Jlm- 16, 1968 c. D. BURHNS ETAL 3,363,335
' Y PATTERNING APPARATUS Filed March 27. 1964 v 2 Sheecs-Sheefl l ATTORNEY Jan. 16, 1968 c* D. BURHNS ETAL 3,363,335
PATTERNING APPARATUS United States Patent Oiiice 3,353,335 Patented Jan. 16, 1968 3,353,335 PATTERNNG APPARATUS Charles D. Bnrhns, 9030 Lynn Ave., Levittown, Pa.
1954; Allen G. Doak, 1(92 Shipper; Road, Erdenheim, Pa.; andl Frederick S. Coiinan, 1704 Walnut Ave., Oreland, Pa. 19075 Filed Mar. 27, 1964, Ser. No. 355,244 11 Claims. (Cl. 35-29) This invention relates to patterning apparatus for human patients, pertaining particularly to patients having some form of interruption of the lfunction of the central nervous system.
The treatment theory, in extremely oversimplitied form,- is that the passive movements of the limbs comprised of legs and arms (and in certain cases the head), in a creeping attitude, with little or no motivation of the limbs yby the patient, is a passive re-laying of the neurological patterns of the development of mankind, resulting in Walking, which, for one reason or another has been interrupted. The theory behind such passive actuation is that it simulates one phase of the neurological patterns developing ultimate walking, and in due course, in some manner, overcoming the earlier interruption.
As previously practiced, in effecting the passive movements of the limbs or appendages, a team of four or iive persons has been required for each treatment of a single patient, (one for each appendage). In many cases, due to the volunteer nature of the operatives, and their uncoordinated skills, the respective passive motions have been more or less out of synchronism, or of the wrong degrees of motion on the respective limbs, affecting the effectiveness of the treatment, and frequent brush burns have been occasioned by the possibly harsh relative motion of a limb and a support. Finally, the Work is exacting and tiring, militating against treatment of more than a feW patients successively, and this lfor relatively short time intervals for each patient. So the labor problem is fundamentally prohibitive.
It is the basic object of the invention to provide apparatus for actively or passively moving all of the limbs of a patient in homolateral or cross patterns of creeping.
It is to be understood that in creeping as an infant creeps, the torso is elevated above the floor and is supported solely on the hands and knees, and of course the infant is facing downwardly. In` normal cross patternsv of infant creeping, the hand and knee on one side move toward each other as the hand and knee on the other side move apart from each other. At the same time the infants head or eyes turn toward the advancing hand.
Despite the great activity in this general field and it has been extensive, so far as known the prior art provides for passive or active limb movement while the patient is lying on his back, or sitting, or, in the only known cases where the subject lies face down, it is in a fully supported position with the legs and arms engaging coupled mechanisms for teaching the subject to swim. Usually the motivating force is the subjects own muscles. It willbe clear that there is no teaching of the mechanical passive actuation of the limbs of a patient in a simulation of the creeping attitudes of an infant either in cross patterning or homolateral patterning. This latter is the fundamental objective of the instant invention.
In carrying out the invention in an illustrative form the apparatus is provided with four pads, movable in translation in a generally horizontal plane. The pads respectively are for the temporary reception or anchored mounting of the respective limbs of the patient in a creeping attitude. Means are prow'dedV for moving the pads, and
thus the coupled or attached limbs in horizontal translation, so as to passively move the limbs, in either cross,
or homolateral, patterning, simulative of a phase of the neurological development of mankind, and thus of the regeneration of the patient. When desired, with patients for whom the cross patterning is too advanced, the pads are coupled in pairs as units, to cause movements there of as units to move the limbs of the patient in a homolateral pattern of passive actuation. Finally, in some forms or the apparatus, eye-following signal means, such as a moving lamp, may be provided for relative translational movement in synchronism with the movements of the hand-engaging pads, to cause the patient to move his eyes and eventually his head toward the instantly advancing hand. Usually, for protection and not as a permanent support, a transverse web 8 is stretched across the apparatus below the patient on the pads in such adjacency as to receive the torso if one or more of the limbs collapses.
In general, creeping is a more advanced stage of neurological development than crawling. At this instant stage the patient has been able to at least partially raise himself from the crawling attitude, although one or more of the supporting limbs may be weak and susceptible to collapse. At any rate creeping is a stage beyond mere crawling in which latter the torso engages the ground or support, while the limbs make crawling motions in the vgeneral plane of the torso contact.
Other objects and advantages will become more apparent as the description proceeds.
In the accompanying drawings, forming part of this description:
FIG. 1 represents a purely illustrative schematic plan of the respective movable pads oi the invention against a background of the silhouette of a supporting organization, showing in full lines the Widely spaced right han-: pads, and the closely associated slightly spaced relation of the left hand pads, in one phase of relative pad motion, and showing in dotted lines the positions of the then closely associated spaced pads on the right side and the widely spaced left hand pads (in the opposite phase of relative pad motion), in an illustrative system of passive creeping cross patterning.
FIG. 2 represents a purely illustrative schematic plan of the respective pads of the invention against a background of the silhouette of a supporting organization, showing in full lines the right hand pads, as in coupled relation, at one eXtreme horizontal positioning, and the related left hand pads, as in coupled relation at this juncture, also in full lines, and showing in dotted lines the right hand pads in their other extreme positioning, and the left hand pads in their opposite extreme positioning, in an illustrative system of homolateral creeping patterning.
FIG. 3 represents a schematic fragmentary plan of a purely illustrative motivating system for the relative pad movement in a simple and economical form.
FlG. 4 represents a schematic plan of a possibly more sophisticated illustrative form of the invention, showing the respective pads in one relative positioning, an illustrative endless chain organization for moving same, and a hydraulic cylinder and piston organization for actuating the chain system for effecting the relative pad motions in cross patterning.
FIG. 5 represents a schematic plan of tht illustrative form of the invention showing the right hand pads moved apart and the left hand pads moved toward each other (opposite to the showing of FIG. 4) in cross patterning.
FIG. 6 represents a similar schematic plan of a slightly modified form of FIG. l, effecting a homolateral movement of the respective pads.
FIG. 7 represents a schematic fragmentary end elevation of the organization of FIG. 1, showing a rear pad and its selective alternate means establishing connections to one course or the other of the chain conveyor.
FIG. 8 represents a schematic plan of a system according to FIG. 4, incorporating a traveling light source, in synchronous transverse movement with the longitudinal movement of the hand pads of the apparatus.
Referring to FIG. 1, a plurality of translationally movable pads or movable supports are disclosed schematically, comprising right front pad 10, for engagement by the right hand of the patient, right rear pad 11, for engagement by the right knee of the patient, left front pad 13 for engagement by the left hand of the patient, and left rear pad 14, for engagement by the left knee of the patient. These are mounted on suitable supports moving in narrow slots 6 in a platform 7. Means, to be described, are provided below the platform 7 for moving the respective pads in cyclic relative motions.
The basic theory of passive cross patterning in the creeping attitude, is that as the right hand limbs are caused to approach each other along a general longitudinal path, the left hand limbs are caused to separate from each other along a general longitudinal path, parallel to the rst mentioned path, and vice versa. As noted, if homolateral patterning is indicated, the right hand pads are coupled to move as a unit in one direction, as the coupled left `hand pads move as a unit in the other direction, and vice versa as indicated schematically in FIG. 2.
With the pads or supports having relative translational generally horizontal movements, the details of the instant pads and the mechanisms for effecting the desired relative motions thereof may take many of various forms, without departing from the spirit and scope of the invention.
Usually, as a safety measure, it is preferred to provide a transverse web or safety belt of variable height, positioned just below and, usually, out of contact with the patient, to receive the torso of the patient in the event of a collapse of a limb. This is schematically indicated at 8 in FIG. 7. When desired, by suitable means, a chin rest may be supplied (not shown), mounted on the safety belt 8 or the like, to support the head of those patients who lack the ability to support the head.
It may be noted that in certain `cases cross patterning is too advanced for the instant patient, especially at or toward the beginning of treatment, and it is desirable to submit them to homolateral patterning. In this treatment the arm and leg on one side of the patient are simultaneou'sly moved in unison in the same direction, as the opposite arm and leg are moved in unison in the opposite direction, and Vice versa. Usually, but not always, the passive homolateral patterning of a patient, effects such neurological improvement as to lead successfully into cross patterning, which is the -desired ultimate treatment.
With the pad organization discussed, it will be clear that many sorts of mechanical organizations can be invoked to secure the creeping patterning of the patient, without affecting the spirit and principles of the invention. These can be fairly simple or more or less elaborate and sophisticated. It will be understood that various forms of mechanical, hydraulic or electrical systems or modifications thereof can be utilized to establish the desired relative movements of the pads, either in cross patterning or homolateral patterning. Some of the systems of utility in the invention are described hereinafter.
Referring to the form of the invention shown in FIG. 3, the apparatus comprises illustratively a suitably longitudinally slotted, slightly elevated horizontal support or plaorm 7 -containing slots 6. The pads 10, 11, 13 and 14 are disposed for rolling or sliding support relative to the slotted support 7. The pads may be supported by rollers engaging the upper surface of the support 7 (not shown), but preferably by axles mounting rollers below the surface in guide rails 8 or by pillow blocks 3 on longitudinal guide rails 4 as shown in FIG. 7. Means for effecting and controlling pad motions are preferably disposed in the space below support 7, connected to the pads through the slots 6 therein.
In the illustrative case (FIG. 3) a unidirectional motor 30 is provided, the opposite ends of the shaft 31 of which mount crank webs 32 and 33, respectively having crank pins 40 and 41. Preferably the crank pins are disposed for variable radial spacing from the axis of the shaft 31, and are respectively spaced 180 apart. A pitman 34 connects crank pin 4d and pad 13. A similar pitman 35 connects crank pin 41 and pad 10. It will be seen that running of the motor reciprocates the pads 13 and 10 in opposite directions through cycles of predetermined variable longitudinal extent.
In the illustrative form of the invention shown in FIG. 3, a link or strut, or rod 37, or the like engages and extends between left front pad 13 -and right rear pad 11. A link, strut, or rod 40 (at a ditferent level from link 37) engages and extends between the right front pad 10 and left rear pad 14. It will be seen that pads 13 and 11 reciprocate together relative to platform 7 in the same directions, as, in alternation, do pads 10 and 14. The link connections are adjustable in both instances so as to lengthen or shorten the effective distance between opposite pads. This is to make the cross patterning pad motions variable. Relatedly the links 37 and 40 are arranged for direct adjustable coupling with the pads on the same side, i.e., 13 and 14, and 10 and 11, for conjoint motions when using the apparatus for homolateral patterning.
It will be understood from the preceding description that as shown in FIG. 3, Ias the motor runs and the respective crank pins are rotated about the axis of shaft 31 in synchronism, the right hand pads 10 and 11 approach each other as the left hand pads 13 and 14 move away from each other, and vice versa.
It will be seen of FIG. 3 that the use of cranks moves any given pad from a stationary position with a gradual increase in acceleration having a peak at the midpoint of pad travel, after which it decreases in speed until it attains a stationary position at the end of the stroke. 'I'his is a sinusoidal function of pitman travel. The advantage, additional to economy, is that this motion closely duplicates the motions of the human being at the creeping stage.
Another illustrative form of the invention is disclosed in FIG. 4 and related iigures, and comprises a multiple course endless conveyor, such as a chain 15, passing about pulleys or rollers 21, beneath the platform 7, so as to pro. vide on the right side parallel courses 16 and 17, always traveling in respectively opposite directions, and on the left side parallel spaced courses 18 and 20, always traveling in opposite directions. In the cross patterning organization, right front pad 10 is attached to course 16, as at 25 and right rear pad 11 is attached to parallel course 17, as at 26. Relatedly, left front pad 13 is attached to course 20 as at 27, and left rear pad 14 is yattached to parallel course 18, as at 28. While the respective pads may have rolling support on or under the platform 7, with a chainengaging element extending through slots 6, it is preferred to provide a structure as indicated in FIG. 7.
In this illustrative instance a plate 22 is provided having upstandng flanges 23-23, extending upwardly through slots 6 and at their upper ends mounting a pad, illustratively pad 14. On the lower surface of plate 22, self lubricating pillow blocks 3V3 are mounted, slidable on longitudinally extending ground bars or shafts 4--4, suitably supported beneath and parallel to platform 7. A transverse plate 24 connects the pillow blocks 3-3 just above the chain courses 18 and 20. A pin housing 29 extends from plate 24 between the chain courses 18 and 20, and mounts a transverse pin 19 having a handle 19' by which the pin can selectively be engaged with either course 18 or 20 or one of a plurality of eyes formed in chain 15, for moving the instant pad in one direction or the other on the bars 4. .Y It will be seen that with the organization just described 1f the chain is reciprocated through a limited path in one direction and then in the other, in the cross patterning set up, right hand hand pad and right hand knee pad 11, will move toward each other in one cycle, and then move away from each other in a succeeding cycle, and in alternation thereto left front hand pad 13 and left knee pad 14 will move away from each other and then move toward each other, in successive cycles.
It remains only to effect the reciprocation of the chain 15 in controlled cycles and it will be seen that attachment of pitman 34 to pad 13, and powered rotation of the web 32, through the course 20, the chain 15 will actuate all of the pads in their respective longitudinal motions.
It is preferred to utilize a hydraulic system for the purpose, to which end a power cylinder 35 is pivotally connected to `an anchorage 36 on the frame below the platform 7, and has combined intake and exhaust lines 37 and 38 communicating with the cylinder on respectively opposite sides of a slidable piston 40 (indicated in dotted lines), mounting a pisto nrod 41. The piston rod 41 at its outer free end is pivoted to a pad, such as pad 14. For the actuation and control of the cylinder and piston, any more or less conventional reversing hydraulic system may be used that has been used to actuate and control cylinder and piston combinations in other relationships. This normally would comprise a motor, a pump, a sump, valving and adjustable limit controls determining the length of stroke of the piston. As this system, per se, forms no part of the present invention, it is thought unnecessary to furnish it in detail.
As a further refinement of the apparatus it is preferred to provide a traveling light source coordinated with the pad movement to catch and hold the eyes of the patient and urge him to move his head toward the light source in synchronism with movement of the hands with the pads on which they are mounted.
A schematic plan of this part of the apparatus is shown in FIG. 8. In this disclosure the respective hand pads only are disclosed as connected to the chain 15, and the latter is reciprocated as before by any suitable means. A transverse bar 40 is supported on suitable standards 41-41, beyond the end of platform 7, and the standards have confronting eyelets 42-42. A slidable light source support 43 -mounting a light source 39 is mounted on the transverse 4bar 40, and has terminal eyes 44 aligned with the bar 40 to receive the respective ends of thin cables 45 and 46. Cable 45 engages one inside course of chain 15, (opposite to the course engaging pad 13), and after passing through an eyelet 47 on the lower surface of platform 7 passes through the adjacent eyelet 42 and enga-ges the juxtaposed terminal eye 44 on the movable support 43. Relatedly cable 46 engages the inside course of chain 15, (opposite to the course engaging pad 10), and passes through an eyelet 50 on ths lower surface of the platform 7, through juxtaposed eyelet 42 to engagement with the juxtaposed terminal eye 44. It will be seen that as the pad 10 advances with its chain course, the parallel chain course is moving in the opposite direction, and as this is the one to which the end of cable 46 is secured, the light source will be pulled to the right in synchronism with the advancing motion of the right hand pad 10. Synchronously left hand engaged pad 13 is moving in retraction (away from the end of platform 7), while the course of chain 15 to which cable 45 is secured moves in the opposite direction, fumishing slack permitting the light source to move toward the right. It will be seen that on `the next cycle as the ri-ght hand pad 10 retracts, left hand pad 13 is extended, and synchronously the light source will be moved to the left. The movement of an infants eyes toward the advancing hand in crawling is an additional link in the establishment of the neurological patterns leading to Walking, and is a helpful factor in reestablishing the interrupted neurological patterns of patients.
Mention has been made of the pin and chain organization of FIG. 7, and it will be understood that with the pin 19 engaging course 20, the system is set for cross patterning, whereas by withdrawal of pin 19 from course 20 and engagement with course 18, the system is set for homolateral patterning.
It will be understood that the pads will have added restraining members, such as looped straps for the front pads for engaging the fingers of the patient, and related loops or straps are provided for the rear pads to firmly hold the knees of the patients on such pads.
We claim as our invention:
1. Apparatus for patterning a patient, comprising agenerally planar horizontal platform, a right hand pair of pads mounted on Iand movable relative to lthe platform in parallelism therewith and comprising a hand pad and a knee pad, a left hand pair of pads mounted on and movable relative to the platform in parallelism therewith and comprising a hand pad and a knee pad, and means synchronously moving one pair of pads apart as the other pair of pads are moved toward each other, and vlce versa, whereby a patient facing toward the platform with his hands attached to the respective hand pads and his knees secured to the respective knee pads, and with his torso generally parallel to but spaced vertically above the platform has his limbs passively actuated.
2. Apparatus for patterning a patient incorporating a right hand pair of pads comprising a hand pad and a knee pad and a left hand pair of pads comprising a hand pad and a knee pad, said pads lying substantially in a common horizontal plane, means moving said respective pads in said plane, and means selectively operated coupling said right h-and pair of pads for actuation by said means for relative or conjoint motions, and means selectively operated coupling said left hand pair of pads for actuation by said means for relative or conjoint motions, whereby a patient with hands on the hand pads and knees on the knee pads can be passively actuated in either cross patterning or homolateral patterning.
3. Apparatus for patterning a patient incorporating a pair of pads comprising a right hand front pad and a right hand rear knee pad and a left hand pair of pads comprising a left hand front pad and a left hand rear knee pad, said pads disposed for translational motion substantially in a common plane, and means connecting the pads to effect simultaneously motion of the left hand front pad and the right hand rear pad in the same direction, and motion of the right hand front pad and the left hand rear pad in the opposite direction.
4. Apparatus as in claim 1, and visual signal means effectively movable transversely of the platform in synchronism with pad movement.
5. Apparatus for patterning a patient, incorporating a right-hand pair of pads comprising a right-hand front pad and a right-hand knee pad and a left-hand pair of pads comprising a left-hand front pad and a left-hand knee pad, said pads disposed for translational motion longitudinally with respect to a patient on the apparatus, `and -means connecting the -pads to effect simultaneously a motion of the left-hand front pad and the right-hand knee pad in one longitudinal direction and simultaneously coordinated motion of the right-hand front pad and lefthand knee pad in the opposite longitudinal direction, for cross patterning.
6. Apparatus according to claim 5 having means alternatively connecting the pads to effect unidirectional longitudinal motion of both pads of the right-hand pair and simultaneously opposite unidirectional longitudinal motion of both pads of the left-hand pair, for homolateral patterning.
7. Apparatus according to claim 5 having a transverse safety means of variable height, positionable below the patient on the apparatus, in a location to receive the torso of the patient in the event of the collapse of a limb of the patient.
8. Apparatus according to claim 5 with driving means for said pads adapted to eect motions thereof simulating typical creeping motions of a human being.
9. Apparatus according to claim 5 with driving means for said pads adapted to effect motions thereof having a stroke of predetermined longitudinal extent typical of the creeping motion of a human being.
10. Apparatus according to claim 9 with means -for adjusting said stroke.
11. Apparatus according to claim 5 having means for making different fixed adjustments of the initial longitudinal spacing between the front pads and the rear pads adapted to eiect patterning of patients of diierent proportions.
Reerences Cited UNITED STATES PATENTS 326,247 9/1885 Root. 2,079,594 5/1937 Clem 128-25 2,666,429 1/1954 Alexander et al. 128--33 2,696,206 12/1954 VBierman 128--25 10 L. W. TRAPP, Primary Examiner.