WO2016002207A1 - Rehabilitation system and method for controlling rehabilitation system - Google Patents

Rehabilitation system and method for controlling rehabilitation system Download PDF

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Publication number
WO2016002207A1
WO2016002207A1 PCT/JP2015/003282 JP2015003282W WO2016002207A1 WO 2016002207 A1 WO2016002207 A1 WO 2016002207A1 JP 2015003282 W JP2015003282 W JP 2015003282W WO 2016002207 A1 WO2016002207 A1 WO 2016002207A1
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Prior art keywords
patient
training
rehabilitation
control device
electroencephalogram
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PCT/JP2015/003282
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French (fr)
Japanese (ja)
Inventor
潤一 牛場
幸治 森川
幹生 岩川
平田　昭夫
Original Assignee
学校法人 慶應義塾
パナソニック株式会社
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Application filed by 学校法人 慶應義塾, パナソニック株式会社 filed Critical 学校法人 慶應義塾
Publication of WO2016002207A1 publication Critical patent/WO2016002207A1/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/369—Electroencephalography [EEG]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H1/00—Apparatus for passive exercising; Vibrating apparatus; Chiropractic devices, e.g. body impacting devices, external devices for briefly extending or aligning unbroken bones
    • A61H1/02—Stretching or bending or torsioning apparatus for exercising

Definitions

  • the present invention relates to a rehabilitation system for giving a stimulus to a patient based on an electroencephalogram and a control method thereof.
  • the rehabilitation system of Patent Document 1 includes an electroencephalogram measurement device, a body drive device that moves the limbs of a patient, and a control device.
  • the control device detects an ERD indicating the expression of the exercise plan by the electroencephalogram measurement device, and drives the body drive device based on the detected ERD.
  • An object of the present invention is to provide a rehabilitation system that provides a patient with rehabilitation according to the degree of plasticity of the patient's brain, and a control method for the rehabilitation system.
  • a rehabilitation system provides an electroencephalogram measurement device, an information presentation device configured to present information to a patient, and an electrical stimulus or a mechanical stimulus attached to the patient's body.
  • an information presentation device configured to present information to a patient
  • an electrical stimulus or a mechanical stimulus attached to the patient's body When a signal related to an exercise plan is extracted from the electroencephalogram configured as described above and an electroencephalogram measured by the electroencephalogram measurement apparatus, and it is determined that the exercise plan is correctly expressed based on at least the signal,
  • a rehabilitation system that provides a patient with rehabilitation according to the degree of plasticity of the brain of the patient can be provided. Differences in recovery speed due to rehabilitation training may occur depending on the patient's brain plasticity and the degree of injury. With regard to the speed of recovery in rehabilitation, recovery is fast immediately after the occurrence of a disorder in which brain plasticity remains the most, and the speed of recovery may decrease with time.
  • the degree of brain plasticity is estimated based on the electroencephalogram before the start of rehabilitation training, and the training schedule is adjusted according to the plasticity. Rehabilitation that matches the patient can be provided to the patient, and improvement of the rehabilitation effect can be expected.
  • the schematic diagram of the rehabilitation system of embodiment The block diagram of a rehabilitation system.
  • the schematic diagram for demonstrating the repetition of a training sequence The schematic diagram of the screen displayed during a rest period. Schematic diagram of the screen displayed during the planning period.
  • the flowchart of the schedule determination method The block diagram of the rehabilitation system of a reference example.
  • the rehabilitation system 1 includes an electroencephalogram measurement apparatus 10, an information presentation apparatus 20, an electric appliance 30, an operation unit 40, and a control apparatus 50.
  • the electroencephalogram measurement apparatus 10 can have a headphone shape suitable for mounting on a patient's head, and includes a plurality of electrodes 11, an electroencephalogram measurement unit 12, and an electroencephalogram transmission unit 13.
  • the plurality of electrodes 11 are arranged, for example, by an arch-shaped elastic head mount so that when the patient wears the electroencephalogram measuring apparatus 10 on the head, the electrodes 11 are arranged at positions suitable for the measurement of the electroencephalogram related to the patient's motion plan. Supported.
  • the plurality of electrodes 11 are, for example, a left motor area that controls the voluntary movement of the patient's right body, and a position that can correspond to the voluntary movement of the patient's left body to the right motor area (an electroencephalogram electrode designation method, international 10 It is preferable to arrange them at positions C4 and C3) in the -20 method.
  • an electroencephalogram electrode designation method international 10 It is preferable to arrange them at positions C4 and C3 in the -20 method.
  • the electroencephalogram measurement apparatus 10 may have a so-called headset shape including the electrodes 11 corresponding to only one motor area.
  • the electroencephalogram measurement unit 12 measures the electroencephalogram by amplifying the potential difference between two of the electrodes 11.
  • the electroencephalogram transmission unit 13 transmits an electroencephalogram signal including the electroencephalogram measured by the electroencephalogram measurement unit 12 to the electroencephalogram reception unit 51 of the control device 50.
  • the information presentation device 20 may be simply referred to as a presentation device.
  • the presentation device 20 includes a speaker 21 as an acoustic output device and an image display unit 22 as a visual output device.
  • the speaker 21 presents sound and voice to the patient based on the acoustic signal from the control device 50.
  • the image display unit 22 presents visual information to the patient based on a control signal from the control device 50.
  • the information presented to the patient includes instruction information regarding an instruction as to what rehabilitation exercise the patient should attempt, and feedback information indicating whether the patient is attempting according to the instruction.
  • the electric appliance 30 includes an appliance 31 to be attached to a patient's finger and arm, a motor 32, and a muscle stimulation electrode 33.
  • the motor 32 is attached near the elbow of the appliance 31.
  • the output shaft of the motor 32 and the back portion of the finger of the appliance 31 are connected by a wire (not shown). As the motor 32 rotates, the finger of the patient wearing the brace 31 is pulled by the wire, a mechanical stimulus is applied to the finger, and the patient's finger is moved in a passive manner.
  • the muscle stimulation electrode 33 is configured to give muscle stimulation to the patient's forearm.
  • the muscle stimulation electrode 33 gives electrical stimulation to the patient's forearm by current control between the electrodes 33 by the muscle stimulation control unit 59 (see FIG. 2) of the control device 50 controlled based on the timing of ERD detection. This electrical stimulation becomes muscle stimulation of the patient's forearm.
  • the passive movement accompanying the muscle stimulation and the control of the motor 32 becomes somatosensory feedback to the patient.
  • the operation unit 40 is configured as, for example, a mouse or a touch panel.
  • a rehabilitation assistant for example, an occupational therapist, registers various information about the patient in the control device 50 via the operation unit 40 or inputs an instruction to start or stop training for the control device 50.
  • the operation unit 40 is configured as a touch panel, it can be integrated with the presentation device 20.
  • the control apparatus 50 includes an electroencephalogram reception unit 51, an ERD detection unit 52, a training control unit 53, a schedule determination unit 54, a frequency analysis unit 55, a feedback control unit 56, a presentation control unit 57, a motor control unit 58, and muscle stimulation control. A portion 59 is provided.
  • the control device 50 can be a so-called microcomputer including an electronic circuit.
  • the control device 50 can include a ROM (Read Only Memory) in which various control programs are stored and a CPU (Central Processing Unit) that can access the ROM.
  • ROM Read Only Memory
  • CPU Central Processing Unit
  • the control device 50 causes the patient to perform a training in which a resting state and an expression of an exercise plan are alternately performed at predetermined time intervals by an operation from the operation unit 40 and a control to the presentation device 20 and the electric appliance 30. .
  • ⁇ Rehabilitation training is started by a start instruction from the operation unit 40.
  • a start instruction is input from the operation unit 40 to the training control unit 53 by the operation of the occupational therapist, and a series of training processes is executed.
  • one rehabilitation exercise (hereinafter referred to as “training sequence”) includes a rest period and an intention period during which an exercise intention is expressed.
  • the rest period the patient is required to relax and not recall specific thoughts.
  • the planning period the patient is required to express an exercise plan.
  • the planning period may be referred to as an exercise planning period.
  • the length of the rest period and the planning period is set, for example, to 5 seconds each.
  • training progresses by alternately performing rest periods and exercise planning periods. For example, a training time of about 40 minutes is set per day, and the control device 50 repeats the training sequence a plurality of times. In other words, the training sequence is executed until the predetermined training time per day ends. For one patient, this training is performed for 10 days, for example, as a rehabilitation training.
  • the training control unit 53 shown in FIG. 2 transmits the switching timing between the rest period and the exercise planning period to the presentation control unit 57.
  • the presentation control unit 57 presents the timing to the patient via the image display unit 22 and the speaker 21.
  • FIG. 4 shows an example of information displayed on the image display unit 22.
  • a rest period frame 23 indicating a rest period and an intention period frame 24 indicating an intention period are displayed side by side on the same time axis.
  • the passage of time is displayed by vertical lines 25 that move from left to right with time.
  • the request contents for the patient are also displayed in the message box 26.
  • the message box 26 displays a message such as “Please relax” during the rest period.
  • the message box 26 displays a message such as “Please plan your exercise” during the planning period.
  • the speaker 21 in the presentation device 20 shown in FIG. 1 may present different notification sounds at the start timing of the rest period and the start timing of the planning period. In this case, the patient can audibly recognize the switching between the rest period and the planning period.
  • the electroencephalogram reception unit 51 receives an electroencephalogram from the electroencephalogram transmission unit 13. At the same time, the brain wave training timing from the training control unit 53 is received.
  • the electroencephalogram measurement apparatus 10 always measures an electroencephalogram and transmits an electroencephalogram signal during the training period.
  • the electroencephalogram reception unit 51 can extract the electroencephalogram during the rest period and the electroencephalogram during the planning period from the electroencephalogram signal.
  • the ERD detection unit 52 detects an ERD signal that is a signal related to the exercise plan from the brain wave during the rest period and the brain wave during the planning period.
  • the ERD is an electroencephalogram that changes due to the expression of the exercise intention, and is uniquely generated when the exercise intention is expressed. If the patient can correctly express the exercise intention, the ERD signal is not detected during the rest period, and the ERD signal is detected only during the intention period.
  • the ERD signal is obtained by the time change of the frequency power of the electroencephalogram. In a predetermined time range, if a change in frequency power at a specific frequency, for example, around 10 Hz, is continuously observed for a predetermined time, it is determined that an ERD signal has been detected.
  • feedback information for the patient is created by the feedback control unit 56.
  • the feedback information is displayed on the screen of the image display unit 22 via the presentation control unit 57 (for example, the band 27 in FIG. 5) or is acoustically output from the speaker 21.
  • one training sequence is started in a state where the patient pinches the peg P on the finger on which the electric brace 30 is worn. For this reason, when the ERD signal is detected, the finger is extended by the control of the motor 32 of the electric appliance 30 and the peg P falls. At this time, feedback from the muscle is given to the nerve function related to finger extension, and recovery of the nerve function is promoted. Further, as the electric appliance 30 is driven, the muscle stimulation electrode 33 applies electrical stimulation to muscles related to finger extension, for example, the total finger extensor muscles. For this reason, feedback from the muscle is given to the nerve function related to finger extension, and the recovery of the nerve function is promoted.
  • the control device 50 starts training control by operating the operation unit 40.
  • the training control unit 53 sends an instruction to the presentation control unit 57 so that the training sequence of the rest period and the planning period can be repeatedly presented.
  • the presentation control unit 57 displays on the image display unit 22 by a graph or the like that training is being performed.
  • the presentation control unit 57 creates presentation information and causes the speaker 21 to present a notification sound.
  • the patient recognizes that it has shifted to the planning period from at least one of the notification sound from the speaker 21 and the display content of the image display unit 22, and expresses the exercise plan.
  • the rest period and the planning period as shown in FIG.
  • the calculation result 28 of the ERD attenuation rate is continuously displayed by the graph, and the ERD is detected when the ERD attenuation rate is not less than a certain value.
  • the time interval is additionally displayed on the image display unit 22 as visual feedback information such as the band 27, for example.
  • the auditory feedback information that the ERD has been detected is notified.
  • somatic sensory feedback is performed from the electric appliance 30 by the motor control unit 58 and the muscle stimulation control unit 59.
  • the visual feedback information from the image display unit 22 and the auditory feedback information from the speaker 21 may be referred to as feedback not via the electric appliance 30, that is, non-somatosensory feedback.
  • the schedule determination unit 54 creates a rehabilitation schedule based on the activity intensity of the ⁇ band and stores it in a memory (not shown) in the training control unit 53.
  • the schedule spans multiple days.
  • the schedule defines the time and number of times to repeat the training sequence on each day.
  • the training control unit 53 executes training control based on the schedule created by the schedule determination unit 54.
  • the training control unit 53 reads the schedule from the memory before starting the rehabilitation for each day.
  • the training control unit 53 repeats the training sequence until the time determined by the schedule elapses.
  • the training control unit 53 ends the training control and ends the rehabilitation for that day.
  • the training schedule determination process will be described with reference to FIG.
  • the schedule determination process is performed before the start of each day's rehabilitation.
  • the schedule determination process is performed in a state where the patient is rested by wearing the electroencephalogram measurement apparatus 10 and sitting on a chair.
  • step S11 the control device 50 determines whether there is a patient ID registration based on a signal from the operation unit 40. For example, when there is no registration of patient ID by an occupational therapist, that is, when an operation to the first day of rehabilitation is performed, it is determined that there is no registration of patient ID. Further, when the occupational therapist has registered the patient ID, that is, when an operation indicating that it is after the second day of the rehabilitation is performed, it is determined that the patient ID is registered.
  • the training control unit 53 creates a patient ID in step S12.
  • the frequency analysis unit 55 calculates the activity intensity of the ⁇ band from the electroencephalogram received by the electroencephalogram reception unit 51 based on the signal from the electroencephalogram measurement apparatus 10 in step S13.
  • the schedule determination unit 54 creates a rehabilitation schedule based on the activity intensity of the ⁇ band, and the training control unit 53 determines this schedule as the rehabilitation schedule.
  • the schedule determination unit 54 reads a pre-stored reference schedule, and when the activity intensity of the ⁇ band is lower than the threshold, at least one of the rehabilitation time of the day and the number of days of rehabilitation Create a schedule so that is longer than the reference schedule. Further, the schedule determined by the training control unit 53 and the schedule determination unit 54 is stored in the internal memory in association with the patient ID. Note that the reference schedule may be, for example, 40 minutes each day for a total of 10 days.
  • an adjustment method to lengthen the schedule for example, (1) increase the number of sequence repetitions per day by increasing the training time of 40 minutes for each day to, for example, 50 minutes, 60 minutes, etc. (2) 1 time The training time of 40 minutes is not changed, and the number of trainings per day is increased to twice in the morning and afternoon, etc., and the number of trainings per day is increased. (3) The number of training days is increased. .
  • step S11 when it is determined in step S11 that the patient ID has been registered, that is, when it is determined that the patient ID is after the second day of rehabilitation, the control device 50 proceeds to step S15.
  • the training control part 53 reads the schedule memorize
  • the rehabilitation system 1 has the following operations and effects. (1) The difference between the rehabilitation system 1 of embodiment and the rehabilitation system of the reference example shown in FIG. 7 is demonstrated.
  • the rehabilitation system of the reference example shown in FIG. 7 is different from the rehabilitation system 1 of the embodiment in that the frequency analysis unit 55 and the schedule determination unit 54 are not provided.
  • the training control unit 53 of the rehabilitation system of the reference example shown in FIG. 7 only performs training for a preset number of times of training regardless of the degree of disorder and plasticity of the patient. For this reason, the training amount suitable for a patient is not set.
  • the control device 50 of the rehabilitation system 1 includes a frequency analysis unit 55 and a schedule determination unit 54.
  • the control device 50 measures a patient's brain wave and creates a rehabilitation schedule based on the measured brain wave. That is, it is possible to create a schedule that improves the prognosis of the patient before the start of rehabilitation. For this reason, rehabilitation according to a patient can be performed. Since the training schedule can be determined according to the degree of plasticity of the patient, the rehabilitation system 1 capable of more effective training can be provided.
  • the control device 50 creates a schedule according to the activity intensity of the ⁇ band of the electroencephalogram.
  • the intensity of ⁇ -band activity correlates well with the patient's prognosis. For this reason, it can contribute to making a patient's prognosis favorable.
  • the control device 50 creates a schedule so that the rehabilitation period is longer when the activity intensity of the ⁇ band is low than when the activity intensity of the ⁇ band is high.
  • patients who are estimated to have low rehabilitation effects based on the activity intensity of the ⁇ band can be rehabilitated for a long time in the early stage of rehabilitation, which is considered to be highly plastic, so the patient's prognosis is improved. it can.
  • the control device 50 creates a schedule for a plurality of days before the start of rehabilitation on the first day. For this reason, rehabilitation can be performed according to the schedule according to the patient from the beginning of the start including the first day of rehabilitation. For this reason, it can contribute to making a patient's prognosis better.
  • the rehabilitation system 1 of this invention is not limited to the said embodiment, For example, you may deform
  • the control apparatus 50 can also change a subsequent schedule, when it is judged that plasticity is low by the activity intensity
  • the schedule can be created so that at least one of the rehabilitation time and the number of days of rehabilitation becomes longer as the activity intensity in the ⁇ band is lower.
  • a relationship map between the activity intensity of the ⁇ band and the rehabilitation time and number of days can be stored in advance in a memory.
  • the control device 50 can create a daily rehabilitation schedule.
  • the rehabilitation schedule for the day can be created based on the electroencephalogram before the start of the rehabilitation for each day.
  • the frequency band for analysis is not limited to ⁇ waves, and a schedule can be created using the intensity of all frequency bands.
  • the muscle stimulation control unit 59 and the muscle stimulation electrode 33, or the motor control unit 58 and the motor 32 can be omitted for a simple system.
  • the electroencephalogram reception unit 51, the ERD detection unit 52, the training control unit 53, the schedule determination unit 54, the frequency analysis unit 55, the feedback control unit 56, the presentation control unit 57, the motor control unit 58, and the muscle stimulation control unit 59 are Hardware may be sufficient and it may be implement
  • the electroencephalogram reception unit 51, the ERD detection unit 52, the training control unit 53, the schedule determination unit 54, the frequency analysis unit 55, the feedback control unit 56, the presentation control unit 57, the motor control unit 58, and the muscle stimulation control unit 59 are It may be realized by one processor which may be the control device 50, or may be realized by a plurality of processors included in the control device 50.

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Abstract

A rehabilitation system is provided with a brain wave measurement device (10), a presentation device (20), an electric tool (30), and a control device (50). The brain wave measurement device (10) measures the brain waves of a patient. The information presentation device (20) presents information to the patient. The electric tool (30) is attached to the body of the patient and applies at least one of electrical stimulation and mechanical stimulation to the patient. The control device (50) extracts an ERD signal that is related to an exercise plan from a brain wave measured by the brain wave measurement device (10) and, when it is determined on the basis of at least the ERD signal that an activation of the motor cortex that is associated with the exercise plan has occurred, controls the information presentation device (20) and the electric tool (30) so that feedback is given to the patient from the information presentation device (20) and the electric tool (30). The control device (50) determines a training amount from a pre-training brain wave analysis result.

Description

リハビリテーションシステムおよびリハビリテーションシステムの制御方法Rehabilitation system and control method of rehabilitation system
　本発明は、脳波に基づいて患者に刺激を与えるリハビリテーションシステム、および、その制御方法に関する。 The present invention relates to a rehabilitation system for giving a stimulus to a patient based on an electroencephalogram and a control method thereof.
　従来、脳卒中等により体肢に麻痺を生じた患者を回復させるために、脳波に基づいて体肢を動作させるリハビリテーションが知られている。このリハビリテーションにおいては、患者が体肢を動作させようとする運動企図の表出を示す脳波の変化、例えば、事象関連脱同期（event-related desynchronization；ＥＲＤ）に合わせて身体駆動装置が体肢を動作させることにより、リハビリテーションの効果が高まることが知られている（例えば、非特許文献１）。 Conventionally, rehabilitation for moving a limb based on an electroencephalogram is known in order to recover a patient who has been paralyzed by a stroke or the like. In this rehabilitation, the body drive device moves the limb in response to a change in the electroencephalogram that indicates the expression of an attempt to move the limb by the patient, for example, event-related desynchronization (ERD). It is known that the effect of rehabilitation is enhanced by operating (for example, Non-Patent Document 1).
　特許文献１のリハビリテーションシステムは、脳波測定装置、患者の体肢を動作させる身体駆動装置、および、制御装置を備えている。制御装置は、運動企図の表出を示すＥＲＤを脳波測定装置によって検出し、検出されたＥＲＤに基づいて身体駆動装置を駆動させる。 The rehabilitation system of Patent Document 1 includes an electroencephalogram measurement device, a body drive device that moves the limbs of a patient, and a control device. The control device detects an ERD indicating the expression of the exercise plan by the electroencephalogram measurement device, and drives the body drive device based on the detected ERD.
特開２０１２－２１７７２１号公報JP 2012-217721 A
　上記リハビリテーションによる訓練の進み具合には患者間の個人差が大きい。同一の手続きによって訓練を実施した場合でも、早期に訓練が進む患者もいれば、訓練に時間がかかる患者もいる。しかし、従来では、一通りの訓練を実施した後に、回復の程度が思わしくない患者に対して追加の訓練が行われていた。 [Individual differences among patients vary greatly in the progress of the rehabilitation training. Even when training is performed according to the same procedure, some patients progress early and others take time. However, in the past, after a series of trainings, additional training has been performed for patients who do not seem to recover.
　本発明の目的は、患者の脳の可塑性の程度に応じたリハビリテーションを患者に提供するリハビリテーションシステムおよびリハビリテーションシステムの制御方法を提供することである。 An object of the present invention is to provide a rehabilitation system that provides a patient with rehabilitation according to the degree of plasticity of the patient's brain, and a control method for the rehabilitation system.
　本発明の一側面に従うリハビリテーションシステムは、脳波測定装置と、患者に対して情報を提示するように構成される情報提示装置と、患者の身体に装着されて、電気的刺激もしくは力学的刺激を与えるように構成される電動装具と、前記脳波測定装置によって計測された脳波から運動企図に関連した信号を抽出し、少なくともその信号に基づいて運動企図が正しく表出されたと判定された場合に、前記情報提示装置と前記電動装具からフィードバックを患者に与えるべく前記情報提示装置と前記電動装具を制御する制御装置とを備え、前記制御装置は、訓練前の脳波の解析結果から訓練量を決定するように構成される。 A rehabilitation system according to one aspect of the present invention provides an electroencephalogram measurement device, an information presentation device configured to present information to a patient, and an electrical stimulus or a mechanical stimulus attached to the patient's body. When a signal related to an exercise plan is extracted from the electroencephalogram configured as described above and an electroencephalogram measured by the electroencephalogram measurement apparatus, and it is determined that the exercise plan is correctly expressed based on at least the signal, An information presentation device and a control device for controlling the electric appliance so as to give feedback to the patient from the electric appliance, and the control device determines a training amount from an analysis result of an electroencephalogram before training. Configured.
　本発明の一側面によれば、患者の脳の可塑性の程度に応じたリハビリテーションを患者に提供するリハビリテーションシステムが提供できる。
　リハビリテーションの訓練による回復速度の差異は、患者の脳の可塑性や障害の程度によって生じることがある。リハビリテーションにおいて回復の速度については、脳の可塑性が最も残っている障害発生直後において回復が速く、時間の経過とともに回復の速度が低下することがある。本発明のいくつかの側面では、リハビリテーションの訓練を開始する前の脳波に基づいて、脳の可塑性の程度を推定し、その可塑性に応じて、訓練のスケジュールを調整する。患者にマッチしたリハビリテーションを患者に提供でき、リハビリテーションの効果の向上が期待できる。 According to one aspect of the present invention, a rehabilitation system that provides a patient with rehabilitation according to the degree of plasticity of the brain of the patient can be provided.
Differences in recovery speed due to rehabilitation training may occur depending on the patient's brain plasticity and the degree of injury. With regard to the speed of recovery in rehabilitation, recovery is fast immediately after the occurrence of a disorder in which brain plasticity remains the most, and the speed of recovery may decrease with time. In some aspects of the present invention, the degree of brain plasticity is estimated based on the electroencephalogram before the start of rehabilitation training, and the training schedule is adjusted according to the plasticity. Rehabilitation that matches the patient can be provided to the patient, and improvement of the rehabilitation effect can be expected.
　本発明の他の側面及び利点は本発明の技術的思想の例を示す図面と共に以下の記載から明らかとなる。 Other aspects and advantages of the present invention will become apparent from the following description together with the drawings illustrating examples of the technical idea of the present invention.
実施形態のリハビリテーションシステムの模式図。The schematic diagram of the rehabilitation system of embodiment. リハビリテーションシステムのブロック図。The block diagram of a rehabilitation system. 訓練シーケンスの繰り返しを説明するための模式図。The schematic diagram for demonstrating the repetition of a training sequence. 安静期間に表示される画面の模式図。The schematic diagram of the screen displayed during a rest period. 企図期間に表示される画面の模式図。Schematic diagram of the screen displayed during the planning period. スケジュール決定方法のフローチャート。The flowchart of the schedule determination method. 参考例のリハビリテーションシステムのブロック図。The block diagram of the rehabilitation system of a reference example.
　図１に示されるように、実施形態に従うリハビリテーションシステム１は、脳波測定装置１０、情報提示装置２０、電動装具３０、操作部４０、および、制御装置５０を備えている。 1, the rehabilitation system 1 according to the embodiment includes an electroencephalogram measurement apparatus 10, an information presentation apparatus 20, an electric appliance 30, an operation unit 40, and a control apparatus 50.
　脳波測定装置１０は、患者の頭への装着に適するヘッドホン形状を有することができ、複数の電極１１、脳波計測部１２、および、脳波送信部１３を備えている。
　複数の電極１１は、患者が脳波測定装置１０を頭部に装着したときに、患者の運動企図に関連する脳波の測定に適した位置に配置されるように、例えばアーチ形の弾性ヘッドマウントによって支持される。複数の電極１１は、例えば、患者の右半身の随意運動を支配する左運動野、および、患者の左半身の随意運動を右運動野に対応できる位置（脳波電極の指定方法である、国際１０－２０法におけるＣ４、Ｃ３の位置）に配置することが好ましい。電極１１の配置を左運動野および右運動野のそれぞれと対応させることにより、同一のリハビリテーションシステム１を左半身の麻痺を有する患者および右半身の麻痺を有する患者の両方に用いることができる。なお、軽量化、簡易装着等の観点から、脳波測定装置１０は、片側の運動野のみに対応する電極１１を備えるいわゆるヘッドセット形状を有してもよい。 The electroencephalogram measurement apparatus 10 can have a headphone shape suitable for mounting on a patient's head, and includes a plurality of electrodes 11, an electroencephalogram measurement unit 12, and an electroencephalogram transmission unit 13.
The plurality of electrodes 11 are arranged, for example, by an arch-shaped elastic head mount so that when the patient wears the electroencephalogram measuring apparatus 10 on the head, the electrodes 11 are arranged at positions suitable for the measurement of the electroencephalogram related to the patient's motion plan. Supported. The plurality of electrodes 11 are, for example, a left motor area that controls the voluntary movement of the patient's right body, and a position that can correspond to the voluntary movement of the patient's left body to the right motor area (an electroencephalogram electrode designation method, international 10 It is preferable to arrange them at positions C4 and C3) in the -20 method. By making the arrangement of the electrodes 11 correspond to each of the left motor area and the right motor area, the same rehabilitation system 1 can be used for both a patient having left-side paralysis and a patient having right-side paralysis. Note that, from the viewpoint of weight reduction, simple wearing, and the like, the electroencephalogram measurement apparatus 10 may have a so-called headset shape including the electrodes 11 corresponding to only one motor area.
　脳波計測部１２は、電極１１のうちの２つの電極間の電位差を増幅して脳波を計測する。脳波送信部１３は、脳波計測部１２にて計測された脳波を含む脳波信号を制御装置５０の脳波受信部５１に送信する。 The electroencephalogram measurement unit 12 measures the electroencephalogram by amplifying the potential difference between two of the electrodes 11. The electroencephalogram transmission unit 13 transmits an electroencephalogram signal including the electroencephalogram measured by the electroencephalogram measurement unit 12 to the electroencephalogram reception unit 51 of the control device 50.
　情報提示装置２０は、単に提示装置と呼ぶことがある。提示装置２０は、音響的出力装置としてのスピーカー２１および視覚的出力装置としての画像表示部２２を備えている。スピーカー２１は、制御装置５０からの音響信号に基づいて、患者に音および音声を提示する。画像表示部２２は、制御装置５０からの制御信号に基づいて、患者に視覚情報を提示する。患者に提示される情報は、患者がどのようなリハビリテーション運動を企図すれば良いかの指示に関する指示情報と、患者が指示通りに企図できているかのフィードバック情報とを含む。 The information presentation device 20 may be simply referred to as a presentation device. The presentation device 20 includes a speaker 21 as an acoustic output device and an image display unit 22 as a visual output device. The speaker 21 presents sound and voice to the patient based on the acoustic signal from the control device 50. The image display unit 22 presents visual information to the patient based on a control signal from the control device 50. The information presented to the patient includes instruction information regarding an instruction as to what rehabilitation exercise the patient should attempt, and feedback information indicating whether the patient is attempting according to the instruction.
　電動装具３０は、患者の指および腕に装着される装具３１、モータ３２、および、筋刺激電極３３を備えている。モータ３２は、装具３１の肘付近に取り付けられている。モータ３２の出力軸と装具３１の指の背の部分とは、図示しないワイヤーにより接続されている。モータ３２が回転することにより、装具３１を装着した患者の指がワイヤーにより引っ張られ、指に力学的な刺激が与えられ、患者の指が他動的に運動させられる。 The electric appliance 30 includes an appliance 31 to be attached to a patient's finger and arm, a motor 32, and a muscle stimulation electrode 33. The motor 32 is attached near the elbow of the appliance 31. The output shaft of the motor 32 and the back portion of the finger of the appliance 31 are connected by a wire (not shown). As the motor 32 rotates, the finger of the patient wearing the brace 31 is pulled by the wire, a mechanical stimulus is applied to the finger, and the patient's finger is moved in a passive manner.
　筋刺激電極３３は、患者の前腕部に筋刺激を与えるように構成される。筋刺激電極３３は、ＥＲＤ検出のタイミングに基づいて制御される制御装置５０の筋刺激制御部５９（図２参照）による電極３３間の電流制御によって患者の前腕部に電気的な刺激を与える。この電気的な刺激が患者の前腕部の筋刺激となる。筋刺激およびモータ３２の制御にともなう他動的な運動は、患者への体性感覚フィードバックとなる。 The muscle stimulation electrode 33 is configured to give muscle stimulation to the patient's forearm. The muscle stimulation electrode 33 gives electrical stimulation to the patient's forearm by current control between the electrodes 33 by the muscle stimulation control unit 59 (see FIG. 2) of the control device 50 controlled based on the timing of ERD detection. This electrical stimulation becomes muscle stimulation of the patient's forearm. The passive movement accompanying the muscle stimulation and the control of the motor 32 becomes somatosensory feedback to the patient.
　操作部４０は、例えば、マウスやタッチパネル等として構成される。リハビリテーションの補助者、例えば作業療法士は、操作部４０を介して患者に関する各種情報を制御装置５０に登録したり、制御装置５０に対する訓練の開始や停止の指示を入力したりする。操作部４０がタッチパネルとして構成される場合には、提示装置２０に一体化することもできる。 The operation unit 40 is configured as, for example, a mouse or a touch panel. A rehabilitation assistant, for example, an occupational therapist, registers various information about the patient in the control device 50 via the operation unit 40 or inputs an instruction to start or stop training for the control device 50. When the operation unit 40 is configured as a touch panel, it can be integrated with the presentation device 20.
　図２を参照して、制御装置５０について説明する。制御装置５０は、脳波受信部５１、ＥＲＤ検出部５２、訓練制御部５３、スケジュール決定部５４、周波数解析部５５、フィードバック制御部５６、提示制御部５７、モータ制御部５８、および、筋刺激制御部５９を備えている。制御装置５０は、電子回路を含むいわゆるマイクロコンピューターであり得る。制御装置５０は、各種制御プログラムが格納されたＲＯＭ（Read Only Memory）及びＲＯＭにアクセス可能なＣＰＵ(Central Processing Unit）を含むことができる。 The control apparatus 50 will be described with reference to FIG. The control device 50 includes an electroencephalogram reception unit 51, an ERD detection unit 52, a training control unit 53, a schedule determination unit 54, a frequency analysis unit 55, a feedback control unit 56, a presentation control unit 57, a motor control unit 58, and muscle stimulation control. A portion 59 is provided. The control device 50 can be a so-called microcomputer including an electronic circuit. The control device 50 can include a ROM (Read Only Memory) in which various control programs are stored and a CPU (Central Processing Unit) that can access the ROM.
　制御装置５０は、操作部４０からの操作と、提示装置２０、電動装具３０への制御とによって、安静状態と運動企図の表出とを交互に所定の時間間隔で行う訓練を患者に実行させる。 The control device 50 causes the patient to perform a training in which a resting state and an expression of an exercise plan are alternately performed at predetermined time intervals by an operation from the operation unit 40 and a control to the presentation device 20 and the electric appliance 30. .
　リハビリテーションの訓練は、操作部４０からの開始指示によって開始される。作業療法士の操作により操作部４０から開始指示が訓練制御部５３に入力され、一連の訓練のプロセスが実行される。 リ Rehabilitation training is started by a start instruction from the operation unit 40. A start instruction is input from the operation unit 40 to the training control unit 53 by the operation of the occupational therapist, and a series of training processes is executed.
　図３に示すように、リハビリテーションの１回の訓練（以下、「訓練シーケンス」）は安静期間と運動企図の表出を行う企図期間とを含んで構成される。安静期間では、患者はリラックスして特定の思考を想起しないことが求められる。一方、企図期間では、患者は運動企図を表出することが求められる。企図期間は、運動企図期間と呼ぶことがある。安静期間および企図期間の長さは、例えば、各５秒間に設定される。 As shown in FIG. 3, one rehabilitation exercise (hereinafter referred to as “training sequence”) includes a rest period and an intention period during which an exercise intention is expressed. During the rest period, the patient is required to relax and not recall specific thoughts. On the other hand, during the planning period, the patient is required to express an exercise plan. The planning period may be referred to as an exercise planning period. The length of the rest period and the planning period is set, for example, to 5 seconds each.
　そして、安静期間と運動企図期間を交互に行うことで訓練が進行する。１日あたり、例えば４０分程度の訓練時間が設定され、その中で制御装置５０は、上記訓練シーケンスを複数回繰り返す。換言すれば、１日あたり所定の訓練時間が終了するまで訓練シーケンスが実行される。患者１名に対しては、この訓練を例えば１０日間にわたって実行することでリハビリテーションの訓練とする。 And training progresses by alternately performing rest periods and exercise planning periods. For example, a training time of about 40 minutes is set per day, and the control device 50 repeats the training sequence a plurality of times. In other words, the training sequence is executed until the predetermined training time per day ends. For one patient, this training is performed for 10 days, for example, as a rehabilitation training.
　図２に示される訓練制御部５３は、安静期間と運動企図期間との切り替えタイミングを提示制御部５７に伝達する。提示制御部５７は、患者に対して画像表示部２２およびスピーカー２１を介してそのタイミングを提示する。 The training control unit 53 shown in FIG. 2 transmits the switching timing between the rest period and the exercise planning period to the presentation control unit 57. The presentation control unit 57 presents the timing to the patient via the image display unit 22 and the speaker 21.
　図４に、画像表示部２２に表示される情報の例を示す。画像表示部２２には、安静期間を示す安静期間枠２３と、企図期間を示す企図期間枠２４とが同じ時間軸上に並べられて表示される。時間の経過は、時間とともに左から右に移動する縦線２５によって表示される。また、患者に対する要請内容はメッセージボックス２６にも表示される。メッセージボックス２６は、安静期間には「リラックスしてください」等のメッセージを表示する。また、図５に示すように、メッセージボックス２６は、企図期間には「運動を企図してください」等のメッセージを表示する。 FIG. 4 shows an example of information displayed on the image display unit 22. On the image display unit 22, a rest period frame 23 indicating a rest period and an intention period frame 24 indicating an intention period are displayed side by side on the same time axis. The passage of time is displayed by vertical lines 25 that move from left to right with time. The request contents for the patient are also displayed in the message box 26. The message box 26 displays a message such as “Please relax” during the rest period. In addition, as shown in FIG. 5, the message box 26 displays a message such as “Please plan your exercise” during the planning period.
　また、図１に示す提示装置２０内のスピーカー２１は、安静期間の開始タイミングと、企図期間の開始タイミングとでは、異なる報知音を提示するようにしてもよい。この場合、患者は、安静期間と企図期間との切り替わりを聴覚的に認識できる。 Further, the speaker 21 in the presentation device 20 shown in FIG. 1 may present different notification sounds at the start timing of the rest period and the start timing of the planning period. In this case, the patient can audibly recognize the switching between the rest period and the planning period.
　次に、図２を参照して、訓練中の運動企図の分析のための脳波解析と患者への解析結果のフィードバックについて説明する。
　脳波受信部５１は、脳波送信部１３からの脳波を受信する。また、同時に訓練制御部５３からの脳波訓練タイミングを受信する。脳波測定装置１０は、訓練期間中には常に脳波を計測して脳波信号を送信している。脳波受信部５１は、訓練タイミングに基づいて、脳波信号から安静期間の脳波と、企図期間の脳波とを抽出することができる。 Next, an electroencephalogram analysis for analyzing an exercise plan during training and feedback of the analysis result to a patient will be described with reference to FIG.
The electroencephalogram reception unit 51 receives an electroencephalogram from the electroencephalogram transmission unit 13. At the same time, the brain wave training timing from the training control unit 53 is received. The electroencephalogram measurement apparatus 10 always measures an electroencephalogram and transmits an electroencephalogram signal during the training period. The electroencephalogram reception unit 51 can extract the electroencephalogram during the rest period and the electroencephalogram during the planning period from the electroencephalogram signal.
　ＥＲＤ検出部５２は、安静期間の脳波と企図期間の脳波とから、運動企図に関連した信号であるＥＲＤ信号を検出する。ＥＲＤは、運動企図の表出により変化する脳波であり、運動企図を表出しているときに特有に発生するとされる。患者が運動企図を正しく表出できている場合には、安静期間には、ＥＲＤ信号は検出されず、企図期間にのみＥＲＤ信号が検出されることになる。 The ERD detection unit 52 detects an ERD signal that is a signal related to the exercise plan from the brain wave during the rest period and the brain wave during the planning period. The ERD is an electroencephalogram that changes due to the expression of the exercise intention, and is uniquely generated when the exercise intention is expressed. If the patient can correctly express the exercise intention, the ERD signal is not detected during the rest period, and the ERD signal is detected only during the intention period.
　ＥＲＤ信号は、脳波の周波数パワーの時間変化によって求められる。所定の時間範囲において、特定の周波数、例えば１０Ｈｚ付近の周波数パワーの変化が、所定の時間継続して見られた場合には、ＥＲＤ信号が検出されたと判定される。 The ERD signal is obtained by the time change of the frequency power of the electroencephalogram. In a predetermined time range, if a change in frequency power at a specific frequency, for example, around 10 Hz, is continuously observed for a predetermined time, it is determined that an ERD signal has been detected.
　ＥＲＤ信号が検出されたと判定された場合には、フィードバック制御部５６によって患者に対するフィードバック情報が作成される。フィードバック情報は提示制御部５７を経由して、画像表示部２２の画面上に表示されたり（例えば図５の帯２７）、スピーカー２１から音響的に出力されたりする。 When it is determined that the ERD signal is detected, feedback information for the patient is created by the feedback control unit 56. The feedback information is displayed on the screen of the image display unit 22 via the presentation control unit 57 (for example, the band 27 in FIG. 5) or is acoustically output from the speaker 21.
　次に、図１、図４、および、図５を用いて訓練中の動作についてさらに説明する。
　図１に示されるように、１訓練シーケンスは、患者が電動装具３０の装着された指にペグＰをつまんだ状態において開始される。このため、ＥＲＤ信号が検出されたとき、電動装具３０のモータ３２の制御により、指が伸展し、ペグＰが落ちる。このとき、指の伸展に関わる神経機能に筋肉からフィードバックが付与され、神経機能の回復が促される。また、電動装具３０の駆動とともに、筋刺激電極３３により、指の伸展に関わる筋肉、例えば、総指伸筋に電気刺激が付与される。このため、指の伸展に関わる神経機能に筋肉からのフィードバックが付与され、神経機能の回復が促される。 Next, the operation during training will be further described with reference to FIG. 1, FIG. 4, and FIG.
As shown in FIG. 1, one training sequence is started in a state where the patient pinches the peg P on the finger on which the electric brace 30 is worn. For this reason, when the ERD signal is detected, the finger is extended by the control of the motor 32 of the electric appliance 30 and the peg P falls. At this time, feedback from the muscle is given to the nerve function related to finger extension, and recovery of the nerve function is promoted. Further, as the electric appliance 30 is driven, the muscle stimulation electrode 33 applies electrical stimulation to muscles related to finger extension, for example, the total finger extensor muscles. For this reason, feedback from the muscle is given to the nerve function related to finger extension, and the recovery of the nerve function is promoted.
　制御装置５０は、操作部４０の操作により訓練制御を開始する。訓練制御部５３は、安静期間と企図期間の訓練シーケンスを繰り返し提示できるように、提示制御部５７に指示を送る。提示制御部５７は、図４に示されるように訓練の実行中である旨をグラフ等により画像表示部２２に表示させる。安静期間の開始時と、企図期間の開始時には提示制御部５７に提示情報を作成させ、スピーカー２１に報知音を提示させる。患者は、スピーカー２１からの報知音、および、画像表示部２２の表示内容の少なくとも一方から企図期間に移行した旨を認識し、運動企図の表出を行う。安静期間および企図期間においては、図５に示されるように、ＥＲＤの減衰率の計算結果２８がグラフによって連続的に表示され、そのＥＲＤの減衰率が一定以上の場合に、ＥＲＤが検出されたと判定し、その時間区間は例えば帯２７のような視覚フィードバック情報として画像表示部２２に追加的に表示される。また、聴覚フィードバック情報として、スピーカー２１からＥＲＤが検出された旨が報知される。また、モータ制御部５８および筋刺激制御部５９によって電動装具３０から体性感覚フィードバックが行われる。画像表示部２２からの視覚フィードバック情報及びスピーカー２１からの聴覚フィードバック情報は、電動装具３０を介さないフィードバックすなわち非体性感覚フィードバックと呼ぶことがある。 The control device 50 starts training control by operating the operation unit 40. The training control unit 53 sends an instruction to the presentation control unit 57 so that the training sequence of the rest period and the planning period can be repeatedly presented. As shown in FIG. 4, the presentation control unit 57 displays on the image display unit 22 by a graph or the like that training is being performed. At the start of the rest period and at the start of the planning period, the presentation control unit 57 creates presentation information and causes the speaker 21 to present a notification sound. The patient recognizes that it has shifted to the planning period from at least one of the notification sound from the speaker 21 and the display content of the image display unit 22, and expresses the exercise plan. In the rest period and the planning period, as shown in FIG. 5, the calculation result 28 of the ERD attenuation rate is continuously displayed by the graph, and the ERD is detected when the ERD attenuation rate is not less than a certain value. The time interval is additionally displayed on the image display unit 22 as visual feedback information such as the band 27, for example. Further, the auditory feedback information that the ERD has been detected is notified. Further, somatic sensory feedback is performed from the electric appliance 30 by the motor control unit 58 and the muscle stimulation control unit 59. The visual feedback information from the image display unit 22 and the auditory feedback information from the speaker 21 may be referred to as feedback not via the electric appliance 30, that is, non-somatosensory feedback.
　これらの処理によって、患者が運動企図を表出した場合に、制御装置５０を介して擬似的に体性感覚のフィードバックを与えることができ、擬似的に思ったとおりに体が動いたという体験が可能になる。これを繰り返すことでリハビリテーションが進められる。 Through these processes, when the patient expresses an exercise plan, pseudo-somatic feedback can be given via the control device 50, and the experience of moving the body as expected can be experienced. It becomes possible. Rehabilitation is advanced by repeating this.
　以上のように、リハビリテーションシステムによって訓練が実施される。
　次に、本願発明者が着眼した患者の特性について説明する。患者の障害の回復度合いに関して、以下の文献に着目した。 As described above, training is performed by the rehabilitation system.
Next, characteristics of the patient focused on by the inventor will be described. With regard to the degree of recovery of the patient's disability, we focused on the following literature.
　「Westlake et.al, “Resting state alpha-band functional connectivity and recovery after stroke”, Experimental Neurology 237 (2012) p160-169」
　上記文献によれば、患者の脳磁図、特にα帯（８～１３ヘルツ）の活動強度と虚血性発作の患者の回復具合が関連しているという知見が記載されている。このα帯の活動強度が強い場合には、脳の可塑性が高まっていると考えられること、また、α帯の活動強度は脳波でも推定可能なことから、発明者らはリハビリテーションシステムにもこの知見が導入可能であると考えた。 “Westlake et.al,“ Resting state alpha-band functional connectivity and recovery after stroke ”, Experimental Neurology 237 (2012) p160-169”
According to the above-mentioned document, the knowledge that the patient's magnetoencephalogram, particularly the activity intensity of α band (8-13 Hz) is related to the recovery status of patients with ischemic stroke is described. When this α-band activity intensity is strong, it is considered that the plasticity of the brain is increased, and since the activity intensity of the α-band can also be estimated by an electroencephalogram, the inventors have also found this knowledge in the rehabilitation system. Thought that it could be introduced.
　具体的には発明者らはこの知見から、α帯の活動強度に応じてリハビリテーションのスケジュールを調整することで、リハビリテーションの効果の向上に貢献できることに着想した。 Specifically, based on this knowledge, the inventors have come up with the idea that adjusting the rehabilitation schedule according to the activity intensity of the α band can contribute to the improvement of the rehabilitation effect.
　スケジュール決定部５４は、α帯の活動強度に基づいてリハビリテーションのスケジュールを作成し、訓練制御部５３内のメモリ（図示略）に記憶させる。スケジュールは、複数日間にわたるものである。スケジュールは、各日において訓練シーケンスを繰り返す時間や回数を定めている。訓練制御部５３は、スケジュール決定部５４により作成されたスケジュールに基づいて訓練制御を実行する。 The schedule determination unit 54 creates a rehabilitation schedule based on the activity intensity of the α band and stores it in a memory (not shown) in the training control unit 53. The schedule spans multiple days. The schedule defines the time and number of times to repeat the training sequence on each day. The training control unit 53 executes training control based on the schedule created by the schedule determination unit 54.
　訓練制御部５３は、各日のリハビリテーションの開始前にメモリからスケジュールを読み込む。訓練制御部５３は、スケジュールにより定められた時間が経過するまで訓練シーケンスを繰り返す。訓練制御部５３は、スケジュールにより定められた時間が経過したとき、訓練制御を終了し、その日のリハビリテーションを終了させる。 The training control unit 53 reads the schedule from the memory before starting the rehabilitation for each day. The training control unit 53 repeats the training sequence until the time determined by the schedule elapses. When the time determined by the schedule has elapsed, the training control unit 53 ends the training control and ends the rehabilitation for that day.
　図６を参照して、訓練のスケジュール決定処理について説明する。スケジュール決定処理は、各日のリハビリテーションの開始前に実施される。スケジュール決定処理は、患者に脳波測定装置１０を装着させ、かつ、患者が椅子に座る等して安静した状態において行われる。 The training schedule determination process will be described with reference to FIG. The schedule determination process is performed before the start of each day's rehabilitation. The schedule determination process is performed in a state where the patient is rested by wearing the electroencephalogram measurement apparatus 10 and sitting on a chair.
　制御装置５０は、ステップＳ１１において、操作部４０からの信号により、患者のＩＤ登録があるか否かを判定する。例えば、作業療法士により患者ＩＤの登録がない、すなわち、リハビリテーションの初日である旨の操作が行われたとき、患者のＩＤ登録がない旨を判定する。また、作業療法士により患者ＩＤの登録がある、すなわち、リハビリテーションの２日目以降である旨の操作が行われたとき、患者のＩＤ登録がある旨を判定する。 In step S11, the control device 50 determines whether there is a patient ID registration based on a signal from the operation unit 40. For example, when there is no registration of patient ID by an occupational therapist, that is, when an operation to the first day of rehabilitation is performed, it is determined that there is no registration of patient ID. Further, when the occupational therapist has registered the patient ID, that is, when an operation indicating that it is after the second day of the rehabilitation is performed, it is determined that the patient ID is registered.
　制御装置５０は、ステップＳ１１において、患者ＩＤの登録がない旨判定したとき、ステップＳ１２において訓練制御部５３は患者ＩＤを作成する。次に、周波数解析部５５は、ステップＳ１３において脳波測定装置１０からの信号に基づいて脳波受信部５１が受信した脳波から、α帯の活動強度を演算する。そして、スケジュール決定部５４は、ステップＳ１４において、α帯の活動強度に基づいてリハビリテーションのスケジュールを作成し、訓練制御部５３がこのスケジュールをリハビリテーションのスケジュールとして決定する。 When the control device 50 determines in step S11 that the patient ID is not registered, the training control unit 53 creates a patient ID in step S12. Next, the frequency analysis unit 55 calculates the activity intensity of the α band from the electroencephalogram received by the electroencephalogram reception unit 51 based on the signal from the electroencephalogram measurement apparatus 10 in step S13. In step S14, the schedule determination unit 54 creates a rehabilitation schedule based on the activity intensity of the α band, and the training control unit 53 determines this schedule as the rehabilitation schedule.
　具体的には、スケジュール決定部５４は、予め記憶されている基準のスケジュールを読み込み、α帯の活動強度が閾値よりも低いとき、１日のリハビリテーションの時間、および、リハビリテーションを行う日数の少なくとも一方が基準のスケジュールよりも長くなるようにスケジュールを作成する。また、訓練制御部５３、スケジュール決定部５４が決定したスケジュールを患者ＩＤと関連付けて内部のメモリに記憶する。なお、基準のスケジュールは、例えば、各日４０分、全体で１０日間であり得る。 Specifically, the schedule determination unit 54 reads a pre-stored reference schedule, and when the activity intensity of the α band is lower than the threshold, at least one of the rehabilitation time of the day and the number of days of rehabilitation Create a schedule so that is longer than the reference schedule. Further, the schedule determined by the training control unit 53 and the schedule determination unit 54 is stored in the internal memory in association with the patient ID. Note that the reference schedule may be, for example, 40 minutes each day for a total of 10 days.
　スケジュールを長くする調整方法としては、例えば、（１）各日の４０分の訓練時間を例えば５０分、６０分等に長くして、１日あたりのシーケンス繰り返し数を増やす、（２）１回の訓練時間４０分は変更せず、１日あたりの訓練回数を午前と午後の２回にするなどして、１日当りの訓練回数を増やす、（３）訓練日数を長くする、などが含まれる。 As an adjustment method to lengthen the schedule, for example, (1) increase the number of sequence repetitions per day by increasing the training time of 40 minutes for each day to, for example, 50 minutes, 60 minutes, etc. (2) 1 time The training time of 40 minutes is not changed, and the number of trainings per day is increased to twice in the morning and afternoon, etc., and the number of trainings per day is increased. (3) The number of training days is increased. .
　他方、制御装置５０は、ステップＳ１１において、患者ＩＤの登録がある旨判定したとき、すなわち、リハビリテーションの２日目以降である旨判定したとき、ステップＳ１５に進む。そして、訓練制御部５３は、ステップＳ１５において患者ＩＤから患者ＩＤと関連付けて記憶されているスケジュールをメモリから読み込み、訓練制御部５３がこのスケジュールにしたがって訓練のための提示装置２０に対する制御を行う。 On the other hand, when it is determined in step S11 that the patient ID has been registered, that is, when it is determined that the patient ID is after the second day of rehabilitation, the control device 50 proceeds to step S15. And the training control part 53 reads the schedule memorize | stored in association with patient ID from patient ID in step S15 from memory, and the training control part 53 performs control with respect to the presentation apparatus 20 for training according to this schedule.
　リハビリテーションシステム１は、以下の作用および効果を奏する。
　（１）実施形態のリハビリテーションシステム１と図７に示す参考例のリハビリテーションシステムとの違いについて説明する。図７に示す参考例のリハビリテーションシステムは、周波数解析部５５およびスケジュール決定部５４を備えていない点において実施形態のリハビリテーションシステム１とは相違している。図７に示す参考例のリハビリテーションシステムの訓練制御部５３は、患者の障害の程度や可塑性の状態に関わらず、予め設定された訓練回数分の訓練を実施するのみである。このため、患者に適した訓練量の設定はされていない。 The rehabilitation system 1 has the following operations and effects.
(1) The difference between the rehabilitation system 1 of embodiment and the rehabilitation system of the reference example shown in FIG. 7 is demonstrated. The rehabilitation system of the reference example shown in FIG. 7 is different from the rehabilitation system 1 of the embodiment in that the frequency analysis unit 55 and the schedule determination unit 54 are not provided. The training control unit 53 of the rehabilitation system of the reference example shown in FIG. 7 only performs training for a preset number of times of training regardless of the degree of disorder and plasticity of the patient. For this reason, the training amount suitable for a patient is not set.
　実施形態のリハビリテーションシステム１の制御装置５０は、周波数解析部５５およびスケジュール決定部５４を備えている。この制御装置５０は、患者の脳波を測定し、測定した脳波に基づいてリハビリテーションのスケジュールを作成する。すなわち、リハビリテーションの開始前において患者の予後が良好になるスケジュールを作成することができる。このため、患者に応じたリハビリテーションを行うことができる。患者の可塑性の程度に応じて訓練スケジュールを決定できるため、より効果的な訓練が可能なリハビリテーションシステム１が提供できる。 The control device 50 of the rehabilitation system 1 according to the embodiment includes a frequency analysis unit 55 and a schedule determination unit 54. The control device 50 measures a patient's brain wave and creates a rehabilitation schedule based on the measured brain wave. That is, it is possible to create a schedule that improves the prognosis of the patient before the start of rehabilitation. For this reason, rehabilitation according to a patient can be performed. Since the training schedule can be determined according to the degree of plasticity of the patient, the rehabilitation system 1 capable of more effective training can be provided.
　（２）制御装置５０は、脳波のうちのα帯の活動強度に応じてスケジュールを作成する。α帯の活動強度は、患者の予後とよく相関する。このため、患者の予後を良好なものにすることに貢献できる。 (2) The control device 50 creates a schedule according to the activity intensity of the α band of the electroencephalogram. The intensity of α-band activity correlates well with the patient's prognosis. For this reason, it can contribute to making a patient's prognosis favorable.
　（３）制御装置５０は、α帯の活動強度が低いとき、α帯の活動強度が高いときよりもリハビリテーションの期間が長くなるようにスケジュールを作成する。すなわち、α帯の活動強度に基づいてリハビリテーションによる効果が低いと推定される患者に、特に可塑性が高いとされるリハビリテーション初期にリハビリテーションを長く行わせることができるため、患者の予後を良好なものにできる。 (3) The control device 50 creates a schedule so that the rehabilitation period is longer when the activity intensity of the α band is low than when the activity intensity of the α band is high. In other words, patients who are estimated to have low rehabilitation effects based on the activity intensity of the α band can be rehabilitated for a long time in the early stage of rehabilitation, which is considered to be highly plastic, so the patient's prognosis is improved. it can.
　（４）制御装置５０は、初日のリハビリテーションの開始前に複数日間にわたるスケジュールを作成する。このため、リハビリテーションの初日を含む開始初期から患者に応じたスケジュールでリハビリテーションを行うことができる。このため、患者の予後をより良いものにすることに貢献できる。 (4) The control device 50 creates a schedule for a plurality of days before the start of rehabilitation on the first day. For this reason, rehabilitation can be performed according to the schedule according to the patient from the beginning of the start including the first day of rehabilitation. For this reason, it can contribute to making a patient's prognosis better.
　本発明のリハビリテーションシステム１は、上記実施形態に限定されず、例えば以下のように変形してもよい。技術的に可能な範囲においていくつかの変形例を適宜組み合わせてもよい。
　・制御装置５０は、２日目以降であっても訓練開始前の脳波のα波の活動強度によって、可塑性が低いと判断された場合には、その後のスケジュールを変更することもできる。例えば、２日目以降にα波の活動強度が低い場合には、１日の訓練時間を増やすようにスケジュール変更してもよい。この構成によれば、毎日の活動強度に応じて、訓練量を柔軟に設定できる。 The rehabilitation system 1 of this invention is not limited to the said embodiment, For example, you may deform | transform as follows. Several modifications may be combined as appropriate within the technically possible range.
-The control apparatus 50 can also change a subsequent schedule, when it is judged that plasticity is low by the activity intensity | strength of the alpha wave of the electroencephalogram before training start even after the 2nd day. For example, when the activity intensity of the α wave is low after the second day, the schedule may be changed to increase the daily training time. According to this configuration, the training amount can be flexibly set according to the daily activity intensity.
　・α帯の活動強度が高いとき、基準のスケジュールよりも１日のリハビリテーションの時間、および、リハビリテーションを行う日数の少なくとも一方をα帯の活動強度が低いときよりも短くするようにスケジュールを作成することもできる。 ・ When the activity intensity in the α band is high, create a schedule so that at least one of the rehabilitation time of the day and the number of days for rehabilitation is shorter than when the activity intensity in the α band is low. You can also.
　・α帯の活動強度が低いほど、１日のリハビリテーションの時間、および、リハビリテーションを行う日数の少なくとも一方が長くなるようにスケジュールを作成することもできる。この場合、基準のスケジュールに代えて、α帯の活動強度とリハビリテーションの時間および日数との関係マップを予めメモリに記憶しておくこともできる。 ・ The schedule can be created so that at least one of the rehabilitation time and the number of days of rehabilitation becomes longer as the activity intensity in the α band is lower. In this case, instead of the standard schedule, a relationship map between the activity intensity of the α band and the rehabilitation time and number of days can be stored in advance in a memory.
　・制御装置５０は、単日のリハビリテーションのスケジュールを作成することもできる。この場合、作業療法士等により定められたリハビリテーションの期間において、各日のリハビリテーションの開始前に、脳波に基づいてその日のリハビリテーションのスケジュールを作成するようにできる。 The control device 50 can create a daily rehabilitation schedule. In this case, during the rehabilitation period determined by the occupational therapist or the like, the rehabilitation schedule for the day can be created based on the electroencephalogram before the start of the rehabilitation for each day.
　・分析の周波数帯はα波のみに限らず、全周波数帯の強度を用いてスケジュールを作成することもできる。
　・簡易なシステムとするため筋刺激制御部５９および筋刺激電極３３、または、モータ制御部５８およびモータ３２を省略することもできる。 -The frequency band for analysis is not limited to α waves, and a schedule can be created using the intensity of all frequency bands.
The muscle stimulation control unit 59 and the muscle stimulation electrode 33, or the motor control unit 58 and the motor 32 can be omitted for a simple system.
　・患者の下肢に装着する形状の電動装具３０に変更することもできる。
　・脳波受信部５１、ＥＲＤ検出部５２、訓練制御部５３、スケジュール決定部５４、周波数解析部５５、フィードバック制御部５６、提示制御部５７、モータ制御部５８、および、筋刺激制御部５９は、ハードウェアであってもよく、ＣＰＵがＲＯＭに記憶された制御プログラムを実行することによってソフトウェア的に実現されてもよい。 -It can also change into the electric appliance 30 of the shape with which a patient's leg is mounted | worn.
The electroencephalogram reception unit 51, the ERD detection unit 52, the training control unit 53, the schedule determination unit 54, the frequency analysis unit 55, the feedback control unit 56, the presentation control unit 57, the motor control unit 58, and the muscle stimulation control unit 59 are Hardware may be sufficient and it may be implement | achieved like software, when CPU runs the control program memorize | stored in ROM.
　・脳波受信部５１、ＥＲＤ検出部５２、訓練制御部５３、スケジュール決定部５４、周波数解析部５５、フィードバック制御部５６、提示制御部５７、モータ制御部５８、および、筋刺激制御部５９は、制御装置５０であり得る一つのプロセッサによって実現されてもよく、制御装置５０に含まれる複数のプロセッサによって実現されてもよい。 The electroencephalogram reception unit 51, the ERD detection unit 52, the training control unit 53, the schedule determination unit 54, the frequency analysis unit 55, the feedback control unit 56, the presentation control unit 57, the motor control unit 58, and the muscle stimulation control unit 59 are It may be realized by one processor which may be the control device 50, or may be realized by a plurality of processors included in the control device 50.
　本発明は、例示したものに限定されるものではない。例えば、例示した特徴が本発明にとって必須であると解釈されるべきでなく、本発明の主題は、開示した特定の実施形態の全ての特徴より少ない特徴に存在することがある。 The present invention is not limited to the illustrated example. For example, the illustrated features should not be construed as essential to the invention, and the subject matter of the invention may reside in fewer features than all the features of the specific embodiments disclosed.
　１…リハビリテーションシステム、１０…脳波測定装置、２０…提示装置、３０…電動装具、４０…操作部、５０…制御装置。 DESCRIPTION OF SYMBOLS 1 ... Rehabilitation system, 10 ... Electroencephalogram measuring apparatus, 20 ... Presentation apparatus, 30 ... Electric appliance, 40 ... Operation part, 50 ... Control apparatus.

Claims (6)

  1. 　脳波測定装置と、
    　患者に対して情報を提示するように構成される情報提示装置と、
    　患者の身体に装着されて、電気的刺激もしくは力学的刺激を与えるように構成される電動装具と、
    　前記脳波測定装置によって計測された脳波から運動企図に関連した信号を抽出し、少なくともその信号に基づいて運動企図が正しく表出されたと判定された場合に、前記情報提示装置と前記電動装具から患者にフィードバックを与えるべく、前記情報提示装置と前記電動装具を制御する制御装置とを備え、
    　前記制御装置は、訓練前の脳波の解析結果に応じて訓練量を決定するように構成される、リハビリテーションシステム。     An electroencephalograph,
    An information presentation device configured to present information to a patient;
    An electric brace that is worn on the patient's body and configured to provide electrical or mechanical stimulation;
    When a signal related to an exercise plan is extracted from an electroencephalogram measured by the electroencephalogram measurement apparatus and it is determined that the exercise plan is correctly expressed based on at least the signal, the patient is obtained from the information presentation device and the electric appliance. In order to give feedback to, the information presentation device and a control device for controlling the electric appliance,
    The control device is a rehabilitation system configured to determine a training amount according to an analysis result of an electroencephalogram before training.
  2. 　前記制御装置は、α帯の活動強度を分析するように構成される、請求項１に記載のリハビリテーションシステム。 The rehabilitation system according to claim 1, wherein the control device is configured to analyze the activity intensity of the α band.
  3. 　前記制御装置は、前記α帯の活動強度が低いときの訓練時間が、前記α帯の活動強度が高いときの訓練時間よりも長くなるようにスケジュールを作成するように構成される、請求項２に記載のリハビリテーションシステム。 The control device is configured to create a schedule such that a training time when the activity intensity of the α band is low is longer than a training time when the activity intensity of the α band is high. The rehabilitation system described in 1.
  4. 　前記制御装置は、１日あたりの訓練時間を増やすように構成される、請求項１～３のいずれか一項に記載のリハビリテーションシステム。 The rehabilitation system according to any one of claims 1 to 3, wherein the control device is configured to increase training time per day.
  5. 　前記制御装置は、毎日の訓練前に脳波計測を実施し、当日の訓練量を決定するように構成される、請求項１～４のいずれか一項に記載のリハビリテーションシステム。 The rehabilitation system according to any one of claims 1 to 4, wherein the control device is configured to perform electroencephalogram measurement before daily training and determine a training amount for the day.
  6. 　訓練前の脳波の解析結果に応じて前記制御装置が訓練量を決定することを備える、請求項１～５のいずれか一項に記載のリハビリテーションシステムの制御方法。 The control method of the rehabilitation system according to any one of claims 1 to 5, wherein the control device determines a training amount according to an analysis result of an electroencephalogram before training.
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