WO2006027277A1

WO2006027277A1 - A physiotherapeutic manipulation apparatus

Info

Publication number: WO2006027277A1
Application number: PCT/EP2005/009849
Authority: WO
Inventors: Alain Bardon; Chantal Bardon; Frank Dillon; Gianfranco Tudico
Original assignee: Bardon Research & Development Limited
Priority date: 2004-09-09
Filing date: 2005-09-09
Publication date: 2006-03-16

Abstract

A physiotherapeutic manipulation apparatus comprises means 40 for supporting a supine human patient and at least one manipulator element 66 located below the human patient in the region of the patient's vertebral column when the patient is supported on the support means. The manipulator element is actuable to provide a repetitive local pressure on the patient by up and down movement of the element relative to the patient.

Description

A Physiotherapeutic Manipulation Apparatus

This invention relates to a physiotherapeutic manipulation apparatus, designed to simulate different therapeutic manipulations of the human body, such as neuromuscular manipulation and the like, as practiced by professionals such as chiropractors, physical therapists and doctors.

According to the present invention there is provided a physiotherapeutic manipulation apparatus comprising means for supporting a supine human patient and at least one manipulator element located below the human patient in the region of the patient's vertebral column when the patient is supported on the support means, the manipulator element being actuable for up and down movement relative to the patient to provide a local pressure on the patient.

Embodiments of the invention will now be described, by way of example, with reference to the accompanying drawings, in which:

Fig. 1 is a plan view of an apparatus according to a first embodiment of the invention,

Fig. 2 is a side view of the apparatus of Fig. 1,

Fig. 3 is a schematic detailed view of the of the manipulator elements of the apparatus of Fig. 1,

Fig. 4 is a perspective view of a second embodiment of the invention, Fig. 5 is a perspective view of the carriage mechanism of the embodiment of Fig. 4,

Fig. 6 is an end perspective view of the carriage mechanism of the embodiment of Fig. 4,

Fig. 7 is an enlarged perspective view of part of the carriage mechanism of the embodiment of Fig. 4,

Fig. 8 is a perspective view of the head and neck support of the embodiment of Fig. 4,

Fig. 9 is a plan view of the carriage mechanism of the embodiment of Fig. 4, and

Fig. 10 is a side view of the carriage mechanism of the embodiment of Fig. 4.

Referring first to Figs. 1 to 3, the first embodiment of the invention comprises four components:

a. A patient support platform containing an array of vertebral/sacral manipulator elements.

b. A cervical vertebrae manipulation simulator (CVMS) .

c. An occipital manipulation simulator (OMS) .

d. A device to measure the forces generated by the cervical musculature of a subject (Cervical

Musculature Measuring Device, CMMD) .

The patient support platform 10 rests on a central pedestal or column 12 which sits on the ground. It is about 190cm long and 80cm wide, to accommodate a supine human patient, and is at a height of about 70cm from the floor.

Along the length of the platform and mid-way between its opposite longitudinal edges are two parallel rows of vertebral/sacral manipulator elements (VSMs) 14 set into the top surface 16 of the platform at positions corresponding to the vertebral column of a supine patient. In this embodiment each row of VSMs 14 has twenty elements, and each VSM 14 comprises a vertical jack 18 on which is mounted a horizontal plate 20. On each horizontal plate 20 there is mounted the part of the VSM which comes into contact with the patient's spine. This contact part is in the form of a hemisphere 22 with a diameter of 2cm to 5cm.

The jacks 18 are operated by electric motors and gearing 24 so that, upon actuation of a VSM 14, the corresponding hemisphere 22 is caused to reciprocate up and down relative to the top surface 16 of the platform and thereby apply a repetitive local pressure to the patient's spine. A programmable control unit, not shown, is able to actuate the VSMs 14 individually or in pre- defined groups, according to the particular program selected. The control unit also preferably has the capability of adjusting the amplitude and/or repetition frequency of the movement of the hemispheres 22.

It will be understood that the number of VSMs 14 is not limited to twenty, nor the construction of the VSMs limited to that shown in Fig. 3. More or less VSMs may be provided, and any suitable construction of VSM can be used which provides a contact part which can be moved to apply a repetitive local pressure on the patient's spine.

The separation of the rows of VSMs 14 can be adjusted relative to the patient' s mid-line in order to allow for different spine widths. This can be achieved, for example, by making the platform 10 in two longitudinal halves 1OA, IOB which are laterally adjustable mutually away from one another, and providing each row of VSMs 14 on a respective half. Alternatively, rather than making the platform in two halves, each VSM 14 could be individually adjustable laterally of the centreline of the platform. This could be achieved, for example, by having each hemisphere 22 set into a respective slot in the top surface 16 of the platform, the slots being orientated perpendicular to the centreline of the platform and each hemisphere being adjustable in position along its respective slot.

The CVMS comprises a cradle-like structure 26 to accommodate the patient' s cervical vertebrae and is attached to the "head end" of the platform 10 by a bracket 28. Like the platform 10, the cradle 26 is in two halves with the division between the two halves being in the sagittal plane. The cradle 26 is controlled by the programmable control unit to automatically to provide the following movements:

- Antero-posterior movement of the patient's cervical vertebrae.

- Rotation of the patient's cervical vertebrae. The OMS comprises a further cradle-like structure 30 to accommodate the patient' s occipital bone and is attached to the head end of the platform 10 by the same bracket 28. Like the cradle 26, the cradle 30 is in two halves with the division between the two halves being in the sagittal plane. The cradle 30 is controlled by the programmable control unit to automatically to provide the following movements:

- Antero-posterior movement of the patient' s cranium relative to his cervical vertebrae.

- Rotation of the patient's cranium relative to his cervical vertebrae.

The combined use of the OMS 30 and the VSMs 14 in the sacral region will allow for corrections in the patient' s cranio-sacral balance.

The CMMD comprises a third cradle-like structure 32 which has the capacity to measure the force generated by the patient in making flexion, extension, rotation and side- bending movements of the cranium in the sagittal, frontal and horizontal planes. Such forces are measured, in this embodiment, by incorporating a pressure receptor 34 into the cradle 32 to measure the force generated during extension. Measurement of the force generated during flexion can be achieved by providing an adjustable band (not shown) around the patient's forehead, the band being attached to the receptor 34.

The bracket 28 supporting the CVMS 26, OMS 30 and CMMD 32 is adjustable into and out of the platform 10 to accommodate patients of different heights. Referring now to Figs 4 to 10, a second embodiment of the invention comprises a patient support in the form of a strong, flexible web 40 slung between two rigid parallel poles 42 in the manner of a hospital stretcher. The dimensions of the web 40 are similar to those of the platform 10 in the first embodiment, i.e. about 190cm long and 80cm wide, to accommodate a supine patient lying lengthwise of the web. The poles 42 are rigidly supported by brackets 44 on an underlying open rectangular frame 46. The frame 46 is in turn mounted on articulated supports 48 which allow the height above ground of the frame 46, and thus of the web 40, to be adjusted.

A carriage 50 is mounted within the frame 46 below the web 40. The carriage 50 is slidable longitudinally of the web on two fixed parallel guide rods 52. Such movement is effected by a reversible electric motor 54 which drives a screw-threaded shaft 56 running parallel to the guide rods 52. The shaft 56 passes through and engages complementary internal threads of a threaded fitting 58 at one end of the carriage 50, whereby rotation of the shaft 56 in one direction moves the carriage 50 in one direction along the guide rods 52 and rotation of the shaft 56 in the opposite direction moves the carriage 50 in the opposite direction along the guide rods. In this embodiment the carriage 50 is capable of a maximum longitudinal displacement of about 80cm.

The two blocks 60 of Teflon or other low coefficient of friction material are slidably mounted on the carriage for movement laterally of the shaft 56. Such movement is effected by a reversible electric motor 62 which drives a second screw-threaded shaft 64 running perpendicular to the shaft 56 and guide rods 52. The shaft 64 passes through and engages complementary internal threads in each block 60. However, the portion of the shaft 64 passing through one block 60 is oppositely handed to the portion passing through the other block 60, so that when the shaft 64 is rotated in one direction the blocks 60 move mutually apart whereas when the shaft 64 is rotated in the opposite direction the blocks 60 move mutually towards one another. The blocks are preferably capable of being displaced up to about 10cm laterally from the centre line of the carriage 50 (corresponding to the patient' s vertebral column) , so that their maximum separation is about 20cm.

Each block 60 contains two manipulator elements 66 (shown in Figs. 4, 7 and 10 but omitted from the other figures) . Each element 66 is individually driven by a respective reversible electric motor 68 (Fig. 10) for vertical movement relative to the respective block 60, rotation of a motor 68 in one direction driving the corresponding element 66 upwards and rotation of the motor 68 in the opposite direction driving the corresponding element 66 downwards. The electric motors 68 should be capable of generating significant force in order to apply suitable pressure to a patient regardless of the weight of the patient, and are preferably capable of displacing the elements 66 in very small increments, for example in steps of 1mm.

The manipulator elements 66 contact a patient through the material of the web 40. The hemispherical heads 70 of the manipulator elements are therefore preferably formed from Teflon, again to give a smooth frictionless contact with the patient. In addition, the heads 70 of the elements 66 are removable, and may therefore be replaced with heads of varying size/shape.

Since the manipulator elements 66 are in this embodiment separate from the patient support (web 40) , the elements will initially need to be dropped vertically downward away from the underside of the web, since the position at which each patient comes to rest in the vertical direction will vary depending on the size and weight of the patient. Once a patient is lying on the web, one or more of the elements will then need to be raised vertically into a position just short of, or lightly contacting, the underside of the web. This positioning of the manipulator elements may be achieved in one or a combination of ways. The most simple way of achieving the correct position of the elements is to drive the elements using manual control, and position them visually. Alternatively, the elements are each provided or associated with a pressure sensor of conventional form, which will arrest the vertical displacement of the respective element when a pre-set pressure is sensed - this pressure will be relatively light, corresponding to a very light contact with the underside of the support. Alternatively, laser mapping could be used, with one or more lasers being positioned to illuminate the underside of the support and feedback information to suitable control circuitry in order to instruct the positioning of the manipulator elements. The frame 46 and/or carriage 50 are also preferably provided with sensors/limit switches at various positions, in order to turn off the respective motor when the carriage 50 or blocks 60 have reached the limit of the available displacement in a given direction. One end of the frame 46 is provided with a cradle for the neck and head of the patient, which may be displaced in various directions in order to simulate different therapeutic manipulations of the head/neck. Referring especially to Fig. 8, the cradle comprises a saddle 72 which is primarily intended to support the neck, although it may also support the back of the head, depending on the position of the patient on the apparatus. The cradle further includes a U-shaped element 74 for supporting the back of the head when the neck is supported on the saddle. In the embodiment illustrated, the U-shaped element 74 is fixed to the saddle by a pair of wingnuts 76 which allow the position of the element 74 to be altered relative to the saddle. Located beneath the cradle is another reversible electric motor 78 which drives a further screw-threaded shaft 80 to rotate the cradle about a horizontal axis defined by pivot 82, preferably through an angle of approximately 60°.

In use, the apparatus is provided with control circuitry which may be programmed to execute a number of different cycles or operations, depending on the requirements of the patient. The basic operation is to provide a repetitive local pressure on the patient using one or more of the elements 66, by driving the element (s) individually or in groups up and down using the corresponding motor (s) 68. This can be done while the blocks 60 are stationary at selected positions, or while they are moving, for example to impart a circular motion to the heads 70, by appropriate control of the motors 54 and 62. As before, the control circuitry also preferably has the capability of adjusting the amplitude and/or repetition frequency of the movement of the elements 66. In addition, one or more of the elements 66 may be raised vertically to apply continuous pressure to the patient, adjacent the spine. While still pressing on the patient these element(s) may then be displaced longitudinally such as to be drawn along the patient's back, in order to effect a neuromuscular action. This moves the joints of the spine lightly relative to one another, in order to release pressure. The elements may also be moved laterally of the patient while maintaining pressure on the patient. The heads 70 of the manipulator elements 66 may be adapted to vibrate in order to further increase the efficacy thereof. It will be appreciated that the control circuitry necessary to carry out these procedures is relatively simple and could be readily implemented by those skilled in the art.

Although Figs. 7 to 10 have described an embodiment where the elements 66 are disposed in groups of two in the blocks 60, and accordingly are only movable laterally and longitudinally in such groups, it is possible to place each element 66 in is own individual block 60 which is individually movable both longitudinally and laterally of the web 40. There may also be more than two elements 66 in each block 60.

The benefit of using the stretcher type support arises from the fact that the patient is not truly relaxed when lying on a rigid table, and thus the full benefits of the therapeutic manipulations of the elements cannot be achieved.

The foregoing embodiments, working individually or collectively on the cranium, vertebrae and sacrum allows: - Therapeutic movement to liberate stiffness and loss of mobility in the vertebrae.

- Therapeutic movement of the cervical vertebrae.

- Therapeutic movement of the occipital bone.

-Therapeutic movement to allow the restoration of cranio-sacral balance.

- Measurement of the forces generated by the cervical musculature. Having measured such forces, the machine can be calibrated to maximize the efficacy of cervical musculature re-training. Such re-training can then be monitored by re-measurement of the subject's capacity to generate such forces.

The invention is not limited to the embodiments described herein which may be modified or varied without departing from the scope of the invention.

Claims

1. A physiotherapeutic manipulation apparatus comprising means for supporting a supine human patient and at least one manipulator element located below the human patient in the region of the patient' s vertebral column when the patient is supported on the support means, the manipulator element being actuable for up and down movement relative to the patient to provide a local pressure on the patient.

2. An apparatus as claimed in claim 1, wherein there are a plurality of manipulator elements actuable for up and down movement individually and/or in groups.

3. An apparatus as claimed in claim 2, wherein the manipulator elements are movable individually and/or in groups laterally of the patient's vertebral column.

4. An apparatus as claimed in claim 3, wherein at least two manipulator elements are movable laterally away from one another on opposite sides of the patient' s vertebral column.

5. An apparatus as claimed in claim 2, wherein the manipulator elements are movable individually and/or in groups longitudinally of the patient's vertebral column.

6. An apparatus as claimed in claim 3, 4 or 5, wherein at least one element is movable laterally and/or longitudinally while pressing on the patient.

7. An apparatus as claimed in any preceding claim, wherein the amplitude and/or repetition frequency of the up and down movement of the manipulator element (s) is adjustable.

8. An apparatus as claimed in any preceding claim, wherein the support means comprises a platform and an array of manipulator elements is set into the top surface of the platform in positions corresponding to the vertebral column of the patient.

9. An apparatus as claimed in claim 6, wherein the manipulator elements are disposed in at least two substantially parallel rows.

10. An apparatus as claimed in any one of claims 1 to 7, wherein the support means comprises a flexible web and the manipulator element (s) exert pressure on the patient through the web.

11. An apparatus as claimed in any preceding claim, further including an adjustable neck and head support for the patient.