WO2014174202A1

WO2014174202A1 - Anatomically accurate mannequin for simulating behaviours of a human body

Info

Publication number: WO2014174202A1
Application number: PCT/FR2014/050972
Authority: WO
Inventors: Philippe Foucqueteau; Umberto Simeoni; Cyrille Michaud
Original assignee: Université D'aix-Marseille; Assistance Publique - Hopitaux De Marseille
Priority date: 2013-04-23
Filing date: 2014-04-22
Publication date: 2014-10-30
Also published as: FR3004842A1

Abstract

The anatomically accurate mannequin for simulating behaviours of a human body comprises a neck (18), a mouth cavity (20) and a larynx (24). The larynx (24) extends the mouth cavity (20) and is mounted such that it can move in the neck (18) between a position, referred to as the down position, in which the larynx (24) is at rest, and a deglutition position referred to as the up position.

Description

Anatomical manikin for simulating the behavior of a human body

The present invention relates to an anatomical model, dynamic, for the simulation of behaviors of a human body, particularly a manikin for learning tracheal intubation, and more particularly in a child or a newborn.

Tracheal intubation is intended to introduce a tracheal tube into the trachea of a patient so as to allow mechanical ventilation of the patient, particularly in the case of anesthesia or medical resuscitation.

To do this, the tracheal tube can be placed in the trachea using a laryngoscope. The laryngoscope is an apparatus that allows the operator to recline the tongue and visualize the patient's glottis, which is the upper orifice of the larynx and which constitutes the initial part of the airways, located just above the trachea.

It turns out that tracheal intubation is a difficult, relatively aggressive, poorly tolerated by the patient, which must be performed quickly and delicately by the operator and can have vital consequences if it is not performed so satisfactory. In particular, certain simultaneous movements and spontaneous or reflex behaviors of the patient can slow down or prevent the satisfactory introduction of the tube. This intubation is particularly difficult to implement during the neonatal period, as the body of an infant presents extremely small and fragile organs. Also, to train to reproduce gestures adapted to intubation, especially in the case of newborns, we use simulators for operator training.

Document US5509810 is already known, an anatomical manikin for simulating human behaviors, comprising elements reproducing vocal cords and comprising a hatch that can take an open or closed position in the trachea.

The present invention is intended to provide a manikin more faithful to the anatomical reality but also behavioral and dynamic of a patient, especially in the region between the oral cavity and the throat during intubation.

For this purpose, the subject of the invention is an anatomical dummy for simulating the behavior of a human body, comprising a neck, an oral cavity and a larynx extending the oral cavity, in which the larynx is mounted movably in the neck between a rest position of the larynx, said low position, and a swallowing position, said high position.

Thus, it is proposed to make a manikin to reproduce movements of the larynx during swallowing, these movements constituting a difficulty that the operator encounters during the intubation of a patient. Indeed, the swallowing movement, which may be a spontaneous behavior of the patient or a reflex generated by the introduction of the laryngoscope, can prevent the introduction of the device into the trachea, or at least the braking. The proposed dummy allows to reproduce this difficulty, so as to cause the operator to take it into consideration, and this in the closest possible way to reality.

Note that the "low" position and the "high" position of the manikin are designated with reference to a standing position of the dummy, front, called reference anatomical position. Thus, the "down" direction refers to the direction of the patient's feet, the "up" direction is a direction to the top of the patient's head, the "forward" direction refers to a direction toward the patient's nose, and the "Back" direction refers to a direction towards the patient's neck.

The swallowing position corresponds to a high position on the manikin relative to the rest position, that is to say that the swallowing position is higher than the rest position, so as to simulate a swallowing reflex at during intubation. In other words, the proposed dummy is able to simulate the movement of the larynx upwards towards the tongue, a position in which the tongue may block access to the larynx, so that a tracheal tube could not not pass.

Preferably, the simulated swallowing position corresponds to a high position and forward on the manikin, so as to simulate even more real swallowing movement. This movement of the larynx is similar to the movement of the "Adam's apple" visible from the outside in a male subject.

Note that, since the proposed larynx is movable between a swallowing position and a rest position, it is now possible to simulate non-reproducible situations with mannequins of the state of the art. For example, a movement of the larynx to a high position can be simulated, preventing a tracheal tube from passing during an intubation simulation, while still having an unobstructed larynx, with vocal cords sufficiently apart, that could have let the tube pass if the larynx was in the low position. Indeed, we can see on the dummy the functions of position of the larynx with respect to the tongue, and the function of opening or not the vocal cords.

Note also that the mobility of the larynx as defined preferably corresponds to a displacement of the larynx duct located between the tongue and the trachea. Thus the low and high positions of the larynx are distinguished from an opening or closing of a valve disposed in the larynx.

In the present description, the expression "the manikin includes such organ ", the fact that" the manikin includes elements allowing the reproduction of such organ ". For example, the manikin defined above includes elements for reproducing a neck, an oral cavity, a larynx extending the oral cavity, etc.

A manikin as presented above may further comprise one or more of the following features, taken alone or in combination.

The dummy comprises a tongue having a trailing end, called a pharyngeal segment and comprising an epiglottis part, the larynx comprises a glottis, the upper position of the larynx being defined so that, when the larynx is in the raised position, access to the the glottis, from the oral cavity, is obstructed by the epiglottis part. Thus, the proposed manikin simulates a situation in which a tracheal tube can not reach the trachea of the patient, and thus allows the operator to train to take account of this phenomenon.

- The manikin comprises an electrically controlled return means having two ends, one end being attached to the larynx and the other end being attached to a fixed point of a tongue, the displacement of the larynx between the high and low positions being obtained by compression or traction of the return means. Note that the larynx is preferably simulated by a tubular element, and that the end of the return means which is attached to the larynx is preferably attached to the outside of this tube, so as to move the tube under the action of the return means.

- The biasing means comprises two springs interposed between two parallel blades mounted sliding on two piano ropes parallel to each other, one of the blades being attached to the larynx and the other being attached to the fixed point of a tongue.

- The manikin further comprises a tongue reproducing two sections, namely a root and a body, the body of the tongue being composed of a pharyngeal segment and a mouth segment, the mouth segment being on the lip side of the manikin , the pharyngeal segment being movably mounted in the oral cavity, movable between a rest position, said front position, and a retrotrusion position, said rear position. It is also movable in intermediate positions. The pharyngeal segment can also be called a basic segment. Thus, it is proposed to simulate in the manikin a movement of the posterior part of the tongue of a patient. This movement is combined with the movement of the larynx to simulate the behavior of the human body in the throat area even closer to reality. The movement of the pharyngeal segment is particularly interesting in that, besides the segment buccally, the pharyngeal segment may also impede access of a tracheal tube to a glottis during intubation. Thus, the proposed dummy can simulate, not only the movement of the anterior part of the tongue, via a movement of the oral segment, but also a movement of the posterior part of the tongue, via the movement of the pharyngeal segment. We thus obtain a simulation of the movement of the language closer to reality than those proposed in the state of the art, proposing a movement of the front part of the language only. The rear position of the tongue is preferably a position of the tongue towards the back and the top of the manikin. It is understood that the mobility of the pharyngeal segment between the front and rear positions differs from the mobility of the oral segment. This mobility means that part of the pharyngeal segment moves and is distinguished from a simple rotation of the buccal segment around an axis located in the pharyngeal segment. Furthermore, it is understood that a mobile segment is distinguished from a simple removable segment, which could be detached from the manikin.

- The manikin has a glottis and, when the pharyngeal segment is in retrotrusion position, part of the pharyngeal segment covers and obstruct access to the glottis, and when the pharyngeal segment is in the forward position, access to the glottis is released. Thus, the proposed manikin simulates a situation in which a tracheal tube can not reach the glottis of the patient, and thus allows the operator to train to take into account this phenomenon.

- The manikin comprises an electrically controlled return means having an end attached to the pharyngeal segment or in the vicinity of the junction between the pharyngeal segment and the buccal segment, the displacement of the pharyngeal segment between the front and rear positions being obtained by the action of this return means.

- The larynx comprises two vocal cords, mounted movable relative to each other between a close position and a remote position, and in intermediate positions. The close position of the vocal cords allows to simulate a contraction of the glottis, and the distant position a relaxation of the glottis. Thus, it is proposed to simulate in the manikin a movement of approximation or removal of the vocal cords of the patient, which allows to simulate the movement of the vocal cords closer to reality than when, for example, we use a simple flapper to simulate the opening or closing of vocal cords. Indeed, it is possible to simulate cases in which the vocal cords are certainly open, but not open enough to allow the easy introduction of the tracheal tube, or in a position weakly open, slowing the tube forward considerably, or braking it completely. This movement is combined with the movement of the larynx to simulate the behavior of the human body in the throat area even closer to reality

- The vocal cords are simulated by a biasing means comprising two branches resiliently biased toward the close position, the biasing means being preferably a piano wire spring and provided with two electrically controlled traction wings.

- The manikin comprises a head and a neck, the head being articulated relative to the neck so as to be able to take a position tilted back relative to the neck, and a position tilted forward with respect to the neck, this joint being preferably controlled electrically. Thus, the manikin can simulate the high or low position of the head relative to the neck, and thus to simulate the cases in which a patient moves or in which the operator would not have positioned the head appropriately at the time of intubation.

- The manikin comprises a head and a neck, the head being articulated with respect to the neck so as to be able to assume a centered position, a position obtained by turning to the right and a position obtained by rotating the head to the left on the neck, this articulation being preferably electrically controlled. The manikin thus makes it possible to simulate an orientation to the right or left of the head with respect to the neck, and thus to simulate the cases in which a patient moves or in which the operator would not have positioned the head in a suitable way to the moment of intubation.

- The dummy includes a saliva reproduction means, comprising a liquid storage pouch connected to the oral cavity. The production of saliva may hinder the intubation process, so we propose a manikin simulating reflexes during intubation even closer to reality.

- The dummy is connected to a computer able to electrically control the movements of parts of the manikin, including movement of the larynx and / or pharyngeal segment and / or vocal cords and / or head relative to the neck.

The dummy further comprises sensors configured to acquire data relating to the effects of the simulation of an intubation in the dummy, for example a pressure sensor capable of evaluating the pressure and / or orientation of a dummy blade; laryngoscope on a language, and transmit them to the computer.

- The dummy reproduces a child's body, and preferably a body of new born. Thus, the practice of tracheal intubation during the neonatal period can be simulated.

- The tongue can be mobile, especially laterally, under the effect of pressure exerted by the user with his laryngoscope. In this case, the language does not necessarily move actively (under the effect of electrical control means) but is mobile "passively" under the effect of the user. In other words, the mobility of the language is not motorized. This case is interesting in that it allows an even more realistic rendering, insofar as the practitioner is brought to move the tongue to clear the passage for his laryngoscope and proceed to intubation.

The invention also relates to an anatomical dummy for simulating the behavior of a human body, comprising an oral cavity and a tongue reproducing two sections, namely a root and a body, the body of the tongue being composed of a pharyngeal segment and an oral segment, the oral segment being on the lip side of the dummy, the pharyngeal segment being mounted movably in the oral cavity between a rest position, said front position, and a retrotrusion position, said rear position . Some of the benefits relating to this manikin have been presented previously.

The invention furthermore relates to an anatomical manikin for simulating the behaviors of a human body, comprising a buccal cavity and a larynx extending the oral cavity, wherein the larynx comprises two vocal cords, mounted movable relative to one another. to the other between a close position and a distant position. Some of the benefits relating to this manikin have been presented previously.

The invention will be better understood on reading the appended figures, which are provided by way of examples and are in no way limiting, in which:

- Figure 1 is a schematic side view partially in longitudinal section of a manikin according to one embodiment, during an intubation phase by a practitioner;

Figure 2 is a schematic side view of the tongue of Figure 1;

FIG. 3 is a diagrammatic cross-sectional view taken slightly above the neck of the manikin of FIG. 1;

FIG. 4 is a schematic view illustrating means for implementing the movement of the larynx of the manikin of FIG. 1; and

FIG. 5 is a diagrammatic view illustrating vocal cord simulation means of the manikin of FIG. 1.

With reference to FIG. 1, an anatomical manikin 10 has been made for the simulation of human behaviors. This manikin is more specifically intended for learning tracheal intubation. In the example, the dummy is that of a newborn. The manikin 10 is connected to a computer 12, preferably by wireless communication.

The manikin 10 comprises a bust 14, a head 16, a neck 18. The head 16 has a buccal cavity 20, including a mouth 22 forming the opening of the oral cavity 20. In addition, the manikin has a larynx 24, disposed in the neck 18 and the top of the bust 14 and which extends the oral cavity 20. In this example, a pharynx 26 is reproduced and disposed between the larynx 24 and the oral cavity 20. A trachea 28 is reproduced below 24. In addition, a tongue 30 is disposed inside the oral cavity 20 and extends to the top of the larynx 24. The tongue 30 is described hereinafter, it comprises in particular an epiglottis 31 in a lower part.

Thus, the oral cavity 20 allows the introduction of a tracheal intubation tube 32 through the mouth 22 of the manikin 10, towards the trachea 28. The introduction of the tube is aided by a blade 34, called laryngoscope.

The oral cavity 20 of the manikin 10 comprises a hollow housing located in the lower part of the head 16 and which extends from the opening of the mouth 22 to the beginning of the pharynx 26. In this example, it reproduces the anatomy of the main organs of the mouth of a patient and includes in particular the tongue 30, a palate, gums, lips 33, a lower jaw, mounted movably between a closed position and an open position, a uvula 35 and a soft palate. Within this buccal cavity 20, the manikin 10 comprises sensors making it possible, by means of the computer 12, to account for the effects produced on the manikin by the manipulations taking place during the tracheal intubation, in particular during the passage of the intubation tube 32 or the pressure performed by the laryngoscope 34. These sensors are arranged on the tongue 30 but it is also found on other organs present in the oral cavity, in the larynx and in the rest of the dummy.

The oral cavity 20 also includes a saliva reproduction means, comprising a sealed liquid storage pouch connected to the oral cavity. This pocket is waterproof and is provided with a means of evacuation and filling the pocket. Such an envelope is arranged for example in a rigid tube having two ends, one of these ends being closed while the other end has a piston actuated by an electric jack which, when moving, compresses the envelope and evacuates the liquid from the waterproof pocket. A valve is disposed on the filler tube to prevent the flow of liquid to the outside of the manikin. The liquid supply takes place after a retraction of the piston by means of a syringe in the filling tube. As shown in Figure 2, the tongue 30 reproduces two sections, namely a root 36, which is the fixed point of the tongue and allows the tongue to be fixed on the manikin 10, and a body 38, 40. The tongue body 30 has a rear portion 38, said pharyngeal segment 38, and a front portion 40 being on the side of lips 33, said mouth segment 40. The mouth segment 40 has a substantially flat shape and corresponds to the part of the tongue visible from the outside when the tongue is positioned in the manikin 10. This mouth segment is then in a substantially horizontal position within the oral cavity 20, while the pharyngeal segment 38 is in a substantially vertical position at right pharynx 26 at the upper neck 18. In other words, the pharyngeal segment 38 extends from the mouth segment 40 to the larynx 24. The pharyngeal segment 38 is movably mounted in the oral cavity 20 between a rest position, said front position, and a retrotrusion position, said rear position. The front position of the pharyngeal segment 38 simulates the usual resting position of the tongue within the oral cavity, while the rear position simulates the position of the tongue during swallowing. The tongue 30 also includes an epiglottis 31 which is located in the lower portion of the pharyngeal segment 38, above the larynx 24.

In this example, the manikin comprises a return means 42, electrically controlled by a servomotor 44. The return means 42 has an end 46, attached to the pharyngeal segment 38 or in the vicinity of the junction between the pharyngeal segment 38 and the segment 40, the displacement of the pharyngeal segment between the front and rear positions being obtained by the action of the return means 42.

As illustrated in FIG. 3, the larynx 24 is situated below the pharyngeal segment 38 of the tongue 30 and in the downward extension of the pharynx 26. The larynx 24 comprises a body and a glottis 48 provided with vocal cords 50. The vocal cords 50 are located at the upper end of the larynx 24, facing the bottom of the oral cavity 20. The larynx 24 has a substantially tubular outer shape. It is mounted movably inside the neck 18 between a rest position of the larynx 24, which is its usual position, also called low position, and a swallowing position, said high position. The high position corresponds to a high position and forward compared to the low position. When the larynx is in the high position, access to the glottis 48, from the oral cavity 20, is obstructed by the epiglottis portion 31.

The manikin 10 comprises a return means 54, shown schematically in FIG. 4, making it possible to electrically control the movements of the larynx 24. The return means 54 has two ends 58, one end attached to the larynx, more specifically to a posterior wall 59 of the body of the larynx in this example, and the other end being attached to a fixed point of the tongue, for example to the root 36. The displacement of the larynx 24 between the positions high and low is obtained by compression or traction of the return means 54. In the example, the biasing means 54 comprises two springs 56 interposed between two parallel blades 58 which correspond to the aforementioned ends and are slidably mounted on two piano strings 60 parallel to each other. One of the blades 58 is attached to the larynx while the other is attached to the fixed point of the tongue 36.

As can be seen from an example in FIG. 5, the vocal cords 50 of the larynx 24 are movably mounted relative to each other between a close position and a remote position. The distant position of the vocal cords simulates an open position of the glottis 48 of a patient, while the close position simulates a position in which the glottis 48 is almost completely closed or completely closed. Thus, the simulation of intubation can be facilitated or made more difficult depending on the position taken by the vocal cords.

In the example, the vocal cords 50 are simulated by a return means 60 comprising two branches 62 resiliently biased towards the close position. The biasing means is a piano wire which forms a spring 64 and is provided with two electrically controlled pulling fins 66.

The head 16 of the manikin 10 is articulated with respect to the neck 18 so as to be able to assume a position tilted backwards relative to the neck, in particular when intubation is being performed, this position facilitating the simulation of the intubation. The head 16 can also take a tilted position forward relative to the neck 18, this position being unfavorable, however, to the smooth running of the intubation. The articulation of the head relative to the neck is in this example electrically controlled by means of a ball joint (not shown). The head is also articulated relative to the neck so as to take a centered position or a position oriented to the right or left which is obtained by a rotation of the head on the neck. Here too, this articulation is achieved by means of an electrically controlled ball joint.

The principle operation of a manikin according to the example will now be described. When it is desired to simulate a tracheal intubation, a simulation program is started on the computer 12. According to the instructions defined by the program, the computer controls and activates the organs of the manikin 10 through the various electrical controls. Thus, the computer can control movements, so-called autonomous movements, parts of the dummy, including movements of the larynx and / or the pharyngeal segment and / or vocal cords, and / or head relative to the neck, so as to simulate the autonomous functioning of a human body.

The method also makes it possible, by means of the sensors described above, to acquire data relating to the effects of the simulation of an intubation in the manikin. It allows for example to detect a certain pressure and / or orientation of the laryngoscope blade 34 on the tongue 30, and to transmit this information to the computer 12. The sensors that are placed in the manikin have the role of measuring the effects. manipulations of tracheal intubation of an operator. The information collected by the sensors is sent to the computer that analyzes it, and, in response to intubation manipulations, will send new instructions to the manikin to simulate reflex behaviors of the manikin. Thus, the dummy can reproduce reflex movements of the parts of the manikin, including the movements of the larynx and / or pharyngeal segment and / or vocal cords and / or head relative to the neck.

The invention is not limited to the embodiments presented above. In particular, other ways of simulating the movements of the larynx and / or the pharyngeal segment and / or the vocal cords and / or the head relative to the neck are conceivable.

In particular, the mechanisms can be pneumatically controlled. In particular, piano strings can be replaced by compressed air tubes.

Moreover, the tongue can be mobile, especially laterally, under the effect of pressure exerted by the user with his laryngoscope. In this case, the language does not necessarily move actively (under the effect of the simulator) but is mobile "passively" under the effect of the user.

In addition, the manikin as described above could simulate the body of a child or an adult.

Claims

Anatomical dummy (10) for simulating the behavior of a human body, comprising a head (16), a neck (18), an oral cavity (20) and a larynx (24) extending the oral cavity (20), characterized in that the larynx (24) is movably mounted in the neck (18) between a resting position of the larynx (24), said low position, that is to say oriented towards the feet, and a swallowing position, said high position, that is to say towards the top of the head (16).

A dummy (10) according to claim 1, further comprising a tongue (30) having a trailing end, referred to as a pharyngeal segment (38) and comprising an epiglottis portion (31), the larynx (24) comprising a glottis (48), the high position of the larynx (24) being defined so that when the larynx is in the raised position, access to the glottis (48) from the oral cavity (20) is obstructed by the epiglottis portion (31).

Manikin according to any one of claims 1 to 2, comprising a return means (54) electrically controlled and having two ends, one end being attached to the larynx (24) and the other end being attached to a fixed point (36) a tongue (30), the displacement of the larynx (24) between the high and low positions and intermediate positions being obtained by compression or traction of the biasing means (54).

Manikin according to the preceding claim, wherein the biasing means (54) comprises two springs (56) interposed between two parallel blades (58) slidably mounted on two piano strings (60) parallel to each other, one of the blades (58) ) being attached to the larynx (24) and the other being attached to the fixed point (36) of a tongue (30).

Manikin according to any one of claims 1 to 4, further comprising a tongue (30) reproducing two sections, namely a root and a body, the body of the tongue being composed of a pharyngeal segment (38) and a mouth segment (40), the mouth segment being on the lip side (31) of the manikin, the pharyngeal segment (38) being movably mounted in the oral cavity (20) movable by a motor device between a rest position, said front position, and a retrotrusion position, said rear position, with all the intermediate positions.

Manikin according to the preceding claim, comprising a glottis (48) and wherein, when the pharyngeal segment (38) is in the retrotrusion position, part of the pharyngeal segment (38) covers and obstructs access to the glottis (48), and when the pharyngeal segment (38) is in the forward position, access to the glottis (48) is released.

Anatomical dummy according to any one of the preceding claims, wherein the larynx (24) comprises two vocal cords (50) movably mounted relative to each other between a close position and a remote position.

8. Manikin according to the preceding claim, wherein the vocal cords (50) are simulated by a biasing means (60) comprising two branches (62) resiliently biased towards the close position, the biasing means being preferably a piano string spring (64) and provided with two electrically actuated pulling wings (66).

A manikin according to any one of the preceding claims comprising a saliva reproduction means comprising a liquid storage bag connected to the oral cavity (20).

Manikin according to any one of the preceding claims, the dummy being connected to a computer (12) adapted to electrically control the movements of parts of the manikin, in particular the movements of the larynx (24) and / or the pharyngeal segment (38). and / or vocal cords (50) and / or the head (16) relative to the neck (18).

1 1. Manikin according to any one of the preceding claims, the manikin reproducing a child's body, and preferably a newborn body.