WO2019064321A1

WO2019064321A1 - Customised pelvic support to correct sitting posture

Info

Publication number: WO2019064321A1
Application number: PCT/IT2018/050180
Authority: WO
Inventors: Gian Pietro MAINARDI
Original assignee: Mainardi Gian Pietro
Priority date: 2017-09-28
Filing date: 2018-09-28
Publication date: 2019-04-04
Also published as: IT201700108909A1

Abstract

The seating orthoses currently available on the market do not provide an assessment of the individual posture of the single patient (posture of sacral flexion or extension), do not take into account the possible height difference of the iliac bones when sitting (PSIS measurement) and are not customizable to obtain a horizontal (and therefore correct) position of the sacrum when sitting. The present patent aims to solve the aforementioned problems by means of a pelvic support (apparatus and assembly method) which allows to obtain a horizontal (and therefore correct) position of the sacrum during the step of sitting. Said pelvic support consists of a base, an economically shaped saddle applicable to said base and a series of corrective buttons having different heights, which can be inserted between the base (101) and the saddle (100) and are necessary and functional to configure and customize the support itself. The possible insertion of said corrective buttons precedes the final assembly of the pelvic support and is evaluated on the basis of specific physiotherapeutic / osteopathic tests. Said tests allow to highlight any dysfunctions of the pelvis of the patient in order to be able to insert below the aforementioned saddle the corrective buttons, which are suitable to the case.

Description

Customised pelvic support to correct sitting posture

State of the art

The human pelvis represents an important instrument for the amortization of all the ascending and descending forces, to which we are all subjected when standing; in such position, there can be some imbalances at the level of the vertebral column, caused by a podalic problem, and in this case special plantar supports, which can correct this dysfunction, are available. In the sitting position, this "non-weight bearing" on the pelvic ring excludes the ascending forces and therefore concentrates all the weight against the lumbosacral column; moreover, due to postural imbalances, most people sit incorrectly and therefore further worsen the weight distribution to which the vertebral articular facets are subjected.

To cope with this problem, various chairs, cushions and ergonomic seats have been created over time, which only partially solve the problem. There are chairs (for example the well-known ergonomic Stokke chair), which neutralize a direct weight on the lumbosacral column, making the person assume a non-weight bearing posture on the knees. There are also cushions ( from the well-known Tempur company http://it.tempur.coi accessori/cuscini-per-seduta/ ) made of so-called memory foam materials cushioning the weight and giving a temporary imprint of a person sitting. Other solutions finally take into account the flexion behaviour (posterior base of the sacrum) of the sacrum and therefore induce, with an inclination towards the front of the cushion, the maintenance of a more upright posture. Finally, there are chairs assembled with cushions having special holes where it is possible to lay the bones of the pelvis when sitting in order to unload the weight thereof.

Over time, there have been provided solutions for modular seats to improve the quality of the seat or to reproduce orthopaedic forms such as in US 4 744 351 A (GRUNDEI HANS [DE] ET AL, 1988-05-17), but said solutions produced poor results in terms of comfort due to the uneven surface, the poor ergonomics and the seating surface. In other cases, such as in DE 202 17 645 Ul (HSU CHIN CHENG [TW], 2003-03-13), there have been realised modular seats, which instead guaranteed the comfort of the entire seating area and, in particular, of the external surface of the pelvic support, but without having corrective and therapeutic functions. Finally, there are modular solutions based on recessed seat systems characterised by an ergonomic shape, but wherein said cavity was designed to obtain a ventilation of the seat such as in US 5 226 188 A (LIOU YAW- TYNG [TW], 1993-07-13) and therefore very far in conceptual terms from the technical problem addressed in this context.

In particular, all the above-mentioned solutions and, in particular, the seating orthoses currently available do not provide an assessment of the individual posture of the single patient (behaviour of sacral flexion or extension), do not take into account the possible height difference of the iliac bones when sitting (the so-called PSIS measurement) and are not modular and above all characterised by a shape of the saddle which can be corrected and customised to obtain a horizontal and correct position of the sacrum when sitting. Technical field

The solution of the invention aims to improve, through the correction of the sitting posture, the condition of those already suffering from problems of chronic low back pain (the main cause of absenteeism in the world), but also to maintain the well-being of those who do not have particular dysfunctions and want to prevent them as in the case of those who work for many hours sitting or those who have a disability that forces them in that position. The proposed solution is also proposed as a valid tool to prevent lumbosacral pathologies or dorsal adaptive torsions (postural scoliosis) of school-age individuals who in the delicate developmental age are to spend many hours sitting at school. The aforementioned objects are to be achieved by means of an apparatus (individual and customizable pelvic support) which allows to: evaluate the main postural problem through specific physiotherapeutic / osteopathic tests;

• mechanically evaluate the height difference of the posterior-superior iliac spines (PSIS) of the patient;

• create, on the basis of the aforementioned information, a customised pelvic support, and correct possible dysfunctions by means of appropriate rises made up of several corrective buttons of different dimensions which can be integrated into the support itself;

• impressing on said base an ischial imprint (bones of the pelvis on which the pelvis rests) and then create a customised seat. The pelvic support thus obtained will allow to obtain a horizontal (and therefore correct) position of the sacrum when sitting.

It is also desired that said pelvic support, once shaped, can be used on any type of base and is highly adaptable thanks to its supporting base and to the type and shape of the material being used.

Finally, it is desired that the produced solution is easily transportable and therefore characterised by small dimensions, even if scalable, and lightness, in order to be adaptable to the most varied application areas.

Disclosure of the invention According to the proposed solution, it is desired to produce a pelvic support to improve the posture of the vertebral column in sitting position; said pelvic support consisting of a base, an economically shaped saddle applicable to said base and a series of different corrective buttons having different heights, which can be inserted between the above-mentioned parts and are necessary and functional to configure and customize said pelvic support. In particular:

• The base will have a parallelepiped shape and on the upper surface it will have a rectangular recess characterised by different cylindrical coupling pads suitable to receive and hold in pre-established positions corrective buttons. The lower surface of said base will instead be generally smooth or customised so as to be validly rested on any type of seat.

• The saddle will have two lateral concavities separated by a longitudinal ridge, lateral margins and a rear edge which are useful to give it an ergonomic shape and will be modelled to lay down and fit the special niche made in correspondence of the base.

• The corrective buttons that can be inserted between the base and the saddle will have a flattened cylindrical shape and will have a full and smooth upper edge, side edges and a hollow lower edge, so as to be inserted into the corresponding coupling pads on the base; they will also be of different heights and will be made in different colours, in order to make the adjustment by the operator more intuitive and simple. The insertion of said corrective buttons will precede the final assembly of the pelvic support and will be evaluated on the basis of specific physiotherapeutic / osteopathic tests. Said tests will allow to highlight any dysfunctions of the pelvis of the patient in order to be able to insert between base ad saddle the corrective buttons below, which are suitable to the case.

Detailed Description of the Drawings Further characteristics and advantages of the proposed technical solution will appear more evident in the following description of a preferred but not exclusive embodiment shown by way of example and not of limitation in the accompanying no. 4 drawings, wherein:

• Fig. 1 shows the saddle, from which one can appreciate the shape of the two ischial concavities, the longitudinal ridge, the posterior margin and the side edges making the seat enveloping.

• Fig. 2 shows the base, with its central recess and the coupling pads to receive the corrective buttons. • Fig. 3 shows in detail the specifications of the corrective buttons, highlighting the possible dimensions of one of them.

• Fig. 4 shows the pelvic support in its assembled configuration, where the saddle is resting on the base.

• Figs. 5 to 14 show the different possibilities for correcting an altered posture of the person and the different uses of the corrective buttons.

Best mode for carrying out the invention

The customised pelvic support will therefore consist of the union of a base (shown in Fig. 1) and a saddle (shown in Fig. 2) between which it is possible to interpose corrective buttons (represented in Fig. 3), suitable to modify the posture of the person when sitting. The assembly of these three components (shown in Fig. 4) allows to obtain the customised pelvic support according to the invention.

With reference to Fig. 1 , it is shown the saddle (100) as a lightly shaped slab having dimensions suitable to accommodate the seat in an ergonomic manner. Its profile is characterised by a flat surface (1) at the bottom and by two concave support areas reproducing the shape of the buttocks (2, 3) at the top. These support areas are delimited by a ridge (4), which develops centrally along the sagittal plane towards the back and then diverges laterally to envelop the seat (4b), while they are free in their front part to accompany the development of the femoral biceps. With reference to Fig. 2, it is shown the base (101) having a recessed space (5) characterised by different cylindrical coupling pads (6) suitable to receive and hold in pre-established positions the corrective buttons.

With reference to Fig. 3, said corrective buttons which can be inserted between the base and saddle are shown, they have a flattened cylindrical shape and a full and smooth upper edge, side edges and a hollow lower edge, so as to be inserted into the corresponding cylindrical coupling pads (6) on the base (101). The corrective buttons are made according to different heights (represented by a way of example in cm). By way of a representative and non-limiting example, it is assumed in this embodiment that said corrective buttons are of five types (A, B, C, D, E) and are characterised by progressively decreasing heights. It is also assumed that they are made in different colours, so as to make the adjustment by the operator more intuitive and simple. With reference to Fig. 4, it is shown the pelvic support in its assembled configuration, where the saddle (100) rests on the base (101).

With reference to the drawings of Figs. 5 to 14, these represent how the corrective buttons (A, B, C, D, E) can be positioned and installed on the base (101), depending on any pelvic dysfunctions identified by appropriate preliminary tests.

In order to customise the pelvic support and identify the most suitable configuration of the corrective buttons for the patient, preliminary tests will be carried out on the patient subject to customisation of the support, in order to identify the possible of sacral extension or flexion behaviour, a possible misalignment of the iliac bones due to a dysfunctional sacroiliac joint and it will also determine if the patient is in anterior or posterior rotational dysfunction. Said tests include:

• Rebound test: With this test we will evaluate a flexion or extension behaviour of the sacrum; it is done with the patient in a prone position, the therapist places his hand on the centre of the sacrum (we must have the sacral crest between the thenar and the hypothenar). The patient is asked to inhale and exhale. In the expiratory phase, we realise a small impulse in antero-posterior. If the sacrum is resistant it is in extension, if it is depressive it is in flexion.

• Standing flexion test or TFE: with this test, we will be able to evaluate on which side the sacro-iliac dysfunction is located; the patient will be in a standing position, the therapist will place his thumbs on the patient's PSIS and will ask for a forward flexion of the torso; the thumb rising more will indicate the presence of a dysfunction on that side.

• Seated flexion test or TFS: with this test, we will be able to evaluate the side of the sacral dysfunction; the patient will sit with his feet resting on the floor to suppress the mobility of the iliacs, the therapist will be behind the patient contacting with the thumbs, at first, the projection points of the base of the sacrum and will ask for a forward flexion of the torso; in a second time, he will contact the inferior lateral angles (ILA) of the sacrum, asking again the patient for a forward flexion of the torso. The thumb rising more on both points of reference, will indicate the dysfunctional seat(s), giving a three-dimensional classification of the incorrect pelvic posture.

• Downing test: With this test, we would have the possibility to define if the side found dysfunctional is in anterior rotation or in posterior rotation; in fact, the Downing test is an indirect test evaluating the anteversion and the retroversion of the pelvis through the action exerted on the ligament of Bertin (ileo-femoral ligament), on the pubo-femoral ligament and on the ischio-femoral ligament. The patient will be placed in supine decubitus and the therapist will be on the ipsilateral side to the found sacro-iliac dysfunction. The patient will be asked to lift the pelvis with the knees bent 3 times, in order to rebalance the pelvis and its possible compensations. The patient's legs will then be extended and the length of the lower limbs will be evaluated, placing the thumbs immediately below the lower edge of the medial malleoli. A "stretch test" is then performed; the lower limb of the patient is carried in strong adduction with external rotation and flexion, it is exerted a stretching impulse increasing all the previous parameters. We will expect an elongation of the limb that we will evaluate immediately after, putting again the thumbs below the medial malleoli to evaluate a possible change of heterometry. If the lower limb lengthens, the test is negative, if it did not stretch instead, it would be positive and would indicate a sacred iliac in anteriority. We would bend again the knee of the patient in supine position and ask him again to lift the pelvis (in order to rebalance the ligaments of the pelvis again) and we will proceed with a "shortening test". In this case we will carry the lower limb of the patient in abduction, internal rotation and flexion and we will give an impulse to increase the parameters; we will expect a shortening of the limb which, if it occurs, the test will be negative, but if it did not happen instead it would represent a dysfunction of the sacroiliac joint posteriority.

Once the tests have been completed and the type of posture of the patient's pelvis has been identified, the posture will be correct by installing the corrective buttons as follows:

• If we find a person with a flexion postural behaviour of the sacrum (posterior base of the sacrum) we will use the corrective buttons (as in Fig. 7) to be fitted onto the coupling pads of the base, with a decreasing height of the corrective buttons in the posterior-anterior direction in order to favour a neutral behaviour of the sacrum.

• On the contrary, if we find a person with an extension postural behaviour of the sacrum (anterior base of the sacrum), we will position the corrective buttons in the anterior-posterior direction (as in Fig. 8).

Always starting from the information obtained from the previous tests (behaviour of anterior or posterior rotation of the iliac bones), we will choose the type of configuration to be used among those represented in Figs. 5 to 14, and in particular the different dysfunctions that we could correct will be:

Configuration for right posterior ilium dysfunction (105)

Configuration for left anterior ilium dysfunction (106) Configuration for sacrum flexion dysfunction (107)

Configuration for sacrum extension dysfunction (108)

Configuration for right on right sacral torsion dysfunction (113,114)

Configuration for left on right sacral torsion dysfunction (1 11)

Configuration for left on left sacral torsion dysfunction (1 12)

Configuration for right on left sacral torsion dysfunction (109,110)

Industrial Applicability

The proposed solution allows to reduce macroscopically the pains from prolonged sitting posture to all those who, for reasons of work (both office and commuting / travel), studies, necessity due to disability or dysfunction, are forced to such a posture. The advantages can also be extended from the preventive point of view, especially in the child and in the phases of its development. Being able to make children sit properly at school every day for many hours would have a significant impact on reducing the risks of postural scoliosis.

In addition to correcting the posture in order to address adaptive pathologies or to improve the pain in chronic low back pain, the proposed solution can be used to improve performance and prevent injuries, in all those sports where it is needed to have a sitting position, such as, by a way of non-limiting example, in riding saddles, racing car seats, seats for rowers, etc. For this purpose, the base and saddle components of the support can be made with thermo injection moulding, but also with functionally equivalent systems for the realization of said shapes, such as milling. In the same way, the corrective buttons may be made of a material such as soft PVC or others functionally equivalent in terms of physical and chemical characteristics.

Moreover, the dimensions of the saddle (100) and of the base (101) can be varied according to the application areas and the number, type, thickness and spatial density of the corrective buttons can be varied.

The system can finally be integrated also by an application for tablets and mobile phones, which allows a digital evaluation directly on screen, so that the patient is able to see in real time his postural deficit and relative correction. Using sensors positioned directly on specific points of reference, it will be possible to obtain a comparative picture before and after modelling.

Claims

1. Customised pelvic support to correct the lumbosacral posture comprising a base provided with a recessed space (5) provided with several cylindrical coupling pads (6) spatially distributed to accommodate corrective buttons characterised by:

• a saddle (100) having a shape corresponding to said recessed space (5) hosting two concavities reproducing the shape of buttocks (2), (3);

• a series of corrective buttons having different thicknesses (A, B, C, D, E) which can be inserted between the base (101) and the saddle (100) and anchored to said cylindrical coupling pads (6).

2. Pelvic support according to claim 1, wherein said base (101) is characterised by a flat lower surface (1) or, alternatively, by a surface having a shape corresponding to an underlying seat.

3. Pelvic support according to claim 1, wherein said saddle (100) is characterised by a central ridge (4) extending along the sagittal plane towards the back part and diverges laterally (4b) to limit the two concavities (2), (3).

4. Pelvic support according to claim 1, wherein said corrective buttons (A, B, C, D, E) are further characterised by a cylindrical shape, a smooth and rounded upper edge and a hollow lower edge to fit the cylindrical coupling pads (6) of the base (101).

5. Pelvic support according to claim 1, wherein said corrective buttons (A, B, C, D, E) are characterised by different colours according to their different shapes and heights.

6. Pelvic support according to claim 1, wherein said corrective buttons (A, B, C, D, E) may change in terms of number, height and shape, and possibly be grouped together and positioned on the cylindrical coupling pads (6) of the base (101) according to the different pelvic dysfunctions to be corrected or compensated.

7. Pelvic support according to claim 1, wherein said cylindrical coupling pads (6) may change in terms of number, height, shape and spatial density to accommodate different corrective buttons.

8. Method for configuring and customizing the pelvic support according to claim 1, consisting of the following steps:

• performing a series of preliminary physiotherapeutic and osteopathic tests for the evaluation of the main postural problem of the patient willing to use said pelvic support;

• measuring the height difference of the posterior-superior iliac spines, or PSIS, of the patient;

• spatially arranging the corrective buttons having different thickness (A, B, C, D, E) on the cylindrical coupling pads (6) of the base (101) to correct and compensate for the dysfunctions identified in a) and b);

• putting the saddle (100) on top of the corresponding recessed space (5) of the base (101) and assembling the pelvic support; • impressing the ischial imprint of the patient on said pelvic support.

9. Method for configuring and customizing said pelvic support according to claim 8, wherein said preliminary physiotherapeutic and osteopathic tests include:

• a rebound test;

• a standing flexion test or TFE;

• a seated flexion test or TFS;

• a downing test.

10. Method for configuring and customizing said pelvic support according to claim 8, wherein said dysfunctions include:

• right posterior ilium dysfunction (105);

• left anterior ilium dysfunction (106);

• sacrum flexion dysfunction (107);

• sacrum extension dysfunction (108);

• right on right sacral torsion dysfunction (113, 114);

• left on right sacral torsion dysfunction (111);

• left on left sacral torsion dysfunction (112);

• right on left sacral torsion dysfunction (109, 110).