WO2011076240A1

WO2011076240A1 - Robotic arm trainer

Info

Publication number: WO2011076240A1
Application number: PCT/EP2009/066116
Authority: WO
Inventors: Tom Arild Wike
Original assignee: X-Trainer As
Priority date: 2009-12-01
Filing date: 2009-12-01
Publication date: 2011-06-30

Abstract

A physiotherapy apparatus (10) comprising a robotic arm (11), wherein the robotic arm (11) is attachable to a base (12) for fixing the robotic arm (11) at a first end ( 13) and at the second end (14) the robotic arm (11) is provided with one or more removeable and interchangeable patient interaction means (30) which are designed to be attached to, held by, or interact with, a user (1) of the physiotherapy apparatus (10). The robotic arm (11) is capable of moving, or is adapted to move, the patient interaction means (30) in a known orientation and manner in a full three dimensional range of motion with respect to its first end (13), and is further capable of rotating and tilting the patient interaction means (30) around the second end (14). The robotic arm (11) is programmable and/or adapted to be able to move a limb (2) or other body part of the user (1) via the patient interaction means (30), in a user definable manner.

Description

Robotic Arm Trainer

Background to the Invention

Physiotherapy and physiotherapeutic training has for many years provided invaluable help to patients who have suffered accidents, or who suffer from long term physical problems. In a traditional case, a patient is checked by a physiotherapist who ascertains the problems and injuries to the patient. Once a clear picture of the problems of the patient exist, the physiotherapist is then able to build a training programme which can help strengthen muscles, ease problems with joints and in some cases lead to a regaining of the use of limbs.

In recent years, a number of specific training machines have been developed in order to help the physiotherapist. In particular, these machines are designed to explicitly focus the training performed by the patient or user of the equipment, in order to maximise the results of the training without incurring additional physical damage from poorly performed exercises. It is not possible for the physiotherapist to monitor every single action performed by a patient during a training session, and thus the use of specific machines can ensure that a training exercise is performed correctly each and every time, without the physiotherapist having to stand over the patient, Whilst specific training machines have been developed, these are typically directed to only one particular limb, and often to only one particular exercise. For example, it is not possible to use a machine which is constructed for leg extensions for a patient who has problems with their neck or shoulders. As such, whilst the specific training machines have provided a useful aid in physiotherapists surgeries, the requirements of having many such machines in order to treat the myriad of disorders which may afflict the human body, is simply not practical. Indeed, many physiotherapist surgeries have a selection of the more general and useful machines, but must still rely on more traditional techniques in the case of more specific injuries or training regimes.

A further problem faced by physiotherapists is the provision of unbiased diagnostics for a patient. In order to appropriately monitor the progress of a patient, it is necessary to measure and compare the patient's progress through the sessions of training. In many cases, it is simply not possible to monitor the diagnostics associated with the patient's injury in an unbiased and reliable manner. For example, if the patient must improve strength in his or her shoulder, it is extremely difficult to regularly monitor the strength and range of motion which the shoulder can perform. Further, it is often impossible to monitor how pain experienced by the patient influences the physiotherapy training, and how this pain lessens or increases during the training regime. Accurate diagnostics are vital in physiotherapy training, as these give the physiotherapist immediate insight into how well the training regime is functioning, and how quickly the patient is improving. Likewise, if the patient is responding badly, or indeed if the training is having a detrimental effect on the patient, these diagnostics are crucial for picking this up early.

Another aspect of physiotherapy training which is very difficult to perform, is that of an eccentric training regime. In eccentric training, a muscle group is used by the patient to counteract a movement contrary to the contraction of the muscle group. The force which is applied against the contracting muscle is chosen to be slightly higher than that which can be provided by the patient, such that the muscle group is stretched, even though the patient is providing a maximum force against the action. Eccentric training is extremely difficult to perform for a wide variety of muscle groups, in particular as in most cases the force acting against the muscle group will be a weight acting under gravity. In order to safely perform this exercise, a safety mechanism must be in place to catch the weight should the muscle group give way. Additionally, no account can be made of the difference in strength of the patient over the full range of movement. Finally, if the weight acting under gravity is to be used for the eccentric training, some mechanism of actually raising the weight must also be included.

From the above it is clear that a need exists in the field of physiotherapeutic training for a multifunctional training apparatus. Additionally, this training apparatus should ideally be able to perform a diagnostics measurement on the patient in an unbiased and reliable manner. Finally, the equipment for eccentric training for a full range of muscle groups of a patient simply does not exist, in particular with regard to the back of the patient, and thus a general need for such an apparatus is present.

Summary of the Invention

The above problems, and more, are addressed in the present application by means of the physiotherapy apparatus according to the appended claims. The physiotherapy apparatus of the present application comprises a robotic arm, wherein the moveable part of the robotic arm is provided by an interaction means for appropriately interacting with the user or patient. The use of a robotic arm is particularly

advantageous, as the robotic arm is capable of full three dimensional motion within the space accessible by the robotic arm, with respect of its fixed location. Further, the robotic arm can be structured such that the means for interacting with the patient can be tilted and rotated in any direction around the end of the moveable part of the robotic arm. Quite clearly, this structure allows for any range of movement to be accommodated by the robotic arm, which will allow a full range of training

opportunities and possibilities to be performed.

The present application relates to a robotic arm provided with appropriate patient interaction means for the patient, wherein the robotic arm is appropriately controlled or programmed to perform a range of physiotherapy training exercises. Clearly, changing the patient interaction means at the end of the robotic arm, allows for the robotic arm to train any number of limbs or body parts of the patient.

A further advantageous aspect of the robotic arm of the apparatus of the disclosure, is that a series of sensors are provided for monitoring the patient's movements, A first set of sensors are advantageously used to monitor the force generated between the user and the robotic arm's motion. By monitoring how much force the patient is applying against the movement of the robotic arm and patient interaction means, allows the apparatus to appropriately modify its own movements. For example, if the patient is attempting to train in a concentric manner, it is possible to monitor how much force the patient is applying in the contraction of the muscle, and apply an appropriate opposite force differing from that applied by the patient by a set amount. This force can be applied in real time, and can essentially be a percentage of the applied force by the patient, thus allowing for concentric training over a full range of motion and movement by the patient.

Additionally, the present disclosure relates to a computer program which is used for controlling the robotic arm . The computer program is adapted to monitoring the sensors of the robotic arm and ensure that the control of the robotic arm is appropriate for the chosen training. For example, this program is capable of taking account of the sensor readings in real time, and instantly adjusting the motion of the robotic arm accordingly.

Finally, the present disclosure relates to a method of performing physiotherapy on a patient. This method uses the robotic arm as discussed, so as to perform appropriate physiotherapy training and exercises on the patient. Brief description of the Figures

Description

Figure 1 : The robotic arm of the present disclosure interacting with a patient for guiding patient's arm .

Figure 2: The robotic arm shown in Figure 1 at the upper end of the motion of the user's arm.

Figure 3 : A robotic arm interacting with the leg of a user.

Figure 4: The robotic arm of Figure 3 at the end of the motion of the user's leg. Figure 5; The robotic arm interacting with a patient's leg, wherein the patient is reclining.

Figure 6: The robotic arm of the present disclosure interacting with a helmet for movement of the patient's head.

Figure 7: The patient as shown in Figure 6 from the front.

Figure 8: The user shown in Figure 7 part way through a training of the head and neck.

Figure 9: A user interacting with the robot arm for training of the back.

Figure 10: The user shown in Figure 9 at one end of training of the back. Figure 11 : The user shown in Figures 9 and 10 at another extreme of training. Figure 12: A flow chart showing the user's interaction with a physiotherapist and the physiotherapy apparatus of the present disclosure.

As has been discussed above, a need exists in the field of physiotherapy for a multifunctional training equipment. The present disclosure is directed to a physiotherapy apparatus 10 which is capable of performing a wide variety of physiotherapeutic exercises on a patient or user 1, and is not limited to a single joint or muscle group. This is achieved by providing the physiotherapy apparatus 10 with a modified robotic arm 11, for example a Motoman robotic arm 11. Such a robotic arm 11 is capable of complete movement around a fixed base 12, and can provide such movement over a full three-dimensional space limited only by the reach of the robotic arm 11.

By appropriately controlling the operation and movement of the robotic arm 11, it is clear that the moveable end, called the second end 14 as opposed to the first end 13 which is attached to the base 12, can be used to interact with the user 1 and move the user's limb 2 in an appropriate manner. By connecting the user 1 to the second end 14 of the robotic arm 11, the robotic arm 11 can be controlled, programmed and operated in such a manner to perform appropriate physiotherapy and

physiotherapeutic actions on the user 1. For example, if the user 1 were to hold on to the second end 14 of the robotic arm 11, the robotic arm 11 could be programmed to move the arm of the user 1 in an appropriate pattern to exercise the arm. Further, the robotic arm 11 could be programmed to respond to movement of the arm of the user 1 and in some way resist this movement, so as to train the arm of the user 1. The specifics of the operation of the robotic arm 11 will be discussed later.

Modifying the robotic arm 11 to accept in an interchangeable and removable manner one or more of a range of specific patient interaction means 30 at its second end 14, will allow the user 1 to interact with the robotic arm 11 in a controlled manner. As will be discussed later, it is important for the physiotherapy apparatus 10 to interact with the limb 2 of the user 1 in a known manner. For example, there are many ways of gripping the patient interaction means 30 with a hand 3, and in some orientations the arm of the user 1 will not be in an appropriate position for successful

physiotherapeutic training. As such, the patient interaction means 30 are so designed to ensure that the user 1 is interacting with the robotic arm 11 in a known and predetermined manner, so that the resultant movement of the robotic arm 11 is appropriate for training the arm, or of course other limb 2, of the user 1.

Depending upon which limb 2 of the user 1 is to be trained, the robotic arm 11 may be controlled and programmed to operate a variety of specific movements to perform appropriate physiotherapeutic training. For example, if the user's elbow needs appropriate strength training, the robotic arm 11 will interact with the user 1 via the patient interaction means 30, and will provide controlled movement of, or resistance against movement by, the user 1 in such a way to allow the elbow to be flexed in the correct orientation without inducing improper movements. The skilled person will realise that the precise movements of the robotic arm 11 will require appropriate programming into the physiotherapy apparatus 10, and the robotic arm 11 can be controlled in any particular movement desirable by the physiotherapist, It is also possible to provide the patient interaction means 30 attached and attachable to the robotic arm 11 in such a manner that the patient interaction means 30 can be rotated or tilted in all possible directions around the second end 14 of the robotic arm 11. As will be understood, there are times when the patient interaction means 30 must rotate and twist with respect to the second end 14 of the robotic arm 11, to accommodate appropriate training movements by the user 1. The attachment mechanism between the patient interaction means 30 and robotic arm 11, is so designed such that this movement can be accommodated and controlled by the physiotherapy apparatus 10. Sensor System

It is preferable for the robotic arm 11 to be provided with a plurality of sensors, referred to as first sensors 15, for measuring the resistance or force which is applied by the user 1 against the robotic arm 11. Whilst it is possible to operate the robotic arm 11 in a passive manner to completely control the movement of the limb 2 of the user 1, this does not provide a fully useable multifunctional physiotherapy apparatus 10. Most physiotherapeutic training exercises require the user 1 to act against some form of resistance, thus training both the muscles and joints. As will be understood, in such training regimes it is advantageous to provide the physiotherapy apparatus 10 with a means for measuring the force or resistance to movement applied by the user 1 against the robotic arm 11. In particular, in most training regimes the physiotherapy apparatus 10 will monitor the force or resistance generated by the user 1 against the movement of the robotic arm 11, and utilise this measurement to appropriately control the motion of the robotic arm 11. It is conceived that the robotic arm 11 will generally be controlled by some form of computer system, and the output from the first sensors 15 will be provided to the computer, or other control system, in order to control the continued motion of the robotic arm 11.

For example, the range of force and torque sensors provided by ATI Industrial Automation provide full six dimensional force and torque measurements. That is, such sensors can be used to measure the direct force applied by the user 1 against the motion of the robotic arm 11; the twist and rotation in a variety of directions applied by the user 1 against the patient interaction means 30; the tilt provided by the user 1 against the patient interaction means 30 attempting to tilt the patient interaction means 30 away from the axis defined perpendicular to the second end 14 of the robotic arm 11. Such sensors provide an instant and very quick measurement of the force and torque applied by the user 1 against the patient interaction means 30, wherein these measurements can instantly be used by the computer to control the robotic arm 11 in an appropriate manner. For example, if the user 1 were to try and rotate the patient interaction means 30, and this motion was not desirable for performing appropriate physiotherapy, the first sensors 15 would pick up this motion. The computer when receiving the signal from the first sensors of this undesirable rotation, could control the robotic arm 11 to stop or counter the rotation of the patient interaction means 30, thus ensuring that the user 1 trains in the appropriate manner.

A variety of locations and positions for the first sensors 15 are possible. A first proposed location for the first sensors 15 are at a point directly between the user 1 and the robotic arm 11. For example, if the first sensors 15 were provided at the second end 14 of the robotic arm 11, with the patient interaction means 30 attached or attachable to the first sensors 15, the first sensors 15 would immediately be able to monitor and measure the relative force and torque applied by the user 1 against the patient interaction means 30 and robotic arm 11. It is also possible to locate the first sensors 15 within the robotic arm 11 itseif. Such sensors 15 could be position sensors which are used to actually monitor the position of the robotic arm 11 versus the signal being applied from a computer to drive the robotic arm 11, and thus obtain a value for the force or torque applied by the user 1. It will be appreciated that the physiotherapy apparatus and computer therein, is constantly aware of the precise location of the robotic arm 11. Indeed, the robotic arm 11 can be located in any orientation and location within its maximum range of motion, and the computer can control the robotic arm 11 to move with respect to the starting point in a known manner. As such, the physiotherapy training for different people could be the same pattern of motion of the robotic arm 11, but will necessarily have a different start and end position, as the height and range of motion of each user will be different, thus necessitating a different starting position for the

movement of the robotic arm 11. This will be discussed further, with explanation of the operation of the physiotherapy apparatus 10.

By providing the robotic arm 11 with the first sensors 15, the skilled person will appreciate that the robotic arm 11 can be appropriately controlled to perform, or allow the user 1 to perform, a certain range of movements. Additionally, the first sensors 15 are able to constantly measure the amount of force or torque being provided by the user 1, and thus control the movement of the robotic arm 11 to counteract this force and/or torque by a certain degree. As we will see below, certain physiotherapy training regimes require different responses from the robotic arm 11 to the movement of the user's limb 2, and by constantly and instantaneously measuring the force and torque provided by the user 1 at the second end 14 of the robotic arm 11, these training regimes and patterns can be appropriately accommodated.

As has been touched on above, the first sensors 15 will also ensure that the user 1 moves the patient interaction means 30 in the predetermined and desired manner. To ensure that the appropriate training is followed, the first sensors 15 can ensure that the robotic arm 11 only moves along a set path in three dimensional space, and that the robotic arm 11 wili counter any attempted motion of the patient interaction means 30 away from this desired path. By constantly monitoring and feeding back the force and torque signals from the first sensors 15, the physiotherapy apparatus 10 is able to properly guide and monitor the motion and training of the user 1. Further, by providing such a restricted motion, it is possible for the physiotherapy apparatus 10 to make repeatabie measurements of the strength of the user 1. It is often desirable during physiotherapy training for the user 1 to have an idea of the improvement being made. By appropriately restricting the movement of the patient interaction means 30, by means of the first sensors 15, the physiotherapy apparatus 10 can perform the same test on the user 1 during the whole of the physiotherapy training regime and over a period of sessions. Not only does this provide the user 1 with a clear picture of the improvements being made, it also provides the

physiotherapist with exact and unbiased information of the improvements made, which can be vital for modifying the training regime, should the user 1 not be responding appropriately well.

The use of the first sensors 15 to provide a diagnostics test for the user 1 is extremely powerful and useful. To date, it has been very difficult to ensure that a completely unbiased diagnostics measurement could be made. Not only is it possible to use the first sensors 15 to measure the strength and resistance applied by the user

I against the motion of the robotic arm 11, it is also possible to use the robotic arm

I I to measure the range of motion of the user 1.

As can be understood, the physiotherapy apparatus 10 is constantly aware of the position of the robotic arm 11, and thus the patient interaction means 30 are also provided at a precise and known location. As a further diagnostics test, the robotic arm 11 can be used to monitor, over a number of sessions, the maximum movement which the user 1 can provide in a certain limb 2, For example, the arm of a user 1 can only be moved so far, before the arm is at fuil extension. If the shoulder of the user 1 is being trained, and the user 1 is not capable of lifting their arm from their side completely above their head, the robotic arm 11 can monitor the maximum range of motion of the user 1 over a period of sessions. By knowing the exact starting position of the motion, which will be further monitored by a secondary sensor system to be discussed below, the full range of motion of the arm from the rest position by the side of the patient to above the head, can be measured and checked with previous data.

The full range of motion of a patient can be tested in a variety of ways. The first method is for the robotic arm 11 to be guided and essentially moved by the user 1. By means of the first sensors 15, the user 1 could lift their arm from the rest position to the maximum comfortable position over their head, whilst the computer controlled the robotic arm 11 to be essentially weightless to the user 1. By monitoring the force which the user 1 applies to the patient interaction means 30, the computer can control the robotic arm 11 to follow the motion of the user's arm, thus meaning that the user 1 does not have to pull against the robotic arm 11 in any way. Once the user has reached the maximum range of motion, the first sensors 15 will monitor the fact that the user's arm has stopped moving, and will also stop moving the robotic arm 11. The difference in position from the start to the finish of the motion of the user's arm, will be monitored and stored as the maximum range of motion. A separate way of monitoring the motion of the user's limb 2, could be by the physiotherapy apparatus 10 moving the robotic arm 11 and taking the limb 2 of the user 1 with it. Again, should the user 1 grasp the patient interaction means 30 in their hand, the computer could control the robotic arm 11 to move this from a set position along a desired path 31. Again, by way of example, we will suggest the use of the arm of the patient or user 1 being moved from by the side of the user 1 up above the user's head. The first sensors 15 wili monitor the force applied against the motion of the robotic arm 11 during this motion. It will be assumed that once the limb 2 of the user, in this case the arm, has reached its maximum range of

movement, the force applied against the robotic arm 11, as measured by the first sensors 15, wili increase. Above a certain value, the physiotherapy apparatus determines that the full range of motion has been met, and immediately stops moving the robotic arm 11. Again, the difference between the start and end position can be monitored, and stored as the range of motion of the user's limb 2. A further option would be to have a safety switch which is held by the user, such that if the robotic arm 11 moves the limb 2 of the user 1 too far, and induces too much pain in the limb 2, the patient can push a button or release a button and thus stop the motion of the robotic arm 11. Again, the difference in start to end position is considered as the range of motion of the user's limb 2. Naturally, the motion of the robotic arm 11 in the guided diagnostics pattern would be quite slow, in order to ensure that the !imb 2 of the user 1 was not moved too far before the force was measured by the first sensor 15 in order to stop the movement of the robotic arm 11, or before the patient introduced the safety stop.

Training Regimes

As has been discussed above, the physiotherapy apparatus 10 is required to perform a variety of training regimes with the user 1. The passive training in which the robotic arm 11 is programmed to move the limb 2 of the user 1 is useful for reprogramming motion in a user's limb 2, in particular after a stroke or other accident in which nerve damage has occurred. The controlled movement and training of a variety of motions can be done over a full three dimensional space centered around the user 1, and thus any desired pattern can be encoded into the motion of the robotic arm 11. This repeat motion can be performed as many times as is required, thus hopefully reprogramming the patient or user's nerves to rebuild motion. Additionally, this passive training can be useful for rebuilding muscles which could have been damaged, without straining any further muscles in the user 1. The passive training is, however, only one particular aspect of the physiotherapy apparatus 10 of the present disclosure.

The physiotherapy apparatus 10 can also be used to perform isometric, eccentric and concentric training . Isometric training is a training regime wherein the user 1 performs a motion of the limb 2 against an immovable object. For example, if one were to push against a wall in a certain manner with one's arm, moving the wall is most unlikely, however the arm is being trained in an isometric manner. As the wall is not moving against the action of the arm pushing against it, the arm is being trained in an isometric manner as the muscle is straining and applying a force against the wall.

The robotic arm 11 can be controlled to perform isometric training by monitoring the force applied on the patient interaction means 30, preferably by means of the first sensors 15. Continuing with the arm example, the user 1 could be connected to the patient interaction means 30 and then can provide an appropriate force in a known direction against the robotic arm 11. The first sensors 15 will monitor the force being applied by the user 1, and can thus control the operation of the robotic arm 11 to completely counter this motion. Additionally, whilst performing this isometric training, the physiotherapy apparatus 10 can appropriately monitor the amount of force and torque being applied by the user 1 against the robotic arm 11, and thus perform appropriate diagnostics as to the strength of the user 1. These diagnostics are useful for the appropriate control in concentric and eccentric training as discussed be!ow, as in both of these trainings the maximum force and strength of the user 1 are important for ensuring that the resistance to a motion applied by the robotic arm 11 onto the limb 2 of the user 1, is at the correct level. As will be clear to the skilled person, if the user 1 is able to push with a force of 50 N, it is not appropriate for the robotic arm 11 to be designed to counter this with a force of 100 N, as this is most likely to damage the arm of the user 1, rather than providing any physiotherapy. Another advantage of the physiotherapy apparatus 10, is that the first sensors 15 can aiso monitor that the isometric training (as well as concentric and eccentric) is being provided in the correct manner. As the isometric training should be provided in a certain direction or certain torque direction, the physiotherapy apparatus 10 could be provided with a screen to show the user 1 that he is applying force and twist in the appropriate manner, For example, if the user was supposed to be pushing directly forward against the robotic arm 11, but the first sensors 15 noted that the user 1 was applying a twisting motion in addition to the forward motion, the computer screen can give a clear readout showing the user 1 that the motion was not appropriate. The readout from the first sensors 15 could be used to control the screen to ensure that the user 1 pushes against the robotic arm 11 in a proper and appropriate manner, thus ensuring that the isometric training is performed properly. As will be understood from the above, in isometric training mode the robotic arm monitors the force and torque applied against the patient interaction means 30, and exactly opposes this such that the user's limb 2 is straining against the robotic arm 11, but is not moved. Further, the force generated by the user 1 is monitored during isometric training, and this force is used to control the concentric and eccentric training as discussed below, as well as recorded for diagnostics. In concentric training, the user 1 moves the patient interaction means 30 against an appropriate resistance provided by the robotic arm 11. Once the physiotherapy apparatus 10 has measured the maximum force applied by the user 1 during isometric training, it is possible to set the movement of the robotic arm 11 and patient interaction means 30 accordingly. For example, if the user 1 is able to app!y a force of 40 N in a certain direction, the robotic arm 11 could be controlled by the computer to allow motion in this direction but counter the motion by applying a force in the opposite direction of 35 N. This concentric training will thus allow the user 1 to contract the muscie group and will be provided with a resistive force of a chosen amount against the motion being provided by the user 1. The amount of resistive force applied by the robotic arm 11 can be tuned by the physiotherapy apparatus 10 or could be selected by the user 1. For example, the user 1 could say "I wish for the robotic arm 11 to resist my motion by 35 N", such that the user 1 will only be able to move the robotic arm 11 in the desired manner if he applies a force greater than 35 N . It is also possible, by means of constantly measuring the force applied by the user 1 through the first sensors 15, to concentrically train the user 1 in an active manner. For example, the physiotherapy apparatus 10 could be programmed to control the robotic arm 11 such that it provides a constantly varying force which was 95%, or any other value, of the applied force from user 1. Again, should the user 1 provide a force of 40 N against the robotic arm 11, the first sensors 15 would monitor this applied force, and control the robotic arm 11 to provide a resistance to this motion of 95%, which against 40 N would mean a resistive force of 38 N . As is clear, the user 1 may not be able to apply the full amount of force against the motion of the robotic arm 11 over the full range of motion of the limb 2, and thus providing an active concentric training regime will allow the user 1 to have the motion of their limb 2 constantly resisted by a set amount, completely dependent upon how much force the user 1 provides at any point of the concentric training. In eccentric training, the robotic arm 11 is controlled so as to counter the force applied by the user 1 by a slightly larger amount, thus leading to the limb 2 moving against the direction of force provided by the user 1. For example, the user 1 could try and lift his arm such that the hand reached the shoulder, and the robotic arm 11 could be controlled to act against this motion to actually bring their hand down towards the leg of the user. If the physiotherapy apparatus 10 is aware that the maximum force applicable by the user 1, as determined during isometric training, was 40 N, the robotic arm 11 could be controlled to provide a force of 42 N, or any other user definable amount, to counter the force being applied by the user 1 and thus extend the arm in an eccentric training action.

As with the concentric training, it is also possible to provide active eccentric training. For example, the user 1 could act against the patient interaction means 30, and, by means of the first sensors 15, the physiotherapy apparatus 10 could monitor the amount of force applied. The physiotherapy apparatus 10 could then provide the robotic arm 11 with instructions to move with a slightly higher force against the motion of the user 1, and thus will lead to the opposite motion of the user's limb 2. If the user 1 provides a lower force against the motion of the robotic arm 11, the first sensors 15 would immediately register this and the physiotherapy apparatus would control the robotic arm 11 to move against this force with a lower counter force, but still a slightly higher force than that being applied by the user 1. As is clear from the above, in both the concentric and eccentric training modes, the robotic arm 11 can be controlled to move on a set path. Additionally, the robotic arm 11 can be controlled to stop rotation and tilting of the patient interacting means 30 so as to ensure that movement of the user's limb 2 is in the appropriate manner. That is, the patient interaction means can be moved from a start to finish position on a precise and predetermined line through three dimensional space, whilst also avoiding unwanted tilting and twisting of the patient interaction means 30 around the second end 14 of the robotic arm 11. It is also possible for the robotic arm 11 to be controlled such t hat it will allow some deviation from the set path. In some exercises, a minor deviation or twist by the user is not detrimental to the training, but is much more comfortable for the user 1. Such deviations can readily be allowed by appropriate control of the robotic arm 11.

A further training regime is for the robotic arm 11 to be controlled to move in a certain manner. The user 1 then reacts against the motion of the robotic arm 11 and attempts to bring the patient interaction means 30 back to the original orientation and location. For example, the user 1 could hold on to the patient interaction means 30 with their hand 3, and the robotic arm 11 could move the user's arm to the left. The user 1 would then be requested to pull against the motion of the robotic arm 11 to bring the arm back to the rest position. Again by means of the first sensors 15, the amount of force can be monitored between the user 1 and the patient interaction means 30, and thus the motion of the robotic arm can be controlled to bring this back to the rest position when a certain force is applied. It may also be desirable to provide casts, or bandages or the like, to be placed on the patient. For example, it may be required to lock the precise orientation of the user's arm at the elbow and/or wrist, thus meaning that the motion of the robotic arm 11 only moves the shoulder joint. Such casts can be incorporated into the patient interaction means 30, in particular a glove-like means could be provided which would stop the wrist from moving, and a separate cast could be provided over the elbow to stop this moving. In this way, the precise movement of the joint being trained can be controlled by appropriately moving the robotic arm 11, as the precise movement of the robotic arm 11 leads to a known movement of the joint in question, which is not affected by other joints between the robotic arm 11, and in particular the patient interaction means 30 and the joint being trained. Patient Interaction Means

As has been discussed above, the physiotherapy apparatus 10 operates with the patient interaction means 30 interchangeably attachable with the second end 14 of the robotic arm 11. As will be clear from the above discussion, a wide variety of patient interaction means 30 are conceivable, with the main requirement being that these means 30 appropriately position and hoid the user 1 with respect to the robotic arm 11. As has been touched on above, the robotic arm 11 is intended to be useful for all possible physiotherapy trainings for a user 1, which incorporates all limbs 2 as well as the back. Depending upon the training to be performed by the physiotherapy apparatus 10, the interface between the user 1 and the robotic arm 11 must change and be appropriate.

Looking at Figures 1-11, a variety of different patient interaction means 30 are presented. Each of these means 30 is intended for interacting with the user 1 for training different sections of the body. In Figures 1 and 2, the user 1 is training his arm and/or shoulder; Figures 3-5 show an appropriate interaction means 30 for training parts of the user's leg; Figures 6-8 show an appropriate patient interaction means 30 for controlling and training the neck and upper back of the user 1; finally, Figures 9-11 show a patient interaction means 30 for training the user's trunk, lower back and the like. As can also be seen in Figures 1, 2, 5 and 6, it is also possible to provide the physiotherapy apparatus 10 with some form of resting station 33, upon which the user 1 rests. As will be discussed in further detail below, it is often desirable to position the user 1 in a known position with respect to the robotic arm 11 prior to performing training. In the above figures, the resting section 33 is provided either by a chair 34 or a bed 36. Obviously, depending on which part of the user's body is to be trained, the physiotherapist will select the appropriate resting station 33 for holding the user 1. The resting station 33 is also useful, as it allows the user 1 to relax and train only the relevant limb 2, or other body parts.

Looking at Figures 1 and 2, it is clear that the patient interaction means 30 is provided by hand grip 39. This hand grip 39 could also be replaced by means of a rigid glove, should the specific orientation of the hand and wrist require fixing with respect to the second end 14 of the robotic arm 11. Each of Figures 1 and 2 shows the movement of the arm of the user 1 from a rest position down by the side of the user 1, up to the high position wherein the user's arm is above his head. C!early, by positioning the chair 34 at a different location, for example closer to the robotic arm 11, a different range of motion would also be possible for the arm of the user 1. It would further be possible to move the robotic arm 11, such that the arm of the user 1 is to move from the low or high position to a position in front of the user 1. Indeed, as has been made clear above, the robotic arm 11 can be controlled in any direction and in any way to move the patient interaction means 30, in this case the hand grip 39, within the space bound by the robotic arm's maximum reach.

Figures 3-5 show a second patient interaction means 30, which is that of a shoe or boot 38. This is for attachment to the same robotic arm 11 as shown in Figures 1 and 2. In this embodiment, it is clear that the user 1 is to train some part of the leg or hips, and thus it is appropriate to fix the foot of the user 1 to the patient interaction means 30 by means of the shoe or boot 38. The shoe or boot 38 can either be positioned such that movement of the ankle is possible, in particular if the ankle is to be exercised, or the shoe or boot 38 can hold the ankle solid such that only the knee and hip can move. Again, by choosing the appropriate design of the shoe or boot 38, the physiotherapist can ensure that the leg and/or foot of the user 1 is moved in the desired pattern to ensure appropriate training.

The patient interaction means 30 shown in figures 6-8, is that of a helmet or head brace 37. Clearly, the helmet or head brace 37 is intended to restrict the motion to the head, neck and upper back/shouiders region of the user 1. As can be seen in figures 7 and 8, the robotic arm 11 can be controlied to move the helmet 37 such that the head of the user 1 is moved from a central location to a left or right orientation. The movement of the robotic arm 11 is precise enough to ensure that the head of the user 1 does not move further than is desired by the training regime, and thus no additional damage to the user 1 can occur. This is further ensured by means of the first sensor 15 which will ensure that the robotic arm 11 only moves the limb 2 of the user 1 until a certain amount of resistance is measured from the patient. Further, as has been discussed above, once the range of motion of the patient or user 1 has been determined by the physiotherapy apparatus 10, the robotic arm 11 is controlled such that it never extends beyond this maximum movement range. Finally, as was also discussed above, the user 1 may be in possession of a safety switch, which will ensure that the robotic arm 11 stops motion the moment the safety is actuated.

Obviously, the patient interaction means 30 shown in Figures 1 and 2 could be supplemented by means of an elbow brace. Such an elbow brace could restrict the elbow from moving from the straight position, or a bent position, so as to ensure that the movement of the limb 2 trains the appropriate section of the arm. Likewise, in figures 3-5 it may be appropriate to provide a knee brace, which would stop the motion of the knee, and thus ensure that either only the ankle or the hips were trained in the appropriate manner.

Looking at Figures 9-11, a patient interaction means 30 which is suitable for training the back, lumber and trunk region of the user 1 is shown. These patient interaction means 30 are provided with a pair of extensions 45 which the user 1 holds with their hands 3. It is also possible that the extensions 45 are provided with straps, or the like, to ensure that the user's hands 3 are located at the appropriate point on the extensions 45. Further, the patient interaction means 30 are advantageously provided with a stomach, or chest, against which the user 1 leans to ensure that the position of the user 1, with respect to the second end 14 of the robotic arm 11, does not change. In the example shown, the user 1 is not physically attached to the patient interaction means 30 for training the back region, and so forth, although it would also be possible to provide a harness or corset-type back support, in which the user 1 was appropriately attached by means of the patient interaction means 30 to the second end 14 of the robotic arm 11. Such a back support could be provided with means which would attach to the second end 14 of the robotic arm 11, through the first sensors 15 if provided, such that the motion of the user 1 and the second end 14 of the robotic arm 11 were linked.

The embodiments shown in Figures 1-11 are clearly one of many options for the patient interaction means 30. Quite clearly, depending upon the requirements of the motion of the limb 2 of the user 1, the patient interaction means 30 will be appropriately defined . As we have highlighted above, sometimes the patient interaction means 30 will need to ensure that the joints next to the robotic arm 11 are held solid, and this will lead to a more enclosed patient interaction means 30. In cases where the motion of the most local joint is to be free, the patient interaction means 30 can be provided with a much less complete design, for example as shown in figures 1 and 2 for the hand grip 39.

As can be seen in Figures 1 and 2, the user 1 can be located within the resting station 33, in this embodiment chair 34, by means of a harness 35. The use of the harness 35 interacting with the resting station 33, means that the physiotherapy apparatus 10 is fully aware of the location of the user 1 at all times. It is desirable for the user i to remain in the same location with regard to the robotic arm 11 during training, to ensure that the appropriate motion of the user 1 is allowed and leads to the correct training .

With regard to the em bodiment shown in Figures 9- 11 : for example, the floor underneath the user 1 could be provided with regions in which the user 1 is to stand. Further, the regions could be provided with pressure sensors, such that the

physiotherapy apparatus 10 knows that the user 1 is standing in the correct location . Further, the force sensors could be monitored during training to ensure that the weight of the user 1 was appropriately situated over both feet, so as to ensure that the user 1 is not off balance during such training . This aspect has not been shown in the figures. Actual Use of Physiotherapy Apparatus

Figure 21 shows a conceptual flow chart of the steps which can be performed when a user 1 is to use the physiotherapy apparatus 10. In a first step, the user 1 enters the physiotherapist's office or surgery in order to seek treatment. A second step will be the physiotherapist performing an appropriate examination and diagnosis of the user 1. At this point, the physiotherapist will ascertain whether training by means of the physiotherapy apparatus 10 would be appropriate, or otherwise. If the user 1 can benefit from the physiotherapy apparatus 10, the operation of the apparatus will be explained by the physiotherapist.

In step 3, the user 1 will receive an account held in the physiotherapy apparatus 10. As has been described before, a computer will most likely be provided within the physiotherapy apparatus 10 for controlling the robotic arm 11. The computer will be provided with a memory, which can be used to store a variety of user accounts as weli as all of the diagnostics and training data appropriate for each user 1. Optional!y, the user 1 will then be asked to fill-in a questionnaire in which a series of key questions are asked relating to the disorder and the user's general lifestyle. This questionnaire can also be repeated during the lifetime of the training performed by the user 1, and can be used as a further diagnostic tool to monitor the progress of the user 1. Within the questionnaire, a series of questions are posed relating to the disorder and the lifestyle of the user 1. Such questions can include, but are not limited to:

a. The duration of the pain or disorder prior to the treatment, and during.

b. The general activity level of the user 1, and in particular with regard to the part of the body being trained.

c. What medication, if any, is being taken by the user 1 in relation to the

disorder, and further the actual dosage.

d. The general level of activity of the user 1 in daily life, which is useful as an indication of the general health of the user 1.

e. A self evaluation of the pain and disorder, and how much this is affecting the user's daily activities.

Such a questionnaire will provide a general quality of life indication, or score, this score can be used to compare throughout the training programme the perceived, and actual, improvements the training is having on the user 1. This can be particularly useful in motivating the user 1 and improving the psychological approach to the training. This is especially useful if it becomes clear that improvements are occurring, which may have gone unnoticed by the user 1 without such a direct and regular feedback. Further, if the score is not improving appropriately, this provides another diagnostic too! to the physiotherapist for correcting or adjusting the training programme, to maximise its effectiveness.

At the fourth step, the patient will position himself with relation to the robotic arm 11 in the appropriate location. As is discussed above, this may be by standing on appropriate sensors on the floor, or in a pre-designated section of the floor, or it could be by sitting or lying on a resting station 33. Once the user 1 is in the correct location with respect to the robotic arm 11, the user 1 performs a range of motion tests with the robotic arm 11. As has been discussed above, the user 1 can perform the range of motion tests in a variety of ways, either by being led by the robotic arm 11 until resistance is measured by the first sensors 15 which stop the motion of the robotic arm 11, or by actively pulling the robotic arm 11 to the maximum stretch of the limb 2. Once the patient has gone through the full range of motion exercises, such that the physiotherapy apparatus 10 knows the maximum movement which can be performed on the user 1, this range of motion is stored in the physiotherapy apparatus 10 and will be used to ensured that the robotic arm 11 does not extend further than the user's maximum range of motion. Primarily, this is a safety feature which ensures that additional damage is not done to the user 1, by using the physiotherapy apparatus 10.

In step 5, the actual physiotherapy training can begin. This has been discussed above, and any of the passive, isometric, eccentric, concentric or reaction tests as described above can be performed on the user 1. By means of the first sensors 15 located within the robotic arm 11, the physiotherapy apparatus 10 can perform the appropriate training on the patient or user 1.

In a final step, the physiotherapy apparatus 10 is able to take the full data which has been collected throughout the training programme. This data can relate to the range of motion, the amount of force supplied by the user 1, the amount of torque provided by the user 1, the speed of reaction, the number of repetitions and so forth, such that an entire and accurate picture of the workout can be built-up and stored in the memory 17 of the physiotherapy apparatus 10, If the training session was not the first session performed by the user 1, this step can also compare the current training session with that of the previous training session or sessions, in order to buiid-up a clear picture of the user's progress through the training. it would also be possible to operate the comparison between the actual training session and previous sessions during the current training session, so that the user could see on the computer screen throughout the session how the present session compares with previous sessions. For example, the user 1 could be shown the range of motions and maximum force being applied in the present training regime, and this can be directly compared with the last two or three session, so that the user 1 can see whether he is training to the same level, better or worse than the previous few sessions. Such immediate feedback can be useful to the patient or user 1, as this will instantly show the user 1 his progress, and could psychologically improve the training, which will also improve the end results. For purposes of diagnostics being performed by the robotic arm 11, the physiotherapy apparatus 10 can monitor a variety of different parameters. These have been generally discussed above, but shall be collected here for means of a clear

description. As a first matter, to monitor the range of motion, the robotic arm 11 could be controlled such that this is essentially weightless and responds to the movement of the user's limb 2. It would further be possible to drive the robotic arm 11 to move the limb 2 from a starting point to a maximum physiological stop point, which is essentially the full range of motion that the limb 2 could perform. Further, the range of motion can be stopped prior to this maximum physiological movement if the patient registers too much pain and acts against the motion by too greater force, as measured by the first sensors 15, or triggers a safety button. Further, the strength of the patient can be measured in an isometric fashion, by causing the patient to move against the robotic arm 11 and triggering the robotic arm 11 to appropriately and accurately counter this force. A further important aspect is the possibility of incorporating a pain factor within the diagnostics testing. For example, if the strength test is actually limited by pain in the user, rather than the actual strength of the user's limb 2, this can be incorporated into the data which is saved, so that the user 1 can also monitor and check the reduction in pain during the training sessions. One particularly advantageous aspect of the physiotherapy apparatus 10 is that the monitoring and diagnostics is entirely objective, As there is no human interaction with the user 1 during either the training or explicit diagnostic measurements, the physiotherapist does not influence the outcome of the tests. Further, the

physiotherapy apparatus 10 is able to monitor exactly the changes from one session to the next, and makes identical measurements and tests in each successive session, this allowing for unbiased diagnostic data to be taken. Further, the data is constantly measured, meaning that a complete record of the training is instantly available. This complete data record is particularly useful, in that it allows for a clear and regular view of the training progression, which allows the physiotherapist to quickly spot problems with the programme and correct these to maximise the efficiency of the training.

Position Sensors

As has been discussed a variety of times above, it is desirable for the physiotherapy apparatus 10 to know exactly where the user 1 is located. As a first matter, this is clearly obtained by the resting station 33 as described above. By attaching the user 1 to the resting station 33, and maintaining a relative map of the resting station 33 and the robotic arm 11, the physiotherapy apparatus 10 is able to monitor the location of the user 1 and addressed the training accordingly. Whilst in many situations knowing the location of the user 1 as being on the resting station 33 will be sufficient, it is also possible to provide a range of secondary sensors 18 which can be tailored much more to provide a greater degree of accuracy of location of the user 1 and his limbs 2 for the physiotherapy apparatus 10.

As shown in Figure 1, the user 1 could be provided by an individual sensor 19 forming one of perhaps many secondary sensors 18, at an appropriate location. In this case, it is desirable for the physiotherapy apparatus 10 to know the location of the user's shoulder. By positioning a secondary sensor 18 at the user's shoulder, in this case by simply attaching a sensor 18 to the clothing of the user's shoulder, the physiotherapy apparatus 10 can appropriately monitor the location of the shoulder before and during the training. As will be clear to the skilled person, no two user's are the same shape, and thus whilst generally knowing the location of the user 1 by means of the resting station 33 could be enough, providing a secondary sensor 18 at an appropriate point on the user's body will allow the physiotherapy apparatus 10 to exactly know the location of the user 1, and in particular body parts thereof.

As is shown in Figure 1, the secondary sensor 18 could be located at an appropriate pivot point, or joint, which is to be trained by the physiotherapy apparatus 10. It could further be possible to provide several secondary sensors 18 along the entire limb 2, to ensure that the motion of the limb 2 is appropriate. For example, if the motion to be performed is that shown in Figures 1 and 2, it could be possible to provide the arm of the user 1 with three secondary sensors 18. A sensor at the wrist, a sensor at the elbow and a sensor at the shoulder, would ensure that the robotic arm 11 could be controlled to move the arm in a straight manner from the bottom to the top of the desired motion. The physiotherapy apparatus 10 could monitor the relative locations of the three secondary sensors 18, and ensure that they were moving along the appropriate line between the two extremes of the training motion. If the sensors varied from this desired line, the physiotherapy apparatus 10 would be able to compensate the motion of the robotic arm 11 in real time, and ensure that the limb 2 did not move too far out of shape with motion of the robotic arm 11.

Provision of one or more secondary sensors 18 could be combined with the braces for the elbow and knee 41, 42, as described above. That is, the sensors 18 could be incorporated within the elbow 41 or knee brace 42, so as to ensure that the limb 2 was being moved in the appropriate manner. In this way, sensors on the wrist, elbow and shoulder, for example, would ensure that the limb 2 of the user 1 moved in the appropriate manner, especially as the elbow brace 41 would stop motion of the elbow, thus meaning that fewer degrees of freedom would be possible for the arm.

Indeed, it would be possible to provide a variety of position sensors on each of the relevant parts of the body, for example the hip, knee, foot, shoulder, elbow, wrist and so forth. The physiotherapy apparatus 10 then has a full internal picture of both the robotic arm 11, incorporated with the patient interaction means 30, and the position of the multiple secondary sensors 18. With this knowledge, it is possible for the physiotherapy apparatus 10 to appropriately move the limb 2 of the user 1 in the desired training pattern. The use of these multiple secondary sensors 18 would also be useful for ascertaining the start and finish positions of the training to be performed. For example, if a secondary sensor was to be provided in the region of the wrist, the physiotherapy apparatus 10 can monitor the location of the wrist sensor, and know the start and stop positions of the training motion on the basis of this sensor.

It would also be possible to provide the user 1 with a flexible item 20 to be worn during the training. This flexible item 20 can be provided with a sensor array or matrix 21 therein. By positioning many sensors within this flexible item, the physiotherapy apparatus 10 could build-up a full three-dimensional picture of the user's limb 2 held within the flexible item 20. For example, if the flexible item 20 were worn around the elbow, the physiotherapy apparatus 10 would be able to monitor a complete picture of the forearm and upper arm either side of the elbow, and thus ensure that the motion of the limb 2 around the elbow proceeds in the desired fashion. For example, if it became clear that the forearm of the patient was being twisted and that the elbow was not moving in a straight line, and the motion of the arm was not proceeding appropriately around this fixed point, the physiotherapy apparatus 10 could adjust the motion of the robotic arm 11, to ensure that the training proceeded along the desired path.

As can be seen in Figures 1 and 2, it would also be possible to have a secondary sensor, or range thereof, positioned within the harness 35 of the resting station 33. Again, the secondary sensor 18 provided within the harness 35 would clearly show the exact location of the user 1 for use by the physiotherapy apparatus 10.

As has been discussed in this section, it is clearly advantageous for the physiotherapy apparatus 10 to have a clear picture of the location of the user 1 with respect to the robotic arm 11 and patient interaction means 30. Whilst in many cases the training will be appropriately controlled by means of the first sensors 15 providing immediate feedback, for the physiotherapy apparatus 10 to know the relative location of the joints of the limb 2 with respect to the robotic arm 11, the training can be further improved . Additionally, the use of the secondary sensors 18 allows the physiotherapy apparatus 10 to ensure that the start and finish locations of the training motion of the robotic arm 11 are appropriate for performing the correct physiotherapy training . Indeed, the more information the physiotherapy apparatus 10 knows about the relative location of the patient's limb 2 and the robotic arm 11, the more accurate the training can be.

A final possibility is to provide a series of tertiary sensors 22 which can be used to appropriately map the whole volume of the physiotherapy apparatus 10 and the user 1. A series of infra red or motion sensors could be setup which would appropriately monitor the movement of the user 1 and the robotic arm 11 , Further, the tertiary sensors 22 could be used to buiid a map within the physiotherapy apparatus 10, which would monitor the volume of space, along with the position and movement of the user 1. For example, providing a motion capture system, the physiotherapy apparatus 10 could recognise the location and movement of the user's limb 2, and map this into the known space around a robotic arm 11. Again, this would provide a clear picture to the physiotherapy apparatus 10 as to the location of the user 1 and the robotic arm 11. This additional information of the relative locations of the user 1 and the robotic arm 1 1, can be used to improve the training performed by the physiotherapy apparatus 10.

Safety System

In order to appropriately ensure that the physiotherapy apparatus 10 does not harm the user 1 during training, a safety switch may be provided. This has been disclosed above, in relation to the diagnostic testing . Not only can this safety switch be used to monitor the range of motion of the user 1, but it can be held constantly by the user 1 during training. If the user 1 experiences any discomfort or concern during the training, the safety switch can be activated to immediately stop the motion of the robotic arm 11. If the safety switch is made a dead switch, this can be activated when the user stops pushing on a knob, or gripping a handle. The advantage of a dead switch is that if the user 1 is in some way incapacitated, the safety switch is activated to stop the movement of the robotic arm 11 , A further safety aspect which can be incorporated within the physiotherapy apparatus 10, is the possibi!ity of attaching the user 1, preferably via patient interaction means 30, to the robotic arm 11 with a safety connection or joint. This connection can be provided such that it will break if a relative force or torque between the user 1 and the robotic arm 11 exceeds a pre-set or pre-determined value. In certain training programmes, in particular with regard to the head and neck, it is vital that the robotic arm 11 does not move the patient with too much force. Such a safety connection could be utilised to obviate any concern that the robotic arm 11 would move the limb of the patient too forcefully.

It is conceivable to provide a safety connection by means of a deliberately weak mechanical connection. For example, if the patient interaction means 30 and the robotic arm 11 were connected together by means of a snap fit connection, the force required to disengage the snap fit could be tailored according to the requirements. A further option, is to connect together the robotic arm 11 and the patient interaction means 30 by means of a magnetic connection. By changing the strength of the magnetic interaction, the disengagement force can also be changed. It would further be possible to employ an electro-magnet as the connection means, wherein changing the strength of the electro-magnet, in the manner well known in the art, would also lead to a change in the connection strength. Finally, the use of an electromagnetic coupling is useful, in that it allows for the ready tailoring of the strength of the connection, without having to change elements of the connection means.

Dual Arm Robot

The above description has focussed on a physiotherapy apparatus 10 which is possessed of a single robotic arm 11. It is well known that robotic arm assemblies can be provided with more than one robotic arm 11. Indeed, the otoman company referred to above, also makes an assembly which has two robotic arms 11. It is conceivable that an assembly comprising two robotic arms 11 would readily be adaptable in the manner described above, to give a physiotherapy apparatus 10 with two, or even more, robotic arms 11. The use of such an apparatus in which two robotic arms 11 are provided is

particularly useful in more severe physiotherapy situations. If, for example, a user 1 had suffered multiple traumas, or was severely paralysed, such a dual robotic arm 11 physiotherapy apparatus 10 would be useful in treating such injuries. The ability to perform two physiotherapeutic movements or operations at the same time could be both advantageous to the user 1, as well as speeding up the recovery time. Further, one of the robotic arms 11 could be used to move part of the limb 2 in one manner, with the second robotic arm 11 operating another part of the limb 2. For example, in training the leg of a user 1, the first robotic arm 11 could be attached to the thigh of the patient and move the upper part of the leg in one movement, whilst the second robotic arm 11 could be attached to the ankle and move the lower part of the leg in relation to the upper part. Obviously, a physiotherapy apparatus 10 with two robotic arms 11 couid also be adapted to operate only one of the robotic arms 11, as described above.

General

The above discussion has provided a series of options for the construction of the physiotherapy apparatus 10 and its method of use. As is clear, this physiotherapy apparatus 10 couid be provided with a computer for appropriately operating a robotic arm 11 and making use of the measurements taken from the first 15, second 18 and third 22 sensors or arrays thereof. Obviously, the present disclosure also relates to a computer program which can be used to monitor all of this data, and appropriately control the robotic arm 11. The computer program will be adapted to provide all motions of the robotic arm 11, including the range of motion measurements as well as the concentric and eccentric training regimes. Further, the program can be used to control the isometric training and diagnostics of the user 1.

Additionally, the present disclosure relates to a method of performing physiotherapy on a user 1. By appropriately monitoring the user 1 and problems thereof, the physiotherapist can utilise the correct programmes and training regimes encoded within the physiotherapy apparatus 10, in order to perform training and physiotherapy on the user L This method entails the use of the robotic arm 11 as described above in order to perform appropriate physiotherapy on a user 1.

It is additionally possible to use the physiotherapy apparatus 10 as a strength or body building apparatus. Indeed, the skilled person will realise that the use of isometric, concentric and eccentric training can also be used outside of the physiotherapy field for muscle toning, and the like.

As should be clear from the above, the use of a robotic arm 11 within a physiotherapy apparatus 10 has a number of particular advantages. Firstly, as has been discussed in detail, the physiotherapy apparatus 10 is completely objective in both its diagnostics and training. The monitoring of the actual training performed the user 1 is done without emotion, and can instantly be compared with previous performance stored in the apparatus 10. Secondly, the operation of the robotic arm 11 is extremely accurate, indeed the movements of the robotic arm 11 can be controlled on the millimetre level, and below. This level of control is unattainable in normal

physiotherapy apparatuses, and cannot be achieved by a trained physiotherapist. Clearly, in training of delicate regions of the body, for example the neck, such control is extremely useful and advantageous to the training programme. Further, the use of such control can expedite the training, and lead to improved and quicker results.

A third advantage of the robotic arm 11 physiotherapy apparatus 10 relates to the above advantages, and the improvement they both bring to the training. In particular, the accuracy and constant feedback leads to great improvements in the speed of recovery, and eventual outcome of such. With precise control and immediate diagnostics, the physiotherapist can objectively monitor the training of the user 1, and ensure that this proceeds appropriately and perfectly in each session. This not only reduces any chances of mis-training, but also improves the speed of recovery for the user 1.

Whilst the above description has been presented as a series of different aspects relating to the robotic arm 11 and use thereof, no specific combination of features should be considered as especially described or required, indeed, the system is intended to be provided by the contro!!abie robotic arm 11 which can have an appropriate interaction with a user 1. The skilled person wi!l appreciate that a variety of the above features will be combined depending upon the required training to be performed on the user 1, which can relate to the provision of multiple first, second and third sensors, or the like.

Claims

1. A physiotherapy apparatus (10) comprising a robotic arm (11), wherein the robotic arm (11) is attachable to a base (12) for fixing the robotic arm (11) at a first end (13) and at the second end (14) the robotic arm (11) is provided with one or more removable and interchangeable patient interaction means (30) which are designed to be attached to, held by, or interact with, a user (1) of the physiotherapy apparatus (10); wherein the robotic arm (11) is capable of moving, or is adapted to move, the patient interaction means (30) in a known orientation and manner in a full three dimensional range of motion with respect to its first end (13), and is further capable of rotating and tilting the patient interaction means (30) around the second end (14); wherein further the robotic arm (11) is programmable and/or adapted to be able to move a limb (2) or other body part of the user (1) via the patient interaction means (30), in a user definable manner.

2. The physiotherapy apparatus (10) according to claim 1, wherein one or more first sensors (15) are provided which are located so as to be able to measure the relative force and/or torque generated between the user (1) and the robotic arm (11).

3. The physiotherapy apparatus (10) according to any one of the preceding claims, in particular claim 2, wherein the one or more first sensors (15) are provided in one of more of the following locations: a) between the second end (14) or the robotic arm (11) and the patient interaction means (30), wherein the one or more first sensors (15) are force, pressure and torque sensors which are able to measure the force, pressure and torque provided by the user (1) against the motion of the robotic arm (11) and in particular the patient interaction means (30); and/or b) attached to the actuators (16) of the robotic arm ( 11), wherein the one or more first sensors (15) are sensors which are able to compare the drive signals provided to the actuators (16) to generate a desired motion and position of the robotic arm (11) with the actual location and movement of the robotic arm (11) so as to determine the force, pressure and torque provided by the user (1) against the motion of the robotic arm (11) and in particular the patient interaction means (30),

4. The physiotherapy apparatus (10) according to any one of the preceding

claims, in particular claims 2 and 3, wherein the measurements taken by the one or more first sensors (15) are used to adjust the user defined motion of the robotic arm (11), preferably in order to perform appropriate

physiotherapeutic training.

5. The physiotherapy apparatus (10) according to any one of the preceding

claims, in particular claims 2 to 4, wherein the robotic arm (11) is

programmable to perform appropriate movements which lead to the limb (2) or other body part of the user (1) being trained in one or more of: isometric, concentric and eccentric training regimes.

6. The physiotherapy apparatus (10) according to any one of the preceding

claims, in particular claims 2 to 5, wherein when the robotic arm (11) is controlled to perform isometric training, the first sensors (15) are adapted to measure the force and/or torque generated by the user (1) and this measurement is used to control the robotic arm (11) to exactly match and oppose the force and/or torque being generated by the user (1), so that the force and/or torque being generated by the user (1) is generated without the user (1) moving its limb (2) or other body part; and/or when the robotic arm (11) is controlled to perform concentric training, the first sensors (15) are adapted to measure the force and/or torque generated by the user (1) and this measurement is used to control the robotic arm (11) to oppose the force and/or torque generated by the user (1) by a certain user-definable amount, typically below the level being generated, so that the force and/or torque being generated by the user (1) leads to a movement of the user's limb (2) or other body part in the direction of generated force or torque; and/or when the robotic arm (ii) is controlled to perform eccentric training, the first sensors (15) are adapted to measure the force and/or torque generated by the user ( 1) and this measurement is used to control the robotic arm (11) to oppose the force and/or torque generated by the user (1) by a certain user- definable amount, typically above the level being generated, so that the robotic arm (11) moves in the opposite direction to the force and/or torque being generated by the user (1) thus moving the user's limb (2) or other body part in the opposite direction to the generated force or torque.

7. The physiotherapy apparatus (10) according to any one of the preceding

claims, in particuiar claims 2 to 6, wherein the measurements from the one or more first sensors (15) are used by the apparatus (10) to ensure that the robotic arm (11) moves along a set pre-defined path (31) during training thus also moving the user's limb (2) or other body part along this pre-defined path (31), by monitoring when the user (1) applies force and/or torque away from this pre-defined path (31) and counteracting this motion in the robotic arm (11); and/or the physiotherapy apparatus (10) is provided with a memory (17) which stores the measurements of force and/or torque from the one or more first sensors (15).

8. The physiotherapy apparatus (10) according to any one of the preceding

claims, in particular claims 2 to 7, wherein the robot arm (11) is adapted to be controlled such that it will move the patient interaction means (30) and the !imb (2) of the user (1) in a range of motions until the user (1) acts against the motion of the robotic arm (11) with a pre-determined force and/or torque, so as to determine the range of motion, ROM, of the user (1), wherein the ROM is stored and utilized by the physiotherapy apparatus (10) to ensure that the maximum ROM of the user (1) is not breached, wherein preferably the pre-determined force and/or torque is measured by the one or more primary sensors (15).

9. The physiotherapy apparatus (10) according to any one of the preceding claims, in particular claims 2 to 8, wherein the robotic arm (11) is adapted to be controlled to monitor the force and/or torque applied by a user (1) to the patient interaction means (30) over a pre-defined range of motion of the robotic arm (11), and to store in a memory (17) this force and/or torque data versus position as a diagnostic data run (32), so that subsequent diagnostic data runs (32) can be compared with each other.

10. The physiotherapy apparatus (10) according to any one of the preceding

claims, wherein one or more secondary sensors (18) are provided which are arranged so as to measure the relative location of the user (1), or part thereof, with respect to the robotic arm (11), wherein the physiotherapy apparatus (10) is adapted to monitor the information from the one or more secondary sensors (18) and adapt the motion of the robotic arm ( 11) accordingly.

11. The physiotherapy apparatus (10) according to any one of the preceding

claims, in particular claim 10, wherein the one or more secondary sensors (18) are individual sensors (19) which are adapted to be worn by the user ( 1) to indicate where certain parts of the user's body are in relation to the robotic arm (11), and in particular in relation to the patient interaction means (30), so that the robotic arm (11) can be controlled on the basis of these relative locations to perform appropriate motion of the patient interaction means (30) and user's limb (2) or other body part.

12. The physiotherapy apparatus (10) according to any one of the preceding

claims, in particular claims 10 and 11, wherein one or more of the secondary sensors (18) are formed into a sensor array or matrix (21) within a flexible item (20) which is to be worn by the user (1), wherein both the relative position of the sensor array or matrix (21) with respect to the robotic arm (11), and in particular the patient interaction means (30), and the relative positions between each sensor within the sensor array or matrix (21), is used for controlling the robotic arm (11) to ensure that the user's limb (2) or other body part is moved in the correct pattern or manner; wherein the sensor array or matrix (21) can also be combined with the individual sensors according to claim 11.

13. The physiotherapy apparatus (10) according to any one of the preceding

claims, wherein one or more tertiary sensors (22) are provided, wherein the one or more tertiary sensors (22) are adapted to monitor motion of the robotic arm (11) and the user (1) within a volume defined by the range of motion of the robotic arm (11), so as to monitor the relative locations of the user (1) and the robotic arm (11) in order to control the operation of the robotic arm (11).

14. The physiotherapy apparatus (10) according to any one of the preceding

claims, wherein a resting station (33) for holding the user (1) is provided at a known location with respect to the robotic arm (11), wherein the holding station is preferably one of a chair (34) with a harness (35) or a bed (36); and preferably the patient interaction means (30) are one or more of: a helmet (37), a shoe or boot (38), a handgrip (39), a glove, an elbow brace, a knee brace, a back support, a stomach support or harness (44) which may be provided with extensions (45) for the user (1) to grip with their hands (3).

15. The physiotherapy apparatus (10) according to any one of the preceding

claims, wherein a safety switch is provided for the user ( 1) which, upon actuation by the user ( 1) stops all motion of the robotic arm (11).

16. The physiotherapy apparatus (10) according to any one of the preceding

claims, wherein the connection between the robotic arm (11) and the patient interaction means (30) has a maximum torque or force which it can withstand, such that if the relative torque or force provided by the user (1) which acts on the patient interaction means (30) exceeds this maximum value, the patient interaction means (30) will be disconnected from the robotic arm (11).

17. The physiotherapy apparatus (10) according to any one of the preceding claims, wherein more than one, preferably two, robotic arms (11) are provided for interacting with the user (1).

18. A computer program comprising instructions for controlling a physiotherapy apparatus (10) according to any of the previous claims.

19. A method of performing physiotherapy on a patient, wherein the patient interacts with the physiotherapy apparatus (10) according to any of claim 1 to 17 to perform physiotherapeutic training.