WO2018180400A1

WO2018180400A1 - Vibratory stimulation device

Info

Publication number: WO2018180400A1
Application number: PCT/JP2018/009387
Authority: WO
Inventors: 研太郎上杉; 優人本橋; 聡史宮島; 貴光岡山; 松井　淳
Original assignee: 帝人ファーマ株式会社
Priority date: 2017-03-29
Filing date: 2018-03-12
Publication date: 2018-10-04

Abstract

The present invention is characterized by being provided with: a vibrator that imparts vibration to the palm of a user; an extending action assistance mechanism that applies a load so as to extend a finger from the palm side of the user; and a finger stretching mechanism that comes into contact with the finger from the back of the hand side of the user.

Description

Vibration stimulator

The present invention relates to a vibration stimulation device.

Spasticity is defined by Lance et al. As “movement disorders dependent on upper motor neurons that cause an increase in exercise-speed-dependent stretch reflex and accompanied by increased tendon reflexes”. Cerebrovascular disorders such as cerebral infarction and cerebral hemorrhage It is caused by spinal cord injury. When spasticity occurs, muscle tone is remarkably increased. As a result, the range of motion of the joints and the sophistication of the movement are reduced. It becomes an inhibitory factor.

From such a background, a step (conditioning) is generally taken to relieve muscle tension caused by spasticity as much as possible before rehabilitation. By taking such steps, the reduction in the range of motion of the joint caused by the increased muscle tone due to spasticity is improved in the short term, and rehabilitation can be performed more effectively. However, since conditioning alone does not improve the long-term motor function, it is important to perform many rehabilitations such as physical therapy and occupational therapy in order to obtain a long-term improvement effect.

ストレッチ Stretching is the most commonly used means for conditioning, and thermotherapy and electrical stimulation are performed as others. However, all methods take time to achieve the effect. Currently, the conditioning time performed by the therapist is also considered as a part of rehabilitation, and this time is also calculated as a medical fee (rehabilitation fee for cerebrovascular disease, etc.). However, because there is an upper limit to the time that this medical treatment fee can be calculated in the medical insurance system (up to 9 units per day), the time required for rehabilitation, which is important for long-term improvement effects, is under pressure from conditioning. A sufficient amount is not secured. In addition, due to the revision of the 2016 medical remuneration regulations, outcome evaluation has been introduced in the convalescent rehabilitation ward, and the volume of rehabilitation exceeding 6 units per day cannot be calculated unless the outcome exceeds a certain level. In other words, more efficient rehabilitation is required. Against this background, it is important to reduce the conditioning time and ensure the maximum rehabilitation time.

In recent years, vibration stimulation has begun to attract attention as one of the conditioning means. Vibration stimulation has been reported to have a spasticity-suppressing effect after 5 minutes of treatment, and is useful for reducing conditioning time. However, since strong muscle contraction due to tension vibration reflex (TVR) is caused in the initial stage of vibration stimulation, it is necessary to keep the muscle stretched as much as possible in order to effectively perform vibration stimulation. There is.

In the device disclosed in Non-Patent Document 1, the wrist and fingers bent due to spasticity are stretched and fixed to the device with a strap, so that stretching and vibration stimulation can be simultaneously applied. .

However, in the device, since the fingers are not sufficiently fixed to the vibrator, the fingers are bent when attached to the device or when the treatment is performed, and the contact surface with the vibrating body is reduced, so that vibration stimulation is reduced. There is a problem that it is difficult to obtain sufficient effects. In addition, in patients with a narrow range of movement of the dynamic joint other than the fingers, the fingers cannot be fully extended and must be worn in a bent state, so a sufficient contact surface with the vibrating body is ensured. There is a problem that it is difficult.

Therefore, the present invention has been made in view of the above-described situation, and can sufficiently secure a contact surface with a vibrating body during treatment, and can be applied to a finger that can be applied even to a patient having a narrow range of dynamic joint motion other than the finger. An object of the present invention is to provide a vibration stimulation apparatus having a function.

The present invention includes a vibrator that applies vibration to a user's palm, an extension operation assisting mechanism that applies a load so as to extend a finger from the user's palm side, and abuts on the finger from the user's back side A vibration stimulating device including a finger stretching mechanism is provided.
According to the present invention, a finger in a bent state is extended by the extension operation assisting mechanism, and a finger is reliably extended by the finger extension mechanism, thereby sufficiently securing a contact surface with a vibrating body. Is possible.

The vibrator is fixed to the extension operation assisting mechanism, and the extension operation assisting mechanism changes its shape so that the load can be applied while maintaining a state in which the finger extension mechanism contacts the finger and palm. It may be possible.

The finger extension mechanism may include a mechanism for pressing a finger against the vibrator from the back side of the hand.
In this case, when the fingers are extended and fixed, the extension operation assisting mechanism and the finger extension mechanism apply a force so that the fingers are sandwiched from the palm side and the dorsal side, and the extension is maintained by holding the extension position. Since the finger can be securely fixed, it is possible to prevent the contact area between the finger and the vibrating body from being reduced due to bending of the finger during vibration stimulation, and to sufficiently obtain the effect of vibration stimulation.

You may provide the dorsiflexion angle adjustment mechanism which can adjust the dorsiflexion angle of a patient's wrist.
In this case, the wrist can be bent to an arbitrary angle in accordance with the range of motion of the wrist for each patient by the adjustment mechanism of the wrist dorsiflexion angle.

A sensor may be provided that detects a load applied to the finger by at least one of the extension operation assisting mechanism and the finger extension mechanism.
In this case, by adjusting the degree of extension of the finger by adjusting the degree of extension of the finger by adjusting the degree of extension of the finger by using a sensor that detects the load of the extension assisting mechanism, the degree of extension is adjusted. Is possible. In addition, the sensor for detecting the load of the finger extension mechanism prevents an excessive load from the back of the hand from being applied, and the extension degree can be adjusted according to the range of motion of the patient's finger.

The sensor that detects the load of the extension operation assisting mechanism may be a sensor that detects strain, displacement, and torque.

The sensor that detects the load of the finger extension mechanism may be a sensor that detects pressure, load, displacement, and torque.

The vibration stimulation apparatus may include a forearm stimulation unit including a vibrator that applies vibration to the user's forearm.
In this case, the extension of the fingers and the dorsiflexion of the wrist are performed by the extension operation assisting mechanism, the finger extension mechanism and the wrist dorsiflexion angle adjustment mechanism, so that the muscles of the forearm are simultaneously extended to the forearm. Even when vibration is applied, the effect of vibration stimulation can be sufficiently obtained in the forearm.

According to the present invention, the finger can be sufficiently fixed to the vibrator, the finger is bent when the device is attached to the apparatus or when the treatment is performed, the reduction of the contact surface with the vibrating body is prevented, and the effect of vibration stimulation is obtained. You can get enough. In addition, even in patients with a narrow range of dynamic joint motion other than fingers, contact with the vibrating body can be achieved by applying force in the direction of extending the fingers to the fingers or the entire palm while maintaining contact with the fingers and palm. A sufficient surface can be secured.

BRIEF DESCRIPTION OF THE DRAWINGS It is the schematic (state with the lid | cover opened) of the whole vibration stimulation apparatus of this invention. It is sectional drawing before using the vibration stimulation apparatus finger stimulation part of this invention (state which the cover closed). It is the schematic in use of the vibration stimulation apparatus finger stimulation part of this invention (a state with the lid opened). It is sectional drawing in the use of the vibration stimulating device finger stimulation part of this invention (state which the cover closed). It is sectional drawing (air bag) after extension at the time of extension auxiliary mechanism wearing of the present invention wearing. It is sectional drawing of the adjustment mechanism of the wrist dorsiflexion angle of this invention. It is sectional drawing of the adjustment mechanism of the wrist dorsiflexion angle of this invention. It is the schematic in use of the whole vibration stimulation apparatus of this invention. It is sectional drawing before extension at the time of mounting | wearing with the extension assistance mechanism (joint drive body) of this invention. It is sectional drawing after extension at the time of mounting | wearing with the extension assistance mechanism (joint drive body) of this invention. It is the curved surface shape of the finger | toe or hand back contact surface of the expansion | extension mechanism of this invention. It is the protrusion shape of the finger | toe or hand back contact surface of the expansion | extension mechanism of this invention. It is the shape before using the up-and-down mechanism of the contact surface in the extending | stretching mechanism of this invention. It is the shape in use of the up-and-down mechanism of the contact surface in the extending | stretching mechanism of this invention. It is sectional drawing before use of the up-and-down mechanism of the contact surface in the extension mechanism of the present invention. It is sectional drawing in use of the up-and-down mechanism of the contact surface in the expansion | extension mechanism of this invention. It is the schematic before mounting | wearing with the extension assistance mechanism (by a level | step difference) of this invention. It is the schematic at the time of mounting | wearing with the extension assistance mechanism (by a level | step difference) of this invention. It is sectional drawing before extension at the time of mounting | wearing with the extension assistance mechanism (by a level | step difference) of this invention. It is sectional drawing after extending | stretching at the time of mounting | wearing with the extension assistance mechanism (by a level | step difference) of this invention.

Hereinafter, a vibration stimulation apparatus which is a preferred example according to an embodiment of the present invention will be described with reference to the accompanying drawings.

[Description of device]
The outline of the vibration stimulation apparatus according to the present embodiment will be described with reference to FIG. The vibration stimulating apparatus 1 according to the present embodiment applies vibration stimulation to the finger part of a spastic patient in order to relieve muscle tension (spasticity) caused by cerebrovascular disorders such as cerebral infarction and cerebral hemorrhage and spinal cord injury. Used for. As shown in FIG. 1, the vibration stimulation apparatus 1 includes a forearm stimulation unit 2 that applies vibration stimulation to a forearm and a finger stimulation unit 3 that applies vibration stimulation to a finger.
The finger stimulating unit 3 according to the present embodiment includes a finger extension assisting unit 4 that assists the extension of the finger from the palm side, a lid unit 5 that contacts the finger or the back of the hand and extends the finger, and an extension assisting unit. The vibrating body 6 for imparting vibration, the fixing tool 7 for fixing the finger to the extension assisting part, and the finger extension assisting part 4 so as not to extend the finger beyond the movable range of the finger on the side contacting the palm. A sensor (not shown) for preventing an excessive load from being applied and a sensor 8 for preventing an excessive load from being applied to the finger or the back of the hand by the lid 5 are provided.

The finger extension assisting unit 4 can apply a force in the direction of extending the finger or the entire palm while maintaining a state in which the finger and palm of the spastic patient are in contact with each other, and is shaped in accordance with the extension of the finger. It is configured to be deformable. The extension here refers to an operation of opening a finger from a state such as a fist. Hereinafter, a state in which the finger is opened may be referred to as an extended state.

In the present embodiment, as shown in FIG. 2, the finger extension assisting portion 4 is formed of an air bag 9 that can be deformed by supplying air from an air inlet (not shown). The end of the air bag 9 is attached to the main body 14 with a hook-and-loop fastener or a double-sided tape. Before use, the air bag 9 is formed into an arc shape by an elastic body (not shown) such as an arc shape in the air bag 9. keeping. By sending air from the air inlet, the elastic body is deformed by air pressure and changes from a substantially arc shape to a substantially horizontal shape. Since the change of the air bag 9 from the arc shape to the horizontal shape is close to the operation of extending the finger from the bent state, the extending operation of the finger can be assisted without giving the user a sense of incongruity. The shape of the air bag 9 before use does not necessarily need to be an arc shape and can be changed as appropriate. Although not shown, the upper portion of the air bag 9 is made of a material having a high elastic modulus, and the lower portion is made of a material having a low elastic modulus. By sending air to the air bag 9, the lower portion is made lower than the material having a high elastic modulus. The portion having a low elastic modulus swells and the upper part of the air bag 9 changes from an arc shape to a horizontal shape.
Two vibrating bodies 5 are fixed to the upper portion of the air bag 9, that is, a vibrating body 51 that mainly applies vibration to the fingers and a vibrating body 52 that mainly applies vibration to the palm. The vibrating body 5 is a vibrating body using, for example, an eccentric motor or a piezoelectric element. The number of vibrating bodies is not limited to two, but may be one or three or more. Moreover, the upper part of the air bag 9 may have a structure in which the vibrating body 6 does not hinder the extension of fingers by forming a recess to which the vibrating body 5 can be fixed.

A fixing tool 7 is attached to the upper part of the air bag 9 for fixing after the fingers and palms are installed. One or a plurality of the fixtures 7 are provided in the vibration stimulating device, and are for fixing fingers and palms to the finger extension assisting unit 4. The fixing tool 7 is fixed to the main body part 14 so that the position thereof does not change with respect to the displacement of the extension assisting part 4. The fixing tool 7 is applied with a certain force on the fingers or the back of the fingers or fingers when the fingers or the back of the fingers extended by the finger extension assisting unit 4, which can use rubber, a hook-and-loop fastener, a belt, or the like, abuts the fixing tools 7. This force stretches the fingers or back of the hand. Here, the extension is an operation of further extending the fingers in the extended state.

The lid portion 5 is fixed to the main body portion 14 so as to be openable and closable so that the position thereof does not change with respect to the displacement of the finger extension assisting portion 4. The lid portion 5 is provided on the upper side of the back of the hand with the lid portion 5 closed, and includes a contact surface 10 that comes into contact with a finger on the back side of the hand or the back of the hand. The contact surface 10 is fixed to the lower surface of the lid 5. The finger or the back of the hand extended by the finger extension assisting unit 4 abuts against the abutment surface 10 so that a constant force of the finger or the back of the hand is applied. This force stretches the fingers or back of the hand.

The shape of the finger 10 on the dorsal side of the lid 5 or the contact surface 10 to the back of the lid 5 is, for example, a planar shape as shown in FIG.

The finger extension assisting unit 4 adjusts the degree of extension according to the range of movement of the user's finger so as not to extend the finger excessively. Therefore, a sensor for detecting the load on the finger is provided. It is provided inside or on the surface. The maximum stretchable amount by which the fingers can be extended varies depending on the patient's condition, and applying a load in the direction of extending the fingers beyond that can be painful for the patient. In the present embodiment, when the finger extension assisting unit 4 extends the patient's finger in a bent state, it is applied to the patient's finger so as not to apply a load in the direction in which the finger extends beyond the maximum extendable amount of the patient. The load is measured by a sensor. The sensor may be, for example, a sensor that detects strain or displacement of the finger extension assisting unit 4, or may be a sensor that detects torque applied to the finger extension assisting unit 4. Since the range of finger movement varies depending on the user's symptoms and body shape, it is preferable that the degree of finger extension by the finger extension assisting unit 4 can be made according to the user. For example, by adjusting the amount of air supplied to the air bag 9 while the therapist confirms the strain, displacement, and torque detected by the sensor, an appropriate degree of progress corresponding to the patient is adjusted. Even if the air is automatically supplied, the sensor detects the preset values such as strain, displacement, and torque, and the degree of extension is adjusted by automatically adjusting the air supply. Good.

The sensor 8 for detecting the load applied to the finger of the lid 5 is applied to the finger or the back of the lid 5 as shown in FIGS. 3 and 4 in order to prevent an excessive load from the dorsal side. It is arranged at the position where it touches.

The sensor 8 that detects the load applied to the finger of the lid 5 is, for example, a pressure sensor or a load sensor. Based on the detected information, it is possible to adjust the load applied to the finger from the back of the hand or to apply a constant load.

The finger stimulating device 3 includes an angle adjusting mechanism 11 at a connection portion with the forearm stimulating unit 2 for stimulating the forearm as shown in FIG. The angle adjustment mechanism 11 is provided for the connection between the finger stimulating unit 3 and the forearm stimulating unit 2 and the dorsiflexion of the wrist. As shown in FIG. 8, the angle adjustment mechanism 11 includes a pedestal 12 and a plurality of adjustment holes 13 that are circumferentially provided in the pedestal 12 at predetermined intervals. The main body portion 14 includes a fixed shaft 15 and a hole through which the fixed shaft 15 passes. By passing the fixing shaft 15 through a hole (not shown) provided in the adjustment hole 13 and the main body part 14, the main body part 14 and the base part 12 can be fixed at a predetermined angle. The angle adjustment mechanism 11 is provided with an adjustment hole 13 at a constant angle between 0 ° and 90 °, for example, and can rotate and fix the finger stimulating unit 3 around a predetermined rotation axis. The dorsiflexion angle can be adjusted quantitatively according to the range of flexion.

[Device usage example]
A usage example of the vibration stimulation apparatus according to the present embodiment will be described with reference to FIGS.
When attaching a finger to the vibration stimulating device, first, as shown in FIG. 3, the finger and palm are brought into contact with the air bag 9 of the vibration stimulating device with the lid 5 in an open state before the shape deformation. The finger and palm are fixed to the air bag 9 by the fixing tool 7.

Next, as shown in FIG. 4, the lid 5 is closed. Then, by operating the finger extension assisting unit 4, a load is applied in the direction in which the fingers extend with respect to the fingers, and the fingers are extended.

At this time, the load applied to the fingers is, for example, a load generated in the process of supplying air to the arc-shaped air bag 9 shown in FIGS.

In the case of extending the finger with the air bag 9, the air bag expands while the shape of the air bag is deformed, so that the hand is extended with the air bag in contact with the finger and palm, and at the same time, the contact surface 10 of the lid 5 and The finger on the back side of the hand and the back of the hand abut on the fixture 7, and a load is applied to the finger and the back of the hand from the finger extension part 4.

The abutment surface 10 of the lid 5 and the fixture 7 can obtain a stretching effect by being brought into contact with the joint between the fingers and the back of the hand. In addition, since both the lid 5 and the fixture 7 are in contact with each other, a load is applied to a wider range of the fingers on the dorsal side and the back of the hand, which facilitates extension.

6 and 7, the wrist of the hand in the extended holding state is rotated and held between 0 ° and 90 ° by the angle adjusting mechanism 11 to hold the dorsiflexion at a certain angle. Can do.

Finally, vibration stimulus is applied by the vibrating body 5 in the finger extended position and the wrist dorsiflexion state.

This vibration stimulating device stretches fingers and dorsiflexes the wrist by the extension operation assisting portion 4, the lid portion 5 and the angle adjusting mechanism 11, so that the forearm muscle also has a stretching effect as shown in FIG. Obtainable. Therefore, by providing the forearm stimulation unit 2 with the vibrating body, the forearm fixture, and the vibrator pressing mechanism, it is possible to apply vibration while stretching the muscles in the forearm. Further, by stretching the forearm, it is possible to obtain the same effect as a stretch generally performed as a condition for spasticity, and it is possible to further obtain an effect of relieving muscle tension of the forearm. By combining the vibration stimulation devices of both the forearm stimulation unit 2 and the finger stimulation unit 3, it becomes possible to apply stretching and vibration stimulation simultaneously to the forearm and fingers.
According to this method, the fingers can be sufficiently fixed to the vibrator, the fingers bend when attached to the device or when the treatment is performed, the contact surface with the vibrating body is prevented from being reduced, and the effect of vibration stimulation is improved. You can get enough. In addition, even in patients with a narrow range of dynamic joint motion other than fingers, contact with the vibrating body can be achieved by applying force in the direction of extending the fingers to the fingers or the entire palm while maintaining contact with the fingers and palm. A sufficient surface can be secured.

[Other Embodiments]
As shown in FIGS. 9 and 10, the finger extension assisting unit 4 may be formed from a joint driver 16 having a plurality of joints, for example. The joint driver 16 has an arc shape before use, but can be changed into various shapes by driving a plurality of joints. The upper part of the joint driving body 16 may have a structure in which the vibrating body 5 does not hinder the extension of fingers by forming a recess to which the vibrating body 5 can be fixed. In addition, a fixture 7 for fixing the finger and palm after the finger and palm are installed is attached to the upper part of the joint driver 16. After the fingers and palm are placed on the joint driver 16 and restrained by the fixing tool 7, the fingers can be extended while maintaining the state in which the fingers and palm are in contact with each other. Moreover, since it has a plurality of joints, it can be adjusted according to the patient's range of motion.
In this case, the load that the finger receives from the contact portion is a load that is generated in a process in which the joint driving body 16 having a plurality of joints changes from an arc shape to a horizontal shape.

The shape of the finger 10 on the back side of the lid 5 or the contact surface 10 to the back of the lid 5 may be a curved surface as shown in FIG. In this case, there is an effect that a load for extending the finger more reliably can be applied to the finger or the back of the hand.

The shape of the finger 10 on the dorsal side of the lid 5 or the contact surface 10 to the back of the hand may be a plurality of protrusion shapes as shown in FIG. In this case, there is an effect that a load for extending the fingers more reliably can be applied to the fingers on the dorsal side or a plurality of locations on the back of the hands.

The lid portion 5 is located on the upper side of the back of the hand and includes a contact portion on the dorsal side of the finger or the back of the hand, and the contact surface 10 can move up and down as shown in FIGS. It may be configured such that a certain force can be applied so that the finger or the back of the hand extended by the finger extension assisting unit 4 contacts the contact surface 10. For example, as shown in FIGS. 13 and 14, when air is not put between the lid and the contact surface 10, a flat air bag 17 is installed and the air bag 17 is inflated to thereby contact the contact surface 10. Can be movable. 15 and 16, when the air bag 9 is inflated to the maximum and the abutment surface 10 does not contact the back of the hand, the air bag 17 is inflated and the lid portion 5 is lowered to lower the lid portion. 5 is brought into contact with the fingers on the dorsal side and the back of the hand. As a result, a load is applied to the back of the hand, and the fingers can be extended.

In the case where the fingers are extended by the joint driver 16 having a plurality of joints, after the fingers are extended by shape deformation, the lid portion 5 is lowered, and the contact surface 10 of the lid portion 5 is moved between the fingers on the dorsal side and the palm of the hand. , The load is applied from the lid 5 to the fingers and the dorsal side of the dorsal side. As a result, the fingers are held in the extended position.

As shown in FIGS. 17 to 20, the finger extension assisting unit 4 includes, for example, a step 22 for changing the height of the finger part and the palm part, and an air bag 9 is provided in each of the finger part and the palm part. Good. By changing the heights of the fingers and the palm part and each having the air bag 9 alone, the finger part can be positioned higher than the palm when the air bag 9 is inflated. By placing the finger part higher than the palm, it is possible to extend the finger part.

In the above-described embodiment, the fixture 7 and the contact surface 10 are in contact with the fingers and the back of the hand from the back of the hand, so that a load is applied to the fingers and the back of the hand from the finger extension portion 4. As shown in FIGS. 17 to 20, it is also possible to adopt a configuration in which only the fixture 7 abuts on the fingers and the back of the hand from the dorsal side without using the lid 5. In this case, the fixture 7 includes a sensor 8. Moreover, it can also be set as the structure which only the cover part 5 contact | abuts to a finger and a back from the dorsal side without using the fixing tool 7. FIG. According to these structures, compared with the case where both the cover part 5 and the fixing tool 7 are used, an apparatus can be simplified.

DESCRIPTION OF SYMBOLS 1 Vibration stimulator 2 Forearm stimulation part 3 Finger stimulation part 4 Finger extension assistance part 5 Finger expansion | extension part 6 Vibrating body 7 Fixing tool 8 Sensor 9 Air bag 10 Contact surface 11 Angle adjustment mechanism 13 Air bag 15 Fixed shaft 18 Lid

Claims

A vibrator that applies vibration to the palm of the user, an extension operation assisting mechanism that applies a load so as to extend a finger from the palm of the user, and a finger extension mechanism that contacts the finger from the back of the user A vibration stimulation device comprising:
The vibrator is fixed to the extension operation assisting mechanism, and the extension operation assisting mechanism changes its shape so that the load can be applied while maintaining a state in which the finger extension mechanism contacts the finger and palm. The vibration stimulator of claim 1, wherein
The vibration stimulation device according to any one of claims 1 to 2, wherein the finger extension mechanism includes a mechanism that presses a finger against the vibrator from a dorsal side.
The vibration stimulation device according to any one of claims 1 to 3, further comprising a dorsiflexion angle adjustment mechanism capable of adjusting a dorsiflexion angle of a patient's wrist.
The vibration stimulation device according to any one of claims 1 to 4, further comprising a sensor that detects a load applied to a finger by at least one of the extension operation assisting mechanism and the finger extension mechanism.
6. The vibration stimulation apparatus according to claim 5, wherein the sensor that detects the load of the extension operation assisting mechanism is a sensor that detects strain, displacement, and torque.
6. The vibration stimulation apparatus according to claim 5, wherein the sensor for detecting the load of the finger extension mechanism is a sensor for detecting pressure, load, displacement, and torque.
The vibration stimulation device according to any one of claims 1 to 7, further comprising a forearm stimulation unit including a vibrator that applies vibration to a user's forearm.