WO2013182483A1

WO2013182483A1 - Apparatus and method for gait training

Info

Publication number: WO2013182483A1
Application number: PCT/EP2013/061246
Authority: WO
Inventors: Wolfgang Brunner
Original assignee: Zebris Medical Gmbh
Priority date: 2012-06-04
Filing date: 2013-05-31
Publication date: 2013-12-12
Also published as: CN104540560A; DE102012209359A1; DE202012013610U1; US20150140534A1; CN104540560B

Abstract

The invention relates to an apparatus (1) for gait training, with a predefined walking surface (2b), with placement position sensors (3) assigned to the walking surface and used to detect actual placement positions at which a test subject places his feet on the walking surface, with a training program memory (47) for storing a gait training program that contains data for predefining a sequence of desired placement positions for the feet of the test subject on the walking surface, with an image display device (7) for displaying images showing the desired placement positions, and with a display synchronization device (46, 48) which is connected at the input side to the training program memory and to the placement position sensors and at the output side to the image display device and which is used to synchronize the image display device to output data from the placement position sensors, in such a way that the indication of the desired placement positions is adapted continuously to detected actual placement positions.

Description

Arrangement and method for training the gait

description

The invention relates to an arrangement and a method for training the aisle.

Known devices for detecting pressure or force distributions, as described, for example, in DE 36 42 088 C2 and DE 25 29 475 C3, can be used as platforms for biomechanical gait analysis in which the gait of a vertebrate, in particular of a human, is examined and analyzed. Hereby, only one single step or a single rolling process can be recorded. In order to register and analyze a natural gait behavior, however, it is necessary to record the gait over a longer period of time.

Also devices and methods for gait analysis, which allow this registration and analysis and use a treadmill, are known. For example, reference may be made to DE 40 27 317 C1 or US Pat. No. 6,010,465 A. In R. Kram and AJ. Powell: "A treadmill-mounted force platforrrT Appl. Physiol. 67 (4): 1692-1698 (1989) a measuring device is described as known in which a treadmill over a measuring platform or measuring surface W

2

is pulled and thus a continuous detection of forces exerted by the feet of a subject on the ground forces is possible.

The use of display devices, such as display screens, in treadmill arrangements is also known.

EP 1 145 682 A2 discloses a rehabilitation apparatus and method based on the treadmill technique, in which an adaptation of the function of the treadmill to the current state of the walking or running ability of a patient to be restored is provided. In particular, the treadmill speed is adapted to a personal step cycle of the user, and the device is to give this at the same time a feedback. In a special embodiment, the detection of compressive forces exerted on the occurrence and their evaluation is provided within the framework of the overall program. The document also describes the use of a

Display screen in conjunction with an input keyboard for displaying the footprints generated on the treadmill and for setting

Treadmill parameters based on this display.

US Pat. No. 6,231,527 B1 likewise discloses the use of a display screen in a treadmill device for sports medicine or rehabilitation use, in which case the images of various cameras can be shown which record the athlete / patient in his movements on the treadmill.

Applicants' EP 2 352 426 and WO 2010/057552 also describe treadmill systems for sports medicine or rehabilitation use with an image reproduction technique in which pressure distribution patterns which are generated by a person walking on the treadmill are also recorded and evaluated synchronously with displayed images can.

The invention is based on the object of providing a further improved device of the latter type, which is particularly suitable for sports medicine or rehabilitation purposes. One goal is that System to develop a flexible training / therapy device and thereby further increase the user acceptance and physiotherapeutic effect.

This object is achieved in its device aspects by an arrangement having the features of claim 1 and in its method aspects by a method having the features of claim 12. expedient

Training of the inventive concept are each the subject of

dependent claims.

The invention includes the idea of not rigidly prescribing to a subject or patient to be trained a sequence of steps as a training program, but to the training level and the current

Efforts of the subject to take consideration. It further includes the thought, the steps of the subject or, more precisely, the places where he actually puts his feet on a walking surface

(hereinafter referred to as "actual place of preparation") and to be taken into account in the performance of the training program. This leads to the further idea of synchronizing a pictorial representation of prescribed steps or, more specifically, prescribed placement locations of the subject's feet (hereafter referred to as target placement locations) to the detected actual steps (actual placement locations).

An arrangement is thus proposed under device aspects which, in addition to a predetermined walking area (which may be present independently of the measuring arrangement), includes a positioning location sensor system for detecting actual placement locations at which a test subject places his feet on the walking area, a training program memory for storing a gait training program including data for specifying a sequence of target feet for the subject's feet on the walking surface, an image display for displaying images indicating the target touch locations, and an input with the training program memory and the setter Having sensor. The proposed solution has significant advantages: A disadvantage of the known arrangements is that the patient (usually very seriously handicapped) first has to "synchronize" himself during the measurement, that is to say he has to first set foot with the projection at all Since he starts from any position, it is very difficult, as he has to match one foot to the projection, he has to keep checking on every error (ie the target was not hit correctly)

correct the following step. However, this correction step does not correspond to the step he should actually learn, but is shorter or longer or, if necessary, with greater or smaller increment or foot rotation. This is even more difficult when the projection is not on the belt but on a screen.

As a result, placement errors no longer play a role because the system always automatically outputs the step input to be learned. Here, a significant size is the stride length; beside it can be with the

proposed approach but also the temporal component of

Adjust the gait training program to the actual circumstances of the particular patient.

As a measuring technique for determining the instantaneous position is suitable

preferably the known arrangement of a pressure distribution matrix or pressure switch matrix. However, measuring systems based on refection or transmitted light barrier arrays, 2D or 3D, can also be used

Cameras u. a. be used. Preferably, the arrangement is operated on the treadmill. If the projection is carried out directly on the measuring surface, the technique can also be used on a fixed, possibly also provided with interchangeable coverings and / or certain obstacles, walking distance.

In a further embodiment of the invention, a sequence of actual Aufsetzorten is sequentially detected time-resolved, and the synchronization of the

Image display is made to indicate the adjusted target location to match the sequence of the actual location. Among device aspects thus includes the

Aufsetzortsensorik a memory unit for Zeitaufgeiösten storage of a Sequence of sequentially detected actual locations or a parameter characterizing this sequence, and the display-display synchronization device is configured to load the sequence and to adapt the specified target Aufsetzorte thereto. Alternative to this

However, execution may also include the storage of one or more gait parameters of the test person determined on the basis of the previously recorded placement locations, and an operation of the display synchronization device with evaluation of this parameter or of these parameters.

In another embodiment, the arrangement comprises a feedback unit for detecting contact of the walking area by the subject at locations where predetermined picture elements, in particular target touch points, are displayed or at locations where no predetermined picture element is displayed, and for output a warning or warning signal in

Response to this. Additionally or independently thereof, a user guidance unit can be provided for optically and / or acoustically outputting instruction-accompanying instructions, in particular via earphones and / or as text overlays by the image display device. In addition to the invention realized adaptation of the

Training program to the actual step sequence of the subject can hereby be given additional training support.

In the context of the invention, various algorithms for the consideration of the actually recorded Aufsetzorte the feet of the subject or derived therefrom gear parameters for adapting the training program to the actual circumstances in the subject can be implemented. A preferred embodiment from the present perspective provides for a smooth approximation of a predetermined target step length to a detected actual step length.

In addition, or alternatively, however, as an alternative to this is also a step-like adjustment with respect to the stride length or a sliding or

stepwise adaptation to one or more others

Gear parameters realizable, especially about the step frequency or track width. The realization of training or rehabilitation programs can be as follows: The patient initially runs in his usual running style, With the help of integrated in the treadmill pressure sensor matrix, the

characteristic gait parameters, in particular the stride length ,. Track width, foot rotation angle or applied force values recorded. These parameters can then be used as initial training values. Based on this setting, the patterns projected onto the treadmill are automatically changed to the therapist's desired target within a workout. The change of the values can be carried out linearly, exponentially or with any other mathematical function. Thereafter, an automatic analysis may be performed with a target-actual comparison, i. it is checked how well the patient was able to comply with the guidelines. If the patient is to change the applied force in partial areas of the foot or of the entire foot, then he is instructed by an acoustic signal or a voice output. This is done e.g. the instruction to load a foot more or less strongly.

In a particular embodiment, predetermined pitches or track widths may be continually varied during a training pass (e.g.

be enlarged) to bring the patient slowly to the training goals

introduce. This is an embodiment in which a display process control unit a program memory for storing a plurality of predetermined display processes and / or speed and / or

Relative position setting means for speed adjustment of a display sequence or for specifying relative positions between pixels of a display.

Advantages and expediencies of the invention will become apparent from the following description of preferred embodiments with reference to FIGS. From these show:

Fig. 1 is a schematic representation of a first embodiment of

Invention, Fig. 2 is a schematic representation of a second embodiment of the

Invention,

3 is a detail view of a further embodiment,

Fig. 4 is a detail view of a further embodiment and

Fig. 5 is a pictorial representation, as they can be given as part of a training program on the tread of the arrangement.

Fig. 1 shows a treadmill training system 1, which comprises a running over two rollers 2a treadmill 2b, below the upper, by the user as

Tread 2c used a spatially high-resolution surface

Pressure sensing plate 3 is provided with a plurality of (not individually designated) arrayed pressure sensors for detecting pressure sensing images generated by the user when appearing on the treadmill. The one of the two rollers 2a is driven and pulls the tape 2b at a predetermined speed, the over

Processing and control unit 4 of the arrangement and a

Speed controller 5 is set. Furthermore, (which is shown only symbolically in the figure) via a suitable tilt actuator 6, which can also receive interference signals from the processing and control unit 4, set an inclination of the entire treadmill needs or either just his front part erect something will be.

In the greatly simplified embodiment shown in FIG. 1, signals which are set by the speed controller 5 return to the processing and control unit 4 and serve to synchronize a pictorial representation on the running surface 2c by means of a projector (laser beamer) 7 out

pre-stored picture elements and / or BiSdfolgen is generated (see below). The pictorial representation is controlled on the basis of the speed signals such that - in particular in conjunction with one below

described special embodiment - the user an overall harmonious simulation of a running environment, advantageously combined with the insertion of markings to be taken with the feet and / or with the simulation of obstacles to be overcome or avoided, is presented.

Notwithstanding the representation in the figure, the actual speed of the treadmill can also be detected by a suitable sensor system (not shown) and the measured value of the processing and control unit 4 for the purpose of (to a certain extent fed back) control

Bilddarsteliung and synchronized evaluation of the pressure distribution pattern to be supplied.

In the figure it is shown that the projector 7 is attached to a wall bracket 7a angle adjustable, so that the projection direction with the plane of the treadmill includes a variable angle. To distort the images provided by the processing and control unit 4

To avoid picture elements by the acute projection angle, the projector 7 is preceded by an image signal equalizer 7b. This one can be in

Depending on the actual angular pitch of the projector 7 in the holder 7 a work, but that is in the figure for the sake of

Clarity not shown. Incidentally, an audio stage 8 (symbolized here as a loudspeaker) is provided for completing the user interface, via which the exerciser receives additional acoustic sound

Training instructions can be obtained. For example, the audio stage 8 can also be bidirectional as a headset, so that the trainee also receives acoustic feedback (such as a confirmation received

Instructions or answers to questions asked).

To perform training tasks on the treadmill system, it may be of interest to detect the height of the feet lifting off the tape, for example, when the subject is supposed to exceed a virtual obstacle. Therefore, in a further embodiment, the test person has in each case attached a sensor 9 to the feet, the signals of which are known per se (not here) shown) position detection sensors can be detected to

To give conclusions about the position or the height of the feet. The sensors preferably operate synchronously with the sensors of the

Pressure distribution matrix. An exact time synchronization can possibly via a

Infrared or radio signal or a detection of the time of occurrence are produced.

The sensors 9 can be designed as acceleration sensors or multiaxial acceleration sensors and are optionally connected via radio to the evaluation computer 4. From the acceleration signals, the position of the feet can be calculated, especially if in addition the time and location dependence of the pressure distribution pattern can be included in the calculation. In extended arrangements, inertial sensor systems can be used which additionally use gyroscopes or sensors for detecting the earth's magnetic field. Of course, such sensors can also be attached to other parts of the body, so that the movement of the complete lower extremities or of the whole body can be measured and displayed. However, the sensors 9 can also work according to other measuring principles, for example on the basis of active or passive light markers recorded by stationary cameras, magnetic field sensors or sensors for the ultrasonic waves

deliver or receive from stationary receivers and determine the position of the feet from the duration of the sound.

The pressure sensors of the pressure sensing plate can either have an analogue or - in a simplified and cheaper version - a digital response characteristic (off / on characteristic). Both variants have their authorization for certain applications, and the selection of one of the variants becomes the system designer on the primary

Application requirements.

FIG. 2 shows a modification of the embodiment shown in FIG. 1 and described above arrangement. In that regard, here the same components as in those arrangement are used, these are denoted by the same reference numerals as in Fig. 1 and will not be explained again here.

The essential modification is the use of a large area

electro-optical touch screen 7 'instead of a projector as

Display device. The surface of the touch screen forms a lying below the upper portion of the endless belt 2b in the use position

Display area 2c ', and at the same time forms the touch screen a novel

Pressure sensing plate 3 '. In a modification of the touch screen principle and in view of the cost price of the arrangement, this combined

Display / pressure sensing device may be replaced by a matrix-like, alternating arrangement of a plurality of smaller electro-optical display elements (such as LCD displays) and each adjacent smaller pressure sensing plates, or it may be a more flexible and pressure-insensitive

Display screen (for example of the OLED type) via a normal

Be placed pressure sensing plate.

In all cases, the endless belt 2b is to be formed, at least in the middle region of its lateral extension, of a transparent material in order to allow the trainee to perceive the images displayed on the display surface 2c '.

Fig. 3 shows essential components of the processing and control unit 4 of FIG. 1 or 2 shown arrangement in a detailed view.

Excluded here is the image signal equalizer shown separately in Fig. 1, which is also used only in an embodiment of the arrangement with obliquely directed to the treadmill projector.

In a display control part 4A, the processing and control unit 4 comprises a picture element storage unit 41 and a video memory 42, which are followed by a picture element mixer 43 and finally a video picture element mixer 44 for generating picture sequences with predetermined picture element overlays. Symbolically, it is also shown that both mixers 43, 44 can furthermore be influenced by control signals of a random generator 45 are. The second mixer 44 is also followed by a display flow control 46, which a training program 47 and a program

Synchronization 48 are assigned. A pixel position controller 49 is control coupled to the pixel mixer 43 and operates thereon to vary relative positions of pixels in the final representation.

The synchronization unit 48 can be influenced by signals from the speed controller 5 (not shown in this figure) of the treadmill. Above all, however, the input side of the coordinates of actual Aufsetzorten the feet of the user are supplied, which (as mentioned above) are derived from the generated on the pressure sensing plate 3 shown in FIG. 1 by the feet of the user Druckfassungsbilder. In addition, in addition (which is not shown in the figure), the signals of the sensors 9 of FIG. 1 of the synchronization unit 48 are supplied as further input signals to ultimately the pictorial representation, especially with the specification of target Aufsetzorten for the feet of the user, both with the actual speed of the treadmill and the actual Aufsetzorten the feet of the user and, if necessary Further synchronization parameters of the user's feet are synchronized. Regarding the customization of the user

presented pictorial representations to its current movement sequence, the display sequencer 46 and synchronization unit 48 can be summarized as a display synchronization device of the arrangement.

At the same time these signals are fed to a system control unit 50 of the arrangement, which the various control operations of the display and

Summarize and time-align summary functions and perform necessary adjustments to the data streams and formats. This is symbolized in the figure by double arrows directed at the display control section 4A and the evaluation section 4B.

The evaluation section 4B also receives the final image signal provided at the output of the display sequence control and, on the other hand, the (spatially-temporally resolved) output signal of the pressure distribution plate 3.

The latter is freed from interfering signals and artifacts in a pressure signal preprocessing stage 51, brought into spatial synchronism with the image signals in a pressure signal time adjustment stage 52 in temporal synchrony and in a pressure variable adaption stage 53, and in a training evaluation stage (main processing stage). 53 is processed on the basis of a predetermined training evaluation program, and the results are output on a separate display unit 10 of the therapist. You can also - together with via an input unit 11 of the therapist entered instructions - in a user guidance level 54 to

Instructions are processed to the trainees, which are output via the associated display unit 7 or T and optionally the audio stage 8.

Fig. Fig. 4 shows in a detailed view parts of a further arrangement according to the invention, which are essential for the execution of the present invention. This is a stationary, delimited walking surface 2 ', which - directly above the surface - is associated with a laser light barrier device 12 as the core of a positioning sensor, which work with a laterally spread laser beam or according to the principle of multiple reflection can and is designed as a relatively large-scale light barrier. If a user (test person) places one of his feet on the walking area in the area of this light barrier, this is detected by means of the light barrier. With provision of several individual (commercially relatively inexpensive available) light barrier devices or when using a spatially resolving

Device can thus register each of the Aufsetzort (actual Aufsetzort) the feet of the subject. The coordinates of the registered over a certain period of actual Aufsetzorte be stored time-resolved in one of the laser light barrier device 12 downstream Aufsetzort storage unit 13. This memory can work according to the FIFO principle and thus update itself continuously.

A training program memory 14 is for storing

Training programs for training the gear provided, which in particular by a predetermined step frequency and length and possibly. Other parameters, such as the track width of the aisle, distinguished. Both the on-set memory 13 (as part of the Aufsetzort-sensor) and the training program memory 14 are connected to inputs of a display synchronization device 15 for synchronizing a visual guidance presented to the subject on his actual movements.

The display synchronization device 15 comprises a calculation stage 15a for calculating relevant gait parameters from a time series of actual setup locations loaded from the place of execution memory 13, and a

Adjustment stage 15b for adapting one of the

Trainingsprogram mspeicher loaded predetermined sequence of steps to the actual parameters of the gait of the subject. It outputs a sequence, synchronized to the actual movements of the subject, of the target placement locations for its further walking on walking area 2 ', to a display control unit 16 of a large screen 17 which the subject looks at during his gait training.

Fig. 5 shows, as an example of a pictorial representation to be provided to the trainee (simplified), a series of footprints f combined with background features A (puddle or "soft" spot) and B (stone or hard elevation) Obstacles can be aroused not only by a visual, but in combination with a tactile perception that can be placed on the walking surface or "simulated" by suitable actuators integrated into the walking surface.

The embodiment of the invention is not limited to these examples, but also in a variety of Abwandl ments possible in the frame

professional action.

Claims

Expectations

1. Arrangement for training gait, with

a predetermined walking area,

a landing location sensor system assigned to the walking surface for detecting actual landing locations at which a test subject places his feet on the walking surface, a training program memory for storing a

Gait training program that includes data for specifying a sequence of target landing locations for the subject's feet on the walking surface, an image display device for displaying images that indicate the target landing locations, and

one connected on the input side to the training program memory and to the placement location sensor system and on the output side to the image display device

Display synchronization device for synchronizing the

Image display device based on output data from the placement location sensor system in such a way that the information about the soil placement locations is continuously adapted to recorded actual placement locations.

2. Arrangement according to claim 1, wherein the placement location sensor system is a

Storage unit for the time-resolved storage of a sequence of sequentially recorded actual touchdown locations or a parameter characterizing this sequence and the display synchronization device is designed to load the sequence and to adapt the specified target touchdown locations thereto.

3. Arrangement according to claim 1 or 2, wherein the image display device has a screen or projection screen positioned above the walking surface.

4. Arrangement according to one of the preceding claims, wherein the

Image display device has a projector and the walking surface as

Projection surface is formed.

5. Arrangement according to one of the preceding claims, with a feedback unit for detecting touches on the walking surface by the test subject at locations where predetermined image elements, in particular stand-on points, are displayed or at locations where no predetermined image element is displayed, and to issue a warning or advisory signal in response thereto.

6. Arrangement according to one of the preceding claims, with a

User guidance unit for the optical and/or acoustic output of instructions accompanying the display, in particular via earphones and/or as text displays by the image display device,

7. Arrangement according to one of the preceding claims, with

an endless belt driven by a drive and guided over at least two rollers and serving as a treadmill, one surface of which serves as a walking surface.

8. Arrangement according to one of the preceding claims,

wherein the touchdown location sensor includes:

a force measuring plate located below the walking surface, which is on the

The side facing the end treadmill has a plurality of pressure/force sensors, one connected to the pressure/force sensors on the input side

Evaluation unit, which detects pressure distributions caused by the

Subjects are generated on the walking surface, and

a processing unit connected on the input side to the evaluation unit, which determines the actual touchdown locations from the pressure distributions.

9 ^, Arrangement according to one of claims 1 - 7, wherein the placement location sensor system has optical detection means for detecting the position of the subject's feet The time of placement on the walking surface includes, in particular, a camera or a light barrier device.

10. Arrangement according to one of the preceding claims, wherein the data for determining the sequence of target touchdown locations comprises a target step length and / or the parameter for characterizing the sequence of actual touchdown locations is an actual step length.

11. Arrangement according to claim 10, wherein in the display synchronization device an algorithm for the sliding adjustment of a pre-programmed target step length to a recorded actual step length

is implemented.

12. Method for training the gait of a subject on a

predetermined walking area, whereby

Actual landing locations at which the test subject places his feet are recorded using a landing location sensor system assigned to the walking surface,

According to a predetermined training program, a sequence of original target landing locations of the subject's feet on the walking surface is determined and, by means of an image display device, images are displayed to the subject, which indicate the target landing locations of his feet, the image display continuously being used to indicate adjusted target landing locations The actual landing locations recorded by the sensors are synchronized.

13. The method according to claim 12, wherein a sequence of actual touchdown locations is recorded sequentially in a time-resolved manner and the synchronization of the image display to indicate the adjusted target touchdown locations is carried out in adaptation to the sequence of actual touchdown locations.

14. The method according to claim 12 or 13, wherein the synchronization of the specified target placement locations to the recorded actual placement locations includes a sliding adjustment of a predetermined target step length to a recorded actual step length of the subject.

15. The method according to any one of claims 12 - 14, wherein the detection of the actual placement locations of the subject's feet on the walking surface comprises an optical detection, in particular a camera or light barrier detection, or on the Acquisition of pressure distribution images of the subject's feet is based on a pressure distribution matrix arranged below the walking surface.