismanß sonunda hastalarm bas Lnç merkezlerindeki sapma miktarüiüi azaldggözlemlendi [23]. Alt ekstremite için en SEK arastiühn süreç, göreve yönelik giyilebilir robotik cihazlardm [32][28]. Yap Ian cihazlar hastalarüi becerileri üzerindeki etkisini günlük hayattaki uygulamalarlîi daha düzenli yapmasüilî beklemektedir. Bunlar dsarLdan görüldügü için hastalar taraandan günlük hayatta kullanlmak istenmemektedir. Simdiye kadar yap [Ilan çal Emalar, hastalar için öngörülen postüral düzeltmeleri gelisimi saglarken, farklHyönlerden dengesizlik durumlarlîla kars-hastalarîi reaksiyon süresini, merkez kütlesini ve ayak tabanîia uygulanan bashem-hesaplamaymamaçlayan tFßbi robotik cihaz bulunmamaktad tü. Ayr ca, piyasada bulunan platformlar farkl Liserbestlik derecesi ksLtlar na tabi tutulduklarîiçin hastanm hareket kapasitesine uygun degildir ve kullanitltklarßda hastanß durumunun kötülesmesine neden olabilirler. Bu nedenle, antropometrik verilere uygun alt ekstremite için kullan [Bacak bir robotik cihaza ihtiyaç duyulmaktad m. Nörolojik bozukluga sahip olan hastalar için rehabilitasyon tedavisi tipik olarak kardiyovasküler, kuvvet ve denge egitimini içerir ve çok sayüia klinik çalßma, bu egzersiz müdahalelerinin faydalarmîgöstermistir [33]. Hastalarda yaygii olarak gözüken sorunlar arasTrida bas dönmesi, dengesizlik ve zaytli denge sikayetleri vardni [34]. Simdiye dek yaptlan çalLslmalarda hastalarln tepkilere karsüverdikleri reaksiyon sürelerinin tespit edilmesini saglayan, alt ekstremite odale kuvvet ve denge egitiminin hedeflendigi medikal robotik cihazH bulunmamaktadm Ayrßa, çal Ismalarîi seyrekligi ve fIZIk tedavi uzman ESayEElîi azlEgEhedeniyle, hastalarEidaki en uygun tedavi süresi ve tipi kararlastiiflinam Etli [lS][l9]. Robotik rehabilitasyon alan îida dünya çap Eda yap Ulan arastEmalar son y]]arda önemli ölçüde artm @tm Bu alanda hem endüstriyel ürün hem de arastmrna projesi olarak birçok çal Fsma ortaya konmustur. Robotik cihazlarm hasta için kinematik ve dinamik parametrelerin hassas ölçümü açEEldan olumlu bir etkiye sahip oldugunu ve mevcut klinik ortam tedavilerini tamamlayan objektif degerlendirmeler saglad "gEiFt/urgulanm @tm Ayri Hzamanda mevcut robot cihazlaerinik ortamlarda çok yer kaplglor olmasü yüksek maliyeti ve sEiElZerisime sahip olup tüm hastalarda ayn Hzorlukla çal Tslmas _elestirilmistir [19]. Bulusun Amaçlarüve KIsa Aç [klamasü Mevcut bulus, yukarEla bahsedilen dezavantajlarüortadan kaldmmak ilgili teknik alana yeni avantajlar getirmek üzere gelistirilen nörolojik/nöromuskular hastalarlfi denge kontrolü rehabilitasyonu ve reaksiyon süresi ölçümü için bir robotik platform ve sanal gerçeklik oyun ortam Fiçeren bir sistem ile ilgilidir. Platform, nörolojik/nöromuskular bozukluk durumu yasayan hastalar& denge kaybüllît iyilestirilmesine, hastalartu gerek platform taraandan fiziksel olarak gerekse uyumla çals'tgl_ sanal gerçeklik ortamütarafßdan saglanan uyaranlarß etkisi sonucu beklenmeyen bozucu etkilere karsývermis olduklarTlreaksiyon süresinin kßaltlmasüa imkan sunabilen robotik bir sistemdir. Özellikle, farklüaclardan gelen denge bozucu hareketleri gerçeklestirirken, hastanü reaksiyon süresini, agrlfk ve basEiç merkezleri tespit edilmesi ve hastanin öngörülen postüral düzeltmelerin gelistirilmesi ve takibinin gözlenmesi saglanmaktadhj. Böylece hastanm nöral bölgedeki hasarmm iyilestirilmesine yard Inc :olarak, günlük hayatta aktivitelerini daha dengeli bir sekilde yapmasÜve daha az düsme eylemi gerçeklestirmesi hedeflenmektedir. Ayrîia, hastaylî robotik terapiye devamllJLgHkonusunda tesvik etmek ve aynzzamanda tepkilere kars Llverdigi reaksiyonun süresini azaltmaya yardEtholmak amacßlla tasarlanan sanal gerçeklik oyunu robotik sistemin tamamlay El @ *olarak sunulmaktad m. Bulus, hastaneler, klinikler, rehabilitasyon ve arastlima merkezlerinde kullanEn alanE bulmaktad 1:. Bulus, hastanüt dikey durusunun stabilitesini artlümak ve rahatslz'lfklara kars *reaksiyon süresini azaltmak için kullanmikolay ve düzenli tedavi sürecini destekleyen bir robotik sistemdir. Önerilen robotik sistem, iki temel çalßmaya dayanmaktadm: 3 derece oryantasyon serbestligine sahip platform tasarim-Ne görev tabanFsanal gerçeklik oyunlarÜtasarEnÜ Üst platformda farkll_ alanlarda sekiz adet yük hücresi kullan [EE, bunlarla ayagîi farklEbölgelerine uygulanan kuvvetler birbirinden bagînsß olarak algTanabilmektedir ve hem reaksiyon süresinin hesaplanmasüztda hem de hastann stabilite durumu hakkmda bilgi saglamaktadtii. Alt platformda eskenar üçgen olusturacak sekilde üç yük hücresi yer alE ve bunlar agilüî merkezinin x-y düzlemindeki konumunun belirlenmesinde kullanmli. Her bir yük hücresi, analogdan dijital dönüstürücüye sahip bir amplifîkatöre baglandetan sonra gerçek zamanlL olarak mikroislemciye veri iletmektedir. Platformun uzayda konfigürasyonu, platformun altna yerlestirilecek üç adet dogrusal motor ile gerçeklestirilmektedir. Lineer cetveller (dogrusal potansiyometreler), dogrusal motorlar& konumunu alg [Damak ve kontrol etmek için kullan Elli Platformun kontrolü, kinematik analizi ve dinamik simülasyonu MATLAB / SIMULINK ile gerçeklestirilerek tasarünî dogrulanmßtm. Sistem ürün asamasmda robotik sisteme entegre edilen bir mikrokontroller üzerinden kontrol edilir. Ayr `ea robotik terapi sürecinde rehabilitasyon verimliligini art Lnrnak için çal Isma alan Eda belirtilen platform sîiülarülahilinde bir sanal gerçeklik oyunu tasarJ-nüsunulur. Bulus, hastanlîi dengeli dikey durus süresini art ?mak ve tepkilere kars Fix/erdigi reaksiyon süresini düsürmek amac @li kullanEhE kolay ve istikrarl: tedavi sürecini destekleyen bir platform tasar En îi Five platform ile uyumlu sanal gerçeklik uygulamas lîi .`kapsamaktad E. Bulus, hastaneler, klinikler, rehabilitasyon ve arastmrna merkezlerinde kullanim alanE bulmaktad î. Bulus, hastalarîiîi vücut dengesinin rehabilitasyonu ve tepkilere karsHverilen reaksiyon süresinin hesaplanmas Liçin uygun fiyati, kullanLm_kolay ve tedavi baglLllLgmLarttLtan bir medikal cihaz içermektedir. Hasta bilhassa, denge bozucu fiziksel etkilerin esliginde istenilen görevleri gerçeklestirirken, hastanEi reaksiyon süresi, platformun bozucu etkisine kars* uyguladgIKuvvet miktarü agîjlk ve basîiç merkezleri tespit edilecek ve hastanlIl öngörülen postüral düzeltmelerin gelistirilmesi ve takibi gözlenecektir. Böylece hastanEi günlük hayatta yaptLgLaktivitelerin daha dengeli bir sekilde yapmas ,ve daha az düsme eylemi gerçeklestirmesi hedeflenmektedir. AyrEla, hastanEi tedaviye yönelik ilgisini arttErnak, tedavide süreklilik saglamak ve reaksiyon süresini düsürmek için gerekli olan tedavi temelli, göreve yönelik sanal gerçeklik oyunlarjda tamamlayiügörevde robotik sistemle birlikte hastanlfi hizmetinde görev al Tr!. HastanTi terapi süresince gösterdigi basarFperformansFrobotik platform tarafildan otomatik olarak degerlendirilir, robotik platformun ve sanal gerçeklik oyununun zorluk seviyesi hastanLn performans Ela göre güncellenir. 0 Hasta performansIJEbbjektif olarak degerlendirebilir ve iyilesme ve takip sürecini somut veriler ile sunabilmektedir. sit, bel ve alt ekstremite bölgesinde yer alan kas gruplarlîyogunluklu olmak üzere tüm vücut kaslaan _çal Lst Lnmaya tesvik eder. ° Öngörülen postüral düzeltmeler ile hastanlîi reaksiyon süresini iliskilendirilerek incelemeye imkan tan LÜ. ° Hastalardaki denge problemlerinin çözümlenmesini ve günlük hayatta yapIan aktivitelerin kalitesinin yükseltilmesini saglar. görevlerin sanal gerçeklik ortamgl'la entegre edilmesi ve hareketlerin oyun ortamnda es zamanlL yürütülmesine imkan tan E. kullanLthkolay ve tedavi bagl LlLgLniirtt ran bir medikal ürün potansiyeline sahiptir. Hastane, klinik ve fizyoterapi ve rehabilitasyon merkezlerinde nörolojik ve nöromuskular hastalartn fizik tedavi ve takip süreçlerinde kullantllnak için uygundur. Medikal cihaz sanayisinde uygulanabilir. Bulus ile gelistirilen platformun daha iyi açflllamak için sekiller kullanillngtli. Sekillerin aç dilamas jsag Lda yer almaktad `1. Sekil 1: Platform tasarünßß çizimi Sekil 2: Tasarlanan robotik platformun (a) üst platform, (13) alt platform çizimi Sekil 3: Hastan îi sisteme ayak yerlesiminin çizimi Sekil 4: Hastanîi platform üzerinde (a) ön, (b) yan, (c) arka durus örnegi Sekil 5: Platform tasarinßil yandan görünüs çizimi Parça/unsur referans numaralarLl Bulusun daha iyi anlas Jmas Lliçin unsurlar ve unsurlara ait referans numaralarldasagkia yer yer almaktad m. 1 Üst Platform 2 Yük Hücresi 3 RaylESistem 4 Alt Platform Bilya Basl:l\/Iafsal 6 Orta Destek 7 Lineer Cetvel 8 Dogrusal Motor 9 Taban lO BaglantIElemanD 11 BilyalfMafsa] Bulusun AyrfntmýAç fklamas* Bu detaylLaç Llstlamada bulus konusu yenilik sadece konunun daha iyi anlas Lltnas ma yönelik hiçbir Et Ilay ß Eetki olusturmayaeak Örneklerle aç [klanmaktad E. Söz konusu bulus, nörolojik/nöromuskular hastalarm denge kontrolü rehabilitasyonu ve reaksiyon süresi ölçümü için bir robotik platform ile ilgilidir. Bulustaki sistem, hastann dikey durus dengesini art mak ve reaksiyon süresini düsürmek amaçlL kullanman 3 serbestlik dereceli bir robotik platform ve robotik platformun çal @ma serbestligi ile uyumlu tasarlanan sanal gerçeklik oyunu uygulamalarîi& içeren sanal gerçeklik ortam&|_ kapsamaktad L Çal Lslma serbestligi ile ilgili olarak; serbestlik derecesi, bir mekanizmada bulunan tüm uzuvlar& uzaydaki konumunu belirlemek için gerekli olan parametre say&îl&. Bir nesnenin olasTIher hareketini tan&ilayan toplam 6 serbestlik derecesi vard& bunlardan 3'ü x, y ve z eksenlerinde olusan pozisyon degisimini, kalan 3*ü ise bu eksenlerde olan açüdegisimini ifade eder. Bu bulusta tasarlanan manipulatorün üst ve alt platformun uzayda 3 ayrHeksendeki aç&& degisebilmektedir. O sebeple, uzaydaki serbestligi bu 3 ayrzaçmn aldgzdegere göre sürekli olarak degisim göstermektedir. Platformun altîida bulunan üç adet dogrusal motorun (8) her biri farlestrok uzunlugu saglayarak platformun üç boyutlu uzay içerisinde farkIÜaçflarda hareket etmesi saglayacaktr; böylece hastan& farklU alt ekstremite kas gruplarn& çal &tmürnasld ve öngörülen postüral düzelmelerin gelistirilmesi amaçlanm Ist &. Dogrusal motorlar& (8) maksimum boy uzunlugu ise hastanîi hastalk seviyesine göre belirlenebilme imkânýsunar, böylelikle hastan& güvenli kosullar alt &da terapi görmesine olanak tan E. Platformda bulunan yük hücreleri ise hastan& ayak taban îidan gelecek kuvvetin okunmas &da kullanflrnakta olup bas ?iç ve kütle merkezinin bulunmasnU saglamaktadliilar. Bu iki amaç daha önce birlikte kullanlmamlstln. Böylece hasta dinamik durumlarda dengesini saglamaya çal&&ken ayak taban&da olusan bas &ç farklH&larý.ve öngörülen postural düzeltmelerin iliskisi hakk &da yorum yapilabilmesine imkân sunmaktad Ji Önerilen robotik cihaz# elektromekanik cihaz tasarlmzve görev tabanl& sanal gerçeklik oyunlari& tasarfmýedilmesi olmak üzere iki ayrFtemel çal Sma üzerine kuruludur. l. Elektromekanik Cihaz Tasar&1& Sekil 1'de gösterilen elektromekanik tasarîn platform hareketi ve ayak taban &dan bilgi almak için kullanllan yük hücresi yerlesiminden olusmaktad `1. Sekil 2a'da gösterilen cihaz& üst k&mî1da ayak taban &da bulunan farkljaölgelerden bag &152 olarak veri almak için her ayak için dört adet yük hücresi kullandinaktad& Yük hücresi noktalar&îi yerlesimleri, ayak taban&da bas &ç verilerinin en yogun oldugu k&&11ar olarak belirlenmistir [35]. Ancak ayaklar& uzunlugu gelmek için ayag& topuk klemusabit nokta olarak kabul edildi ve diger yük hücrelerinin altna raylüsistem yerlestirilirdi. Bu özellestirme ile en uygun veriler okunmaktadî. Ayr&a, raylE sistemlerin hareket kapasitesine, insanlar& ortalama antropometrik verileri kullanilarak karar10 verilmistir [36]. Her bir yük hücresi, analogdan sayßala dönüstürücüsü olan yükselticilere bagland ktan sonra bir mikroislemciye gerçek zamanlLblarak veri iletilmektedir. Sanal gerçeklik oyunu smas &da meydana gelen degisikliklere bastan& uyguladgîayak taban Iida meydana gelen ani kuvvet degisimi reaksiyon süresinin belirlenmesinde kullan Hlnaktadil. Sekil 2b"de gösterilen alt platformdaki üç adet yük hücresi üçgen olusturacak sekilde yerlestirilmis ve kisinin bas iç ve kütle merkezi matematiksel manipülasyonlarla hesaplanabilmektedir. Platformun farkançdarda yükselip alçalmasbl altnda bulunan 3 adet dogrusal motor (8) ile saglanmaktadm, bu yerlesim Sekil 3°te gösterilmistir. Dogrusal motorlarîi (8) tabana yerlestirilmesi Sekil l"de gözüken baglantWelemanHile yamelstü Dogrusal motor (8) ve eklem seçimleri insan ayak bilegi antropometrik verileri olan, 0-20° dorsifleksiyon, 0-50° plantar degerlerini dikkate alarak seçmistir [37][38]. Böylelikle hastanil yaralanmasnUönlemek için platformun maksimum aç :degisiklikleri siîlandlilmgtm. Dogrusal motorun (8) strok boyu 20 cm seçilmistir ve motor, tabana 70° ile yerlestirilmistir. Fakat bu degerler yap Llan aktivitenin gereksinimine göre degisiklik gösterilebilir. Dogrusal motorun (8) taban ile yaptggaç :40 ile 70 derece aras hdadm Ayrîza sistem ortalama insan agmlgîilîve hareket eden platformun agTrllFgîilî tas malLdhl, bunun için her bir motorun gücü minimum 900 N olarak seçilmistir, ancak bu deger sEiIlayßDdegildir. Platforma uygulanan yük miktarü ortalama insan agmlgîim üstünde bir degere ulastfgîrlda, gerektiginde daha güçlü bir motora tercih edilebilir. Dogrusal motorlar (8) tabana 70° ile yerlestirilmistir; fakat sistemin üç boyutlu uzayda yüksekliginin degisimi gerektiginde, örnegin bu aç Ida uygulanan tork yeterli olmazsa, daha dik yerlestirilebilir. Diger bir durum ise platform yüksekligi hasta için olmasLl gerekenden fazla ise, daha düsük açUile yerlestirilebilir. O sebeple, motorlari-1 sadece maksimum açülimiti 90° ile SIJEIEIE. Dogrusal motorun (8) gücü en az 900 N olup, bu deger eger gerekli görülürse hastalarilit agrlflllarlî dikkatte albjarak daha güçlü bir motor seçilebilir Dogrusal motorun (8) konumlandLiiLlinashjLij yanÜs lîa, saftîi ne kadar uzayabildigi de önemli bir parametredir. Bu deger de yine bilya basllî mafsallarEi çal @ma serbestligi için yeterli esnekligi saglayabilecek nitelikte seçilmelidir. Motorlar& strok (maksimum uzama) degeri, dogrusal motorun tabanla yaptig: aç Sa göre maksimum 20 cm ve minimum 0 cm degerinde olmallîlii. Tabana belirli bir açßlla (70°) yerlestirildiginde z ekseninde 11 cm yükselebilmektedir. Dogrusal motorlar (8), platformun alt ma esit mesafelerde yerlestirilmistir. Tasarmm özelligi geregi hastaya her açdan ayn_miktarda denge bozucu etki uygulanabilmektedir. Dogrusal motorun (8) konumlandîülnasüiß yanDsEa, saftß ne kadar uzayabildigi de önemli bir parametredi'r. Dogrusal motorlar& (8) konumsal degisimi sekil l"de gösterilen lineer cetveller ile ölçülerek kapalîçevrim kontrolü saglklîbir sekilde gerçeklestirilir. Hastanîi durumundaki iyilesme veya gerilemeye göre platform hastanm ihtiyaczseviyesinde kontrol yükünü üzerine alabilir veya kontrolü hastaya bEakabilir. Uygulanabilir bahsi geçen kontrol mimarisi literatürde "gerektigi kadar yard In" (Assist-as-Needed (AAN)) stratejisi olarak adlandîmlü Üst ve alt platformun, 3 eksende açEal degisimi insan bileginin gerektiginde destek vererek düzeltebilecegi nitelikte olmaldm Örnegin assist as needed kontrol mimarisinin uygulandgýdurumda tüm yetki hastaya verildiginde, hasta üst platformun aç Lsal degisimini bilek ekleminin limitleri dahilinde basarabilmelidir. Üst platformun (l) dogrusal motorlara (8) baglantßßüsaglayan ve piyasada var olan bilya baslLtnafsallarn (ball and socket joint lerin) aç sal limitleri ise 0-18o aralüsttadtn. 3 serbestlik derecesine sahip olan platform sisteminin gerekli olan kinematik ve dinamik analizi yaplllrfs ve MATLAB/SlMULINK'te benzetimi gerçeklestirilmistir. Kinematik analizler sonucunda mekanizmaya ait konum, hî ve ivme gibi parametreleri için aç @al denklemler ve baglîitlllar bulunmustur. Ayrßa, sisteme oryantasyon degisimini etkilemeyecek sekilde destek olmasLiçin Sekil l"de gösterilen orta destek koyulmustur Böylelikle, platform üzerinde bulunan kisinin güvenliginden ve cihaz El saglam] [g :art &Elin Ist E. 2. Görev taban] Üsanal gerçeklik oyunlarr) El tasarüh `l Sistemin sanal gerçeklik oyunu, tedavi etkinligini artmmak ve rehabilitasyon sürecini keyifli hale getirmek için kullanmnaktadlî. HastanEi tedavi sürecinde motivasyonu yüksek ve istikrarmbir yol izlemesi açßßdan oyunun robotun hareketi ile iliskilendirilmesi önem tas Ehaktadm Örnegin, oyun, hastanîi ayagillîi tabanüldaki her dengesizlik degisikligi verisi için farklÜaç [larda bir dengesizlik yaratacak ve sonunda toplam reaksiyon süresi ve bas an _hesaplanmaktad m. Hastantn dikey durusunu korumaya yönelik farle dengesizliklerle öngörülen postüral düzeltmelerde ögrenmenin saglanmasmamaçlanî. Bu sekilde, hasta sonraki dengesizliklere daha istikrarl`bir10 sekilde tepki verebilir ve tepki süresi klsalabilir, çünkü bu kontrol stratejileri çogunlukla ögrenme yoluyla elde edilir ve önceki bozukluk deneyimine baglLblarak tepkisini iyilestirebilir. Bulusun yenilikçi yanlarEl Cözetle vurgulamak gerekirse: 1. Literatürde ve piyasada 3 serbestlik dereceli paralel manipulatörler mevcuttur. Bu platform spesifik olarak nörolojik ya da nöromuskular hastalarEi bozukluklarEida rehabilitasyon sürecinde ve hastalFgFri takibinde kullan Tmaktadil. 2. Bu platformda yer alan dogrusal motorlar, sadece üst platformun 3 eksende (X, y ve z ekseni) aç Fsla] degisiminden sorumlu degildir. Ayn Tlzamanda insan We dogrusal motorlarîi üstüne yerlestirilen ralesistem ve alt platformu da yer çekimine kars Utas Lmaktan ve hastanhi üstüne çüîtEgEüst platformun yuvarlanma, egim, sapma aç Ührßîdegistirmekten sorumludur. Bu degisim kontrollü bir sekilde saglanmaktadü. 3. Platformun serbestlik derecesi sanal bir oyun tasarlîhîida verilen serbestlik ile eslestirilmistir. Hastaya tanFrhlanan hedeflere hastanîi platform üzerinde saglamaya çalâtgl_ stabilite (denge) hareketleri ile erisilir. 4. Hastanül hastalik derecesine bagllTolarak oyunun zorluk seviyesi platform taraf üldan otomatik olarak alg Lllanlr' ve ayarlari hzl. Oyun türüne baglLblarak platform hastanln basar LlLolmasl_ için destek verebilir ya da hastanm saglEk durumu iyiye gidiyorsa hedefe kendi eforu ile erismesi beklenir. Her iki durum da platform taraf hidan gerçeklestirilebilmektedir. . Piyasada var olmayan fakat bulusta belirtilen diger önemli özellik ise hastanm üstüne bastfgmüst platform üzerinde yer alan yük hücreleridir. Her bir ayakaltlîla, ayaklarlîl boyutuna göre ayarlanabilir nitelikte olmak üzere yerlestirilir. HastanLn platforma ne kadar saglklLbas Lnç uygulad g Io'lçümlenir. 6. Yine robotun alt platform olarak adlandLndLgthzt üst ksmlnhj ikinci yarLSlnda yer alan 3 adet yük hücresi hastanlîl tüm vücudunun iki eksende (bir düzlemde) agîllk merkezini naslll degistirildiginin saptanmas Lna yard `m eder. 7. Bulusun diger yenilikçi yan&ise hastanîi platform tarafîidan verilen bozucu etkiler karsleLnda ya da oyun tarafmdan saglanan görsel uyaran sonucunda verdigi tepkiyi, reaksiyon süresini ve Öngörülen Postural Düzeltmeler (Anticipatory Postural Adjustment (APA)) degerini ölçmemize olanak saglamas&&. Ölçümler, platformda yer alan, fiziksel degisimleri ölçümleyen cihazlar taraf&dan saglam& Bu cihazlar aras&da, hastan& her iki ayag&a iletilen ag&l[k dagmînîmve 2 boyutlu uzaydaki (yani platform düzlemi üzerindeki) ag&llt merkezi degisimini belirlememizi saglayan çesitli boy ve saydaki kuvvet sensörleri; bunun yanLsnia dogrusal motorlar& pozisyon degisimini ölçümleyen dogrusal (linear) cetveller olarak adlandîflhn dogrusal potansiyometreler yer almaktadî. Motorlar taraf&dan ani tepkiler üretilerek hastan& bilinçli olarak dengesinin bozulmasUamaçlanabilir, böylece hastan& dengesini korumak ad na reaksiyon göstermesi beklenir. Diger bir kosul ise, sanal gerçeklik ortamBdaki bir görevi gerçeklestiren hastan& karslsîia, ani denge degisimini gerektiren farkllîbir görevin sunulmasF sonucu reaksiyon süresinin ölçülmesi yine basta belirttigim dogrusal cetvel ve kuvvet sensörleri arac mg yla tespit edilir. Sistem, sanal gerçeklik ortami& tasarîn&& MATLAB/SIMULINK ortam&da gerçeklestirilmistir. Ancak baska bir programla da gerçeklestirilebilir, bahsi geçen programlarla s&rl ilegildir. Birbiri ile mekanik olarak baglantlllIüst ve alt platformun açêal konum degisimleri ve h& ve ivmeye bagludegisimleri çesitli kinematik analizler sayesinde belirlenerek veri toplama karti_ aracülg Sila bilgisayara (is istasyonuna) iletilir. IS istasyonuna aynEzamanda, yine ayrDbir veri kart Tüzerinden hastan& ag &lik merkezi dag fllîn *ve platform üzerindeki ag &lik merkezi bilgisi de Yukar&a yer alan detaylýaçfklamalara istinaden, söz konusu olan bulus, hastan& dikey durus dengesini art Hnay Live reaksiyon süresini düsürmeyi saglayan bir sistem olup, özelligi; - Ayag& farklübölgelerine uygulanan kuvvetlerin birbirinden bagîns& olarak al&masî1& saglayan, reaksiyon süresinin hesaplanmas&da kullanflan ve aerca hastan& postural durusundaki bozuklugu ve iyilesme sürecini takip edilmesine yard&ic&01an en az sekiz adet yük hücresini içeren, hastan& üstüne ç &tfglîüst platform (l),10 Hastanm platforma ne kadar saglEklIbasmç uyguladfgüölçülmesini saglamak ve ayak taban Ilda bulunan farlelbÖlgelerden bag Iris& olarak veri almak için üst platformda (1) ayaklarEi boyutuna göre ayarlanarak her bir ayak için en az dört adet olmak üzere yerlestirilen, üst platformun (1) ikinci yarßüolan alt platformda (4) ise hastanîi tüm vücudunun iki eksende agmlfll merkezini nasfll degistirildiginin saptanmasFrla yardîn etmek için en az üç adet olarak yer alan, analogdan saytslal dönüstürücüye sahip yükselticiye bagland [Etan sonra bir mikroislemciye gerçek zamanlEblarak veri iletilmesini saglayan, sanal gerçeklik oyunu sLrlasmda meydana gelen degisikliklerde hastanLn uyguladg: ayak tabanmda meydana gelen ani kuvvet degisimi reaksiyon süresinin belirlenmesinde ayrca bas Hiç ve kütle merkezinin bulunmas Niçin ayak tabanmdan gelen kuvvetin okunmas uida kullan Llan yük hücresi (2), Verilerin okunmas Uiçin farklLlayak uzunluklaanLrl koordinatlarria göre uyum saglamak üzere robotik platformun hareket ettirilmesini saglayan ve yük hücrelerinin (2) altma Agtdüt merkezinin x-y düzlemindeki konumunun belirlenmesinde kullanlan eskenar üçgen olusturacak sekilde konumlandEIan, en az üç yük hücresini (2) içeren alt platform Her bir dogrusal motorun alt platforma (4) baglantßüfsaglayan, birbiri ile baglantm_olan üst platform (3) ve alt platforrna (4) üç eksende dönebilme serbestligi saglayan en az üç adet bilya basllînafsal (5), Platform üzerinde bulunan kisinin güvenliginden ve cihazlîi saglamlgîlartüillmasîilî saglayan, platformun 3 eksende dönüsüne izin veren fakat ötelenmesini engelleyen, alt platforma bilyalümafsal (l 1) ile baglanan orta destek (6) (Dogrusal motorlar (8) her ne kadar platformun 3 eksende aç sal degisimini saglasalar da, bilya mafsallarda (11) olasF milimetre seviyesindeki açLklUtlar platformun ötelenme hareketi yapmasLna neden olabilir. Bu durum, orta destek olarak adlandimein, platformun 3 eksende dönüsüne izin veren fakat ötelenmesini engelleyen çelik çubuk sayesinde gerçeklestirilir. Orta destek alt platforma bilyalTlmafsal (11) ile baglanm, böylece platformun üç serbestlik derecesinde hareket edebilmesine izin verir. Dogrusal motorlar hem üst ve alt platformu hem de yetiskin bir insan jas gabilecek itkiyi üretebilecek kapasitede seçilmislerdir. Yine de olasE bir teknik probleme karsüi platform merkezine yerlestirilen çubuk denge konusunda da destek saglayabilmektedir.), Dogrusal motorlarEi (8) konumunu, pozisyon degisimini algIayan ve kontrol etmeyi saglayan lineer cetvel (7), Her biri farklHstrok uzunlugu saglayarak robotik platformun üç boyutlu uzay içerisinde farklLaç Llarda hareket etmesini ve farklLlaç larda yükselip alçalmasLnLSaglayan, hastanLn üstüne çElâtgEüst platformun (l) yuvarlanma, egim, sapma aç [Ihrmülegistirilmesinden ve ayrîia hastayl] üstüne yerlestirilen ralesistemi (3) ve alt platformu (4) da yer çekimine kars Ltas @haktan sorumlu olan, maksimum boy uzunlugu hastanhj hastalüst seviyesine göre belirlenen, strok boyu ve tabana yerlestirilme açlêýyap (lan aktivitenin gereksinimine göre degisebilen, robotik platformun yükünü ve ortalama insan agmlgnlitasglabilecek güce sahip olan, alt platformun (4) alt Iia yerlestirilen en az üç adet dogrusal motor (8), Sistem bilesenlerinin bozulmadan tas lîlabilmesi ve sistemin stabilize edilmesi için dogrusal motorlarEl, lineer cetvellerin ve orta destegin taslîiabilir bir alana sabitlenmesini saglayan taban (9), Dogrusal motorun (8) tabana (9) yerlestirilmesini saglayan baglantEblemanEUO), Orta destegin (6) platforma baglanmasüve destegin sistemin serbestlik derecesine etki etmemesi için kullanflan, alt platform merkezinde yer alan en az bir adet bilyal_mafsal (11)a Sistemin kontrol edilmesini saglayan, robotik platformun sanal gerçeklik oyunu ile birlikte koordineli olarak çallîsmasßîsaglayan, birbiri ile mekanik olarak baglantfllîüst platform (1) ve alt platformun (4) açsal konum degisimleri, ha, ivmeye baglLldegisim bilgileri, ayrEa hastanEi agmlüî merkezi dagülihîve platform üzerindeki agîlk merkezi bilgilerinin robotik platforma entegre edilen en az bir adet mikrokontrolör ve kinematik analizlerle belirlenen bu bilgilerin is istasyonuna iletilmesini saglayan en az bir adet veri toplama kart : unsurlarîiýiçeren bir robotik platform ve robotik platform ile entegre olarak çal lêan sanal gerçeklik oyun ortamEi jçermesidir. Bulusun bir diger düzenlemesi, dogrusal motorun (8) strok boyunun 0 ile 20 cm aras Lnda olmas, ve tabana (9) 40 ile 90 derece aras Inda yerlestirilmis olmasîlm Ancak strok boyunun uzunlugu ve tabana yerlestirilme açsn bahsi geçen say [Tarla sîilîm olmayi) farkl_ degerlerle de gerçeklestirilebilir. Bulusun bir diger düzenlemesi, bahsi geçen dogrusal motorun (10) gücünün en az 900 N olmas Ld r. Bulusun bir diger düzenlemesi, strok boyu 0 ile 20 cm arasüida olan ve tabana (9) 40 ile 90 derece aras nda yerlestirilen, z ekseninde 11 cm yükselebilen ve gücü en az 900 N olan dogrusal motora (8) olmas BE. Bulusun bir diger düzenlemesi, bahsi geçen bahsi geçen dogrusal motorlarn (8) alt platformun (4) altßda birbirlerine esit mesafede konumlandmîmasîlî Bulusun bir diger düzenlemesi; bahsi geçen orta destek (6) unsurunun çelik çubuk olmasdm Orta destek (6) unsuru çelikle ile süßlüolmaylî› farklüiir malzemeden de olabilmektedir. Bulusun bir diger düzenlemesi, is istasyonunun bilgisayar olmas LdLn: Bulusun bir diger düzenlemesi, bahsi geçen lineer cetvelin (7), dogrusal potansiyometre olmasFdI. Bulusun bir diger düzenlemesi, bahsi geçen yük hücresinin (2) kuvvet sensörü olmas :im Bulusun bir diger düzenlemesi, tabana 70 derece açyla yerlestirildiginde z ekseninde 11 cm yükselebilen dogrusal motora (8) sahip olmasüiî. Bulusun bir diger düzenlemesi, strok boyu 0 ile 20 cm araslîida olan ve tabana (9) 40 ile 90 derece aras nda yerlestirilen, tercihen tabana 70 derece açiyla yerlestirildiginde z ekseninde 1] cm yükselebilen ve gücü en az 900 N olan dogrusal motora (8) olmasîlm TR DESCRIPTION A ROBOTIC PLATFORM FOR BALANCE CONTROL REHABILITATION AND REACTION TIME MEASUREMENT OF NEUROLOGICAL/NEUROMUSCULAR PATIENTS Technical Field The invention provides measurable objective information to the doctor and physiotherapist about the patient's balance status and disease level, to increase the patient's balanced vertical posture time, to reduce the reaction time to reactions. with the aim of giving It includes a platform design that is easy to use and supports a stable treatment process, and a virtual reality application compatible with the platform. State of the art (Prior Art) Since both body functions and mental functions can be affected in neurological patients, dramatic consequences occur for the person, his family and his immediate environment. Diseases that cause disability and disability, such as stroke or multiple sclerosis (MS), directly affect the person's daily movements, functional status, work experience, income, social relations and quality of life [1][2]. It has been observed that these patients walk slower compared to their health conditions and require longer time to reach a stable walking pattern and have a history of falling [3]. Patients with a history of falling and the resulting fear of falling report activity blockages; As a result, it can encourage sedentary lifestyles, reduce community and social participation, and reduce quality of life with the disease. Additionally, a sedentary lifestyle may cause other health-related problems such as obesity, diabetes, and heart disease. Therefore, patients are recommended to exercise regularly [4][5]. The stability of the human vertical posture is influenced by the high position of the center of mass, the small support area and the multiple joints between the feet and the center of mass [6]. Additionally, to maintain vertical posture, the central nervous system uses two main types of adjustments in trunk and leg musculature activity to deal with body irregularities. The first of these, prescribed postural corrections, controls the position of the body's center of mass by activating the trunk and leg muscles before any further body perturbation. Thus, it minimizes the danger of losing balance. Second, compensatory postural corrections are initiated by sensory feedback signals and serve as a mechanism to restore the center of mass position after a perturbation has occurred [7]. While anticipatory postural corrections appear only in predictable situations, compensatory postural corrections can also be observed in unpredictable situations. Problems faced by MS patients in their daily lives: Poor balance control is associated with impaired anticipated postural corrections, and it has been shown that inadequate anticipated postural corrections may cause accidental falls and a delay in the required reaction time may occur [8][9][10]. Predicted postural corrections are produced prior to a muscular motor movement and pleasure of an external predictable perturbation, and these control strategies are often acquired through learning and based on previous experiences of postural perturbation, predicted postural corrections can improve responsiveness and reduce reaction time [4][11][7] . Reaction time is the time between the start of the stimulus and the time interval between the start of the stimulus [12]. The reaction time can be physiologically divided into 5 parts. In other words; to see the stimulation at the receptor level, to transmit the stimulation to the central nervous system, to transfer the stimulation through the nerves, to create the effector signal, to carry the signal to the muscles via the central nervous system and to stimulate the muscles for the mechanical work to be done [13]. Reaction Time is frequently used to evaluate intellectual function and sensorimotor dysfunction in patients with central nervous disorders [12][l4]. Virtual reality can be used to improve these motor skills because players are provided with constant feedback, which increases attention and motivation along with the desire for reward and achievement. Findings from studies using virtual reality in rehabilitation have shown improvements in patients' sensory information processing, anticipatory postural adjustment, balance and walking skills, and shortening of reaction time [15][16]. It is recommended that patients with neurological disorders receive regular rehabilitation treatment. It is very important to observe the effect of the treatment method in the follow-up of the patient. Because untreated patients have to use a cane within 20 years and a wheelchair within 30 years from the onset of symptoms, and they completely lose their mobility or mobility [17]. Physical therapy is necessary so that patients can adapt to daily life more easily, but the number of patients requiring physical therapy does not match the number of physiotherapists [18]. On the other hand, the effectiveness of rehabilitation depended on the personal knowledge and experience of the therapist. It is possible to provide this process, which will make a positive contribution to the patient's recovery process and condition monitoring, by designing a robotic platform [19]. The load platforms designed so far are stationary and do not calculate the response time to the imbalances coming from different directions in the hospital, the central head and the network TUR point, and there are no medical robotic instruments that target strength and balance training together, which allows determination of foot times. Diseases with neurological disorders occur when a person's nervous system is damaged. Therefore, the commands reaching along the nerve slow down and as a result, balance deficits and falling are possible. For example, MS (Multiple Sclerosis) disease affects 3 million people in the world and 35 thousand people in Turkey [24]. It has been observed that patients walk slower than healthy patients and that it is more difficult for them to achieve a stable walking pattern [3]. However, the spatial balance control that patients encounter in their daily lives may be associated with inadequately anticipated postural improvements. Since these corrections can be developed through learning, the stability of the patient's vertical posture can be improved and their slow reaction time to reactions can be accelerated [4][15][25]. That's why physical therapy is necessary for patients to adapt to daily life more easily. However, due to the high number of patients needing physical therapy and the low number of physical therapists, equal resources cannot be provided to all patients. The development of the treatment depends on subjective considerations and patients with a history of falls do not want to participate in physical therapy [17]. Robot-based therapy, which can provide continuous service based on objective evaluation as a solution to such limited and negative effects, has been on the agenda for many years [18]. Findings from clinical interventions using rehabilitation robots show that these robots are effective in restoring patients' functions and can accelerate recovery. Patients' motor recovery level can be measured by prescribing farm-rehabilitation exercises for the robot, so that objective, effective and powerful physical therapy programs can be prepared [26][27][28]. However, for the physical therapy of neurological diseases such as MS, robotic devices are generally produced for the rehabilitation of upper extremity muscle groups such as the hand and wrist [29][30][31]. It is recommended that patients with mild to moderate MS receive rehabilitation support four times a week [6]. However, the effectiveness of rehabilitation on the patient depends on the personal knowledge and experience of the therapist. On the other hand, the therapist's conclusion about the illness is completely subjective, in other words, the illness is characterized according to the therapist's personal opinions. Medical robotic device design for lower extremity strength and balance training is not common. One study examined balance disorders in a control group of falling and non-falling MS patients. Electrical activity of leg muscles and center of pressure points were calculated, and smaller electrical activity with more time than required to maintain balance was obtained in predictive and compensatory postural adjustments in MS patients with a history of falls. This means that patients with a history of falls have higher reaction time and muscle impairment than healthy individuals, so they experience more falling movements [4]. Another study Emada developed specific treatment to see the effect of prescribed postural corrections on balance. While the patient tried to catch the thrown ball at a random time, the head center, displacement center, 3-dimensional body kinematics and electrical activity on the force platform were recorded. After the study was completed, when a smaller deviation in the center of mass was achieved even after one session, it was understood that the predicted postural adjustments had improved as they could improve throughout learning [9]. In another study, a 6-week rehabilitation period was created using a commercially available force platform and virtual reality, and it was observed that the amount of deviation in the patients' pressure pressure centers decreased at the end of the training [23]. The most researched process for the lower extremity is task-oriented wearable robotic devices [32][28]. It is expected that the devices made will have an impact on patients' skills, making their daily life practices more regular. Since these are visible from the outside, patients do not want to use them in daily life. Until now, while the postural corrections provided for the development of the patients, there was no medical robotic device aimed at calculating the reaction time, center mass and bashem applied through the sole of the foot in the face of imbalance situations from different directions. In addition, since the platforms available on the market are subject to different degree of freedom restrictions, they are not suitable for the patient's movement capacity and may cause the patient's condition to worsen when used. Therefore, a robotic device is needed for the lower extremity suitable for anthropometric data. Rehabilitation treatment for patients with neurological disorders typically includes cardiovascular, strength, and balance training, and numerous clinical studies have demonstrated benefits of these exercise interventions [33]. Common problems seen in patients include complaints of dizziness, imbalance and poor balance [34]. In the studies carried out so far, there is no medical robotic device that allows the determination of the reaction times of the patients to the reactions and targets the strength and balance training of the lower extremities. Moreover, due to the rarity of the exercises and the decrease in the availability of physical therapy specialists, the most appropriate treatment duration and type for the patients was decided upon. [lS][ l9]. Research in the field of robotic rehabilitation has increased significantly in recent years. Many studies have been carried out in this field, both as industrial products and as research projects. Robotic devices have a positive effect on the patient in terms of precise measurement of kinematic and dynamic parameters and provide objective evaluations that complement existing clinical environment treatments. Working with difficulty has been criticized [19]. Purposes of the Invention and Brief Description The present invention includes a robotic platform and virtual reality game environment for balance control rehabilitation and reaction time measurement in neurological/neuromuscular patients, which was developed to eliminate the above-mentioned disadvantages and bring new advantages to the relevant technical field. The platform is a robotic system that can enable patients suffering from neurological/neuromuscular disorders and loss of balance to be improved and to shorten the reaction time of patients against unexpected disruptive effects as a result of the stimuli provided both physically by the platform and by the virtual reality environment operated in harmony. In particular, when performing unbalanced movements coming from different angles, the patient's reaction time, weight and head centers are determined, and the patient's prescribed postural corrections are developed and monitored. Thus, it is aimed for the patient to perform his daily activities in a more balanced way and to fall less frequently, by helping to heal the damage in the neural region. In addition, the virtual reality game designed to encourage the patient to continue robotic therapy and also to help reduce the reaction time to reactions is presented as the complementary Hand @ * of the robotic system. The invention finds use in hospitals, clinics, rehabilitation and research centers. The invention is a robotic system that supports an easy-to-use and regular treatment process to increase the stability of the patient's vertical posture and reduce the reaction time to discomfort. The proposed robotic system is based on two basic studies: Platform design with 3 degrees of orientation freedom - What task baseVirtual reality gamesÜtasarEnÜ Use eight load cells in different areas on the upper platform [EE, with these, the forces applied to different parts of the foot can be perceived independently of each other and both without calculating the reaction time and It provides information about the patient's stability status. There are three load cells on the lower platform, forming an equilateral triangle, and these are used to determine the position of the center of gravity in the x-y plane. Each load cell transmits data to the microprocessor in real time after being connected to an amplifier with an analog to digital converter. The configuration of the platform in space is carried out by three linear motors placed under the platform. The design was verified by using linear rulers (linear potentiometers), linear motors & position detector [Elli] The control, kinematic analysis and dynamic simulation of the platform were carried out with MATLAB / SIMULINK. The system is controlled through microcontrollers integrated into the robotic system at the product stage. In order to increase the rehabilitation efficiency in the separate robotic therapy process, a virtual reality game is designed within the framework of the specified platform. The invention increased the patient-balanced vertical standing time. Easy and stable: design a platform that supports the treatment process. Virtual reality application compatible with the Best Five platform. Includes E. Invention, use in hospitals, clinics, rehabilitation and research centers areaE is finding î. The invention includes a medical device that is affordable, easy to use and increases treatment adherence for rehabilitation of patients' body balance and calculation of reaction time to reactions. In particular, while the patient is performing the desired tasks in the presence of destabilizing physical effects, the hospital reaction time, the amount of force applied against the disruptive effect of the platform, weight and pressure centers will be determined and the development and follow-up of postural corrections predicted by the disease will be observed. In this way, it is aimed to make the daily life activities in the hospital more balanced and to cause fewer falls. AyrEla, take part in the hospital service with the robotic system in the treatment-based, task-oriented virtual reality games required to increase the interest in hospital treatment, ensure continuity in treatment and reduce reaction time. The patient's successful performance during the therapy is automatically evaluated by the robotic platform, and the difficulty level of the robotic platform and virtual reality game is updated according to the patient's performance. 0 It can objectively evaluate patient performance and present the recovery and follow-up process with concrete data. It encourages the muscles of the whole body to work, especially the muscle groups in the sit, waist and lower extremity areas. ° LÜ, which allows examining the patient reaction time by correlating the prescribed postural corrections. ° It helps to solve balance problems in patients and improve the quality of activities in daily life. E., which allows the integration of tasks with a virtual reality environment and the simultaneous execution of movements in the game environment, has the potential to be a medical product that is easy to use and provides treatment-related benefits. It is suitable for use in physical therapy and follow-up processes of neurological and neuromuscular patients in hospitals, clinics and physiotherapy and rehabilitation centers. It can be applied in the medical device industry. Figures can be used to better explain the platform developed with the invention. Explanation of the figures is located in jsag L. `1. Figure 1: Platform design drawing Figure 2: Drawing of the designed robotic platform (a) upper platform, (13) lower platform Figure 3: Drawing of the patient's foot placement in the internal system Figure 4: (a) front, (b) side, (13) drawing of the patient's foot placement on the platform c) rear stance example Figure 5: Side view drawing with platform design. Part/element reference numbers. For a better understanding of the invention, the elements and reference numbers of the elements are given below. 1 Upper Platform 2 Load Cell 3 RailSystem 4 Lower Platform Ball Head 6 Middle Support 7 Linear Scale 8 Linear Motor 9 Base Connection Element 11 Ball Joint] Detail of the Invention Explanation* In this detailed listing, innovation is the subject of the invention only for a better understanding of the subject. The invention in question relates to a robotic platform for balance control rehabilitation and reaction time measurement of neurological/neuromuscular patients. The system in the invention includes a robotic platform with 3 degrees of freedom, which is used to increase the patient's vertical posture balance and reduce reaction time, and a virtual reality environment containing virtual reality game applications designed to be compatible with the freedom of work of the robotic platform. Regarding the freedom to work; degrees of freedom is the number of parameters required to determine the position of all members in a mechanism in space. There are a total of 6 degrees of freedom that describe every possible movement of an object, 3 of which represent the position change in the x, y and z axes, and the remaining 3 represent the angle change in these axes. The angle of the upper and lower platforms of the manipulator designed in this invention can be changed in 3 different angles in space. For this reason, the freedom in space constantly changes according to the value of these three separator. Each of the three linear motors (8) located under the platform will provide a long stroke length and enable the platform to move at different angles in three-dimensional space; Thus, it is aimed to improve the patient's ability to work different lower extremity muscle groups and develop the predicted postural improvements. Linear motors (8) allow the maximum height to be determined according to the patient's disease level, thus allowing the patient to receive therapy under safe conditions. The load cells on the platform are used to read the force coming from the patient and the sole of the foot. They enable finding the interior and center of mass. These two purposes have not been used together before. Thus, it provides the opportunity to comment on the relationship between the pressure differences that occur on the sole of the foot while the patient tries to maintain balance in dynamic situations and the anticipated postural corrections. The proposed robotic device is based on two separate basic studies: our electromechanical device design and the design of task-based & virtual reality games. l. Electromechanical Device Design 1. The electromechanical design shown in Figure 1 consists of the platform movement and the load cell placement used to obtain information from the foot sole `1. The device shown in Figure 2a used four load cells for each foot to receive data from different regions on the sole of the foot and the upper foot. Load cell points were determined as the places where the pressure data were most intense on the sole of the foot [35]. However, in order to reach the feet & length, the foot & heel clamp was accepted as a fixed point and the rail system was placed under the other load cells. With this customization, the most appropriate data was read. Additionally, the movement capacity of rail systems was decided10 using people's average anthropometric data [36]. After each load cell is connected to amplifiers with analog to digital converters, data is transmitted in real time to a microprocessor. The sudden force change in the sole of the foot applied to the changes occurring in the virtual reality game is used to determine the reaction time. The three load cells on the lower platform shown in Figure 2b are placed to form a triangle, and the person's head and center of mass can be calculated by mathematical manipulations. The elevation and lowering of the platform at different altitudes is provided by 3 linear motors (8) located underneath, this placement is shown in Figure 3. Placement of the linear motors (8) on the base. The connection shown in Figure 1. The linear motor (8) and joint selections were chosen by taking into account the anthropometric data of the human ankle, 0-20° dorsiflexion, 0-50° plantar values [37][38] . Thus, the maximum angle changes of the platform were adjusted to prevent patient injury. The stroke length of the linear motor (8) was chosen as 20 cm and the motor was placed at 70° to the base. However, these values may vary depending on the needs of the activity. The linear motor (8) is positioned between 40 and 70 degrees with the base. Additionally, the system is designed for the average human weight and the weight of the moving platform is made of stone, for this the power of each motor is selected as minimum 900 N, but this value is not sufficient. If the amount of load applied to the platform reaches a value above the average human capacity, a more powerful engine may be preferred when necessary. Linear motors (8) are placed at 70° to the base; However, when the height of the system in three-dimensional space needs to change, for example if the torque applied at this angle is not sufficient, it can be placed more vertically. Another situation is that if the platform height is higher than necessary for the patient, it can be placed at a lower angle. For this reason, SIJEIEIE motors-1 only have a maximum angle of 90°. The power of the linear motor (8) is at least 900 N, and if this value is deemed necessary, a more powerful motor can be selected by paying careful attention to the lock weights. Depending on the positioning of the linear motor (8), how far its shaft can extend is also an important parameter. This value should also be chosen to provide sufficient flexibility for the freedom of operation of ball-headed joints. Motors & stroke (maximum extension) value must be a maximum of 20 cm and a minimum of 0 cm relative to the angle right of the linear motor with the base. When placed on the base at a certain angle (70°), it can rise 11 cm in the z axis. Linear motors (8) are placed at equal distances under the platform. Due to the nature of the design, the same amount of destabilizing effect can be applied to the patient from every angle. In addition to the positioning of the linear motor (8), how long the shaft can extend is also an important parameter. Closed-loop control is achieved safely by measuring the positional changes of the linear motors and (8) with the linear rulers shown in figure 1. Depending on the improvement or decline in the patient's condition, the platform can take on the control load at the level of the patient's need or leave the control to the patient. The applicable mentioned control architecture is described in the literature as "assist as needed" Named as "In" (Assist-as-Needed (AAN)) strategy, the upper and lower platform should be able to open and correct the change in 3 axes by the human wrist by giving support when necessary. For example, in the case where the assist as needed control architecture is applied, when all the authority is given to the patient, the patient can control the open Lsal change of the upper platform. The angular limits of the ball and socket joints available on the market, which connect the upper platform (l) to the linear motors (8), are in the range of 0-18o. The required kinematic and mechanical functions of the platform system, which has 3 degrees of freedom, Dynamic analysis was carried out in MATLAB/SlMULINK. As a result of kinematic analyses, detailed equations and related relations were found for the parameters of the mechanism such as position, speed and acceleration. In addition, the middle support shown in Figure 1 has been placed to support the system in a way that does not affect the orientation change. Thus, the safety of the person on the platform and the device's stability are ensured. The virtual reality game of the system is used to increase the effectiveness of the treatment and to make the rehabilitation process enjoyable. It is important to associate the game with the movement of the robot in order for the patient to follow a highly motivated and stable path during the treatment process. will create an imbalance and eventually the total reaction time and success are calculated. The aims are to ensure learning in the postural corrections envisaged by minor imbalances aimed at maintaining the patient's vertical posture. In this way, the patient can react more steadily to subsequent imbalances and the reaction time can be shortened, since these control strategies are often is achieved through learning and may improve its response based on previous experience of the disorder. Innovative aspects of the invention To briefly emphasize: 1. There are parallel manipulators with 3 degrees of freedom in the literature and on the market. This platform is specifically used in the rehabilitation process and disease monitoring of neurological or neuromuscular patients and disorders. 2. The linear motors on this platform are not only responsible for changing the upper platform in 3 axes (X, y and z axis). At the same time, the rail system and the lower platform placed on the human and linear motors are also responsible for controlling the gravity and changing the roll, inclination and yaw angle of the upper platform when it falls on the hospital. This change was achieved in a controlled manner. 3. The degree of freedom of the platform is matched with the freedom given in designing a virtual game. The goals assigned to the patient are achieved through the stability (balance) movements attempted to be achieved on the hospital platform. 4. Depending on the degree of the disease, the difficulty level of the game is automatically detected by the platform and the settings are adjusted quickly. Depending on the game type, the platform may provide support for the patient to overcome his illness, or if the patient's health condition is improving, the patient is expected to reach the goal with his own effort. Both situations can be achieved from the platform side. . Another important feature that is not available on the market but mentioned in the invention is the load cells located on the platform above the patient. It is placed under each foot, adjustable according to the size of the foot. It is measured how well the patient applies pressure to the platform. 6. Again, 3 load cells located in the second half of the upper part of the robot, called the lower platform, help the patient to determine how the center of gravity of the entire body changes in two axes (in one plane). 7. Another innovative aspect of the invention is that it allows us to measure the patient's response, reaction time and Anticipatory Postural Adjustment (APA) value in the face of disruptive effects given by the platform or as a result of the visual stimulus provided by the game. Measurements are made by devices located on the platform that measure physical changes. Among these devices, force sensors of various sizes and numbers enable us to determine the weight distribution transmitted to both feet of the patient and the weight center change in 2-dimensional space (i.e. on the platform plane); On the other hand, there are linear motors and linear potentiometers called linear rulers that measure the position change. Sudden reactions can be produced by the motors, aiming to consciously disrupt the patient's balance, so that the patient is expected to react in order to maintain his balance. Another condition is that the measurement of the reaction time of the patient performing a task in the virtual reality environment as a result of being presented with a different task that requires a sudden change of balance is determined by the linear ruler and force sensors tool I mentioned at the beginning. The system was implemented in a virtual reality environment and MATLAB/SIMULINK environment. However, it can also be done with another program, it is limited to the programs mentioned. The angular position changes of the upper and lower platform, which are mechanically connected to each other, and the changes due to h& and acceleration are determined through various kinematic analyzes and transmitted to the Sila computer (workstation) via the data collection card. At the same time, the patient&network center information is distributed to the IS station via a separate data card and the network center information on the platform. Based on the detailed explanations above, the invention in question is a system that allows the patient to increase the vertical posture balance and reduce the Hnay Live reaction time. feature; - Three upper platforms (l) above the patient, which contain at least eight load cells that ensure that the forces applied to different parts of the foot are relative to each other, are used to calculate the reaction time, and also help to monitor the deterioration in the patient's postural posture and the recovery process. 10 How well does the patient press the platform? In order to measure the power applied and to receive data as a link iris from the remote areas located on the foot sole, the upper platform (1) has the feet adjusted according to the size of the feet and placed at least four for each foot, and the lower platform (4), which is the second half of the upper platform (1), covers the entire hospital. It was connected to at least three amplifiers with analog to digital converters to help determine how the center of the body was changed in two axes. Load cell (2), which is used to read the force coming from the sole of the foot, is also used in determining the sudden force change reaction time. Load cell (2), which allows the robotic platform to be moved to adapt to the coordinates with different foot lengths for reading the data, and is placed under the load cells (2). The lower platform containing at least three load cells (2), positioned to form an equilateral triangle used to determine the position of the force center in the x-y plane. The upper platform (3) and the lower platform (4), which are connected to each other and provide the connection of each linear motor to the lower platform (4). At least three ball joints (5) that provide freedom of rotation in the axis, the middle support (6) (Linear), which ensures the safety of the person on the platform and the stability of the device, allows the platform to rotate in 3 axes but prevents its translation, and is connected to the lower platform with a ball joint (l 1). Although the motors (8) enable the angular change of the platform in 3 axes, possible millimeter-level openings in the ball joints (11) may cause the platform to make a translational movement. This is achieved thanks to the steel bar called the middle support, which allows the platform to rotate in 3 axes but prevents its translation. The middle support is connected to the lower platform with a ball joint (11), thus allowing the platform to move in three degrees of freedom. Linear motors have been chosen to have the capacity to produce thrust for both the upper and lower platforms and an adult human being. However, in case of a possible technical problem, the rod placed in the center of the platform can also provide support in terms of balance.), Linear motors (8), a linear ruler (7) that detects and controls the position and position change, each providing a different stroke length, allowing the robotic platform to move in three-dimensional space. The roller system (3) placed on top of the patient, which enables it to move in different conditions and to rise and fall in different conditions, and the lower platform (4), which is responsible for the rolling, inclination, yaw angle [integration of the patient and also the patient], and the lower platform (4), which is responsible for the movement against gravity. At least three linear motors (8) placed at the bottom of the bottom platform (4), the maximum length of which is determined according to the patient's upper level, the stroke length and the angles of placement on the base (may vary according to the needs of the activity), and which have the power to bear the load of the robotic platform and the average human weight. ), Linear motors for grinding the system components without damaging them and stabilizing the system. Base (9), which allows the hand, linear rulers and the middle support to be fixed to a grindable area. Connection, which allows the linear motor (8) to be placed on the base (9).EblemanEUO), The middle support (6) is placed on the platform At least one ball joint (11) located in the center of the lower platform, which is used to prevent the connection and support from affecting the degree of freedom of the system. a. The upper platform (1), which is mechanically connected to each other, allowing the system to be controlled and the robotic platform to work in coordination with the virtual reality game. Angular position changes of the lower platform (4), ha, acceleration-related change information, separate hospital-wide central mountain and gravity center information on the platform are integrated into the robotic platform with at least one microcontroller and at least one data collection device that ensures that this information, determined by kinematic analysis, is transmitted to the workstation. It is a robotic platform containing card elements and a virtual reality game environment that works integrated with the robotic platform. Another embodiment of the invention is that the stroke length of the linear motor (8) is between 0 and 20 cm, and it is placed on the base (9) between 40 and 90 degrees. However, the length of the stroke length and the angle of placement on the base are different. It can also be realized with values. Another embodiment of the invention is that the power of the said linear motor (10) is at least 900 N. Another embodiment of the invention is to have a linear motor (8) with a stroke length between 0 and 20 cm and placed on the base (9) between 40 and 90 degrees, which can rise 11 cm in the z axis and whose power is at least 900 N. Another embodiment of the invention is that the said linear motors (8) should be positioned at an equal distance from each other at the bottom of the lower platform (4); The middle support (6) element mentioned should not be a steel bar. The middle support (6) element should not be decorated with steel, but it can also be made of different materials. Another embodiment of the invention is that the workstation is a computer: Another embodiment of the invention is that the said linear ruler (7) is a linear potentiometer. Another embodiment of the invention is that the said load cell (2) is a force sensor. Another embodiment of the invention is that it has a linear motor (8) that can rise 11 cm in the z axis when placed at a 70 degree angle to the base. Another embodiment of the invention is that the stroke length is 0 to 20 It must have a linear motor (8) with a height of cm and placed between 40 and 90 degrees on the base (9), preferably when placed at an angle of 70 degrees to the base, it can rise 1 cm in the z axis and has a power of at least 900 N.
Publications (1)
| Publication Number | Publication Date |
|---|---|
| TR2021008881A1 true TR2021008881A1 (en) | 2022-12-21 |
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