WO2019173184A1 - Système de rééducation modulaire - Google Patents

Système de rééducation modulaire Download PDF

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Publication number
WO2019173184A1
WO2019173184A1 PCT/US2019/020498 US2019020498W WO2019173184A1 WO 2019173184 A1 WO2019173184 A1 WO 2019173184A1 US 2019020498 W US2019020498 W US 2019020498W WO 2019173184 A1 WO2019173184 A1 WO 2019173184A1
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WO
WIPO (PCT)
Prior art keywords
component
rehabilitation system
knee
hinge
modular
Prior art date
Application number
PCT/US2019/020498
Other languages
English (en)
Inventor
Harry Duane ROMO
Dymphy VAN DER WILK
Teake Bulstra
Emma VAN DEN BERG
Harry CHRISTENHUSZ
Original Assignee
Ossur Iceland Ehf
Ossur Americas, Inc.
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Application filed by Ossur Iceland Ehf, Ossur Americas, Inc. filed Critical Ossur Iceland Ehf
Publication of WO2019173184A1 publication Critical patent/WO2019173184A1/fr

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Classifications

    • 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
    • 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
    • A61H1/0237—Stretching or bending or torsioning apparatus for exercising for the lower limbs
    • A61H1/024—Knee
    • 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
    • A61H1/0237—Stretching or bending or torsioning apparatus for exercising for the lower limbs
    • A61H1/0244—Hip
    • 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
    • A61H1/0237—Stretching or bending or torsioning apparatus for exercising for the lower limbs
    • A61H1/0255—Both knee and hip of a patient, e.g. in supine or sitting position, the feet being moved together in a plane substantially parallel to the body-symmetrical plane
    • A61H1/0262—Walking movement; Appliances for aiding disabled persons to walk
    • 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
    • A61H1/0237—Stretching or bending or torsioning apparatus for exercising for the lower limbs
    • A61H1/0266—Foot
    • 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
    • A61H3/00—Appliances for aiding patients or disabled persons to walk about
    • 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
    • A61H2001/0211—Walking coordination of arms and legs
    • 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
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/01—Constructive details
    • A61H2201/0107—Constructive details modular
    • 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
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/12—Driving means
    • 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
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/16—Physical interface with patient
    • A61H2201/1602—Physical interface with patient kind of interface, e.g. head rest, knee support or lumbar support
    • A61H2201/164—Feet or leg, e.g. pedal
    • A61H2201/1642—Holding means therefor
    • 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
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/16—Physical interface with patient
    • A61H2201/1602—Physical interface with patient kind of interface, e.g. head rest, knee support or lumbar support
    • A61H2201/165—Wearable interfaces
    • 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
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/50—Control means thereof
    • A61H2201/5005—Control means thereof for controlling frequency distribution, modulation or interference of a driving signal
    • 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
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/50—Control means thereof
    • A61H2201/5007—Control means thereof computer controlled
    • 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
    • A61H2205/00—Devices for specific parts of the body
    • A61H2205/10—Leg
    • A61H2205/102—Knee
    • 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
    • A61H2205/00—Devices for specific parts of the body
    • A61H2205/10—Leg
    • A61H2205/106—Leg for the lower legs
    • 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
    • A61H2205/00—Devices for specific parts of the body
    • A61H2205/12—Feet

Definitions

  • the disclosure relates to a modular rehabilitation system for rehabilitating or assisting an individual recovering from physical impairment.
  • Strokes can be disabling. Despite methods and tools for rehabilitation, time for recovery from strokes can vary widely depending on the individual and the severity of the stroke. The impact on an individual from a stroke may likewise depend on the individual, as each stroke affects an individual differently. A stroke may cause hemiparesis or hemiplegia, wherein one side of the body is weakened or paralyzed, which further complicates recovery.
  • a stroke may cause the individual to have muscle weakness, spasticity, impaired sensorimotor control, and/or loss of cognitive function. Secondary impairments may include muscle atrophy, contracture, and reduced aerobic capacity. Depending on the severity of the stroke, degrees of recovery of ambulatory capability may range from severe limitation to normal.
  • the hip, knee, ankle and foot may be flaccid; this makes it difficult for an individual to advance the leg during a swing phase, stabilize the knee during a stance phase, and even clear the toes during swing phase while walking.
  • the hip and knee are typically the first to improve in function with the foot and ankle often seeing minimal recovery.
  • the inability to articulate the foot and ankle into dorsiflexion may lead to persistent plantarflexion contracture, possibly accompanied by supination.
  • the swing phase is important for advancement of the limb and for setting up each step for successful weight bearing, many of the most significant gait problems facing stroke survivors occur during stance phase because of instability and abnormal biomechanical function.
  • KAFO knee-ankle-foot orthosis
  • AFO ankle-foot orthosis
  • RGO reciprocating-gait orthosis
  • HKAFO hip-knee-ankle-foot orthosis
  • a modular rehabilitation system is provided to treat a spectrum of rehabilitation, and to address hip, knee and ankle-foot issues.
  • the modular rehabilitation system can be modified by removing or adding components at each joint to accommodate the functional progress made by the individual. For instance, if the individual has progressed and regained hip function, the hip component may be removed, allowing the KAFO component to continue to offer functional assistance of stabilization of the knee and ankle. If the hip and ankle persist in weakness or coordination but the individual can stabilize the knee, the knee component may be removed.
  • the modular rehabilitation system is provided to match the functional requirements of the individual throughout the rehabilitation process. Rather than replacing the initial orthosis for a secondary appropriate functional design to match the individual’s current needs, this system allows a clinician to add, remove, or adjust each component, providing clinicians with the ability to adapt the rehabilitation system according to the individual’s increasing (or even decreasing for some medical indications) capability during their rehabilitation.
  • An objective of the disclosure is to provide a rehabilitation system which overcomes the above problems in the prior art. It is desired that the modular rehabilitation system be suited for long-term use during rehabilitation, and is adaptable to the progress made and treatment needs unique to the individual.
  • the rehabilitation system is modular so it is easily modified from time-to-time to accommodate for the individual’s progress or treat specific impairments if not all components of the rehabilitation system are required.
  • the components of the system work in harmony with one another, eliminating multiple or disparate orthoses and simplifying the prescription and adaption of the system to a unique individual.
  • the modular rehabilitation system recognizes bilateral movement, between right and left sides of the individual, and offers not only support but also gait movement assistance.
  • a bilateral modular HKAFO reciprocating gait rehabilitation system enables support and gait assistance by relying on movement of a healthy side of the individual.
  • hip, knee, ankle and foot components firmly securable from the hip to the foot, each working together to protect and maintain necessary joint stability, mobility, and integrity, encourage normal orthopedic recovery and development, and assist with upright mobility. Said components may be added or removed as determined necessary during treatment.
  • FIGs. 1A and 1B are schematic views showing a normal gait cycle.
  • FIG. 2A is a frontal view exemplifying a modular rehabilitation system fitted on legs.
  • Fig. 2B is a side view exemplifying the modular rehabilitation system of Fig. 2A.
  • Fig. 2C is a rear view exemplifying the modular rehabilitation system of Fig. 2A.
  • FIG. 3 A is a front elevational view showing a hip orthosis for the modular rehabilitation system of Fig. 2A.
  • Fig. 3B is a side elevational view of the hip orthosis of Fig. 3A.
  • Fig. 3C is a rear elevational view of the hip orthosis of Fig. 3A.
  • Fig. 4A is a schematic view showing flexion/extension adjustment of the hip orthosis of Fig. 3A in a first position.
  • Fig. 4B is a schematic view showing flexion/extension adjustment of the hip orthosis of Fig. 3A in a second position.
  • FIG. 5A is a schematic view showing a cuff of the hip orthosis of Fig. 3 A in a first position.
  • Fig. 5B is a schematic view showing the cuff of Fig. 5 A in a second position.
  • Fig. 6 is a side elevational view of a knee orthosis for the modular rehabilitation system of Fig. 2A.
  • Fig. 7A is a schematic view of a hinge in the knee orthosis of Fig. 6.
  • Fig. 7B is a schematic view of the hinge of Fig. 7A in a first position.
  • Fig. 7C is a schematic view of the hinge of Fig. 7A in a second position.
  • Fig. 8A is a front elevational view showing an ankle orthosis for the modular rehabilitation system of Fig. 2A.
  • Fig. 8B is a side elevational view showing the ankle orthosis of Fig. 8A.
  • Fig. 9A is a schematic view of a first embodiment of an ankle lock configured for the ankle orthosis of Fig. 8 A in a first position.
  • Fig. 9B is a schematic view of the ankle lock of Fig. 9A in a second position.
  • Fig. 10A is a schematic view of a second embodiment of an ankle lock configured for the ankle orthosis of Fig. 8A in a first position.
  • Fig. 10B is a schematic view of the ankle lock of Fig. 10A in a second position.
  • FIG. 11 is a side elevational view of a variation of the ankle orthosis of Fig. 8A.
  • a hip component may assist in initiating a swing phase
  • an ankle component such as an AFO may control drop foot and provide stability to the individual while walking
  • a knee component may prevent hyperextension, provide support and stabilization, and provide stance control such as by locking a knee joint in stance phase and unlocking in a swing phase.
  • the modular rehabilitation system may be employed for treating chronic and acute stroke victims.
  • the modular rehabilitation system can treat other neurological or physical conditions which assist lower limb mobility.
  • the components of the modular rehabilitation system may be adjusted, added, or removed during rehabilitation. The components can work together to support the functionality of each other.
  • the impact of the stroke may affect all, some, or one functional phase of gait.
  • the modular rehabilitation system is adapted to treat each of these phases of gait, as considered necessary for a particular individual’s recovery and rehabilitation.
  • Figs. 1 A and 1B exemplify the functional phases of gait.
  • Normal gait involves a cyclic movement, and a stereotypic movement pattern with rhythmic alternating motion of the trunk and lower limbs.
  • the cycle-to-cycle variation is relatively low.
  • individuals requiring compensatory movement for ambulation they produce abnormal and exaggerated vertical and horizontal displacement of the center of gravity. Impaired balance, sensory and visual deficits and foot drop all contribute to poor ambulation.
  • the leg or limb L moves through functionally distinct postural sequences including stance and swing phases. In each of these phases, there are events critical to assuring a normal gait, and which are achieved by synergistic patterns of the muscles controlling the limb.
  • stance phase Next in the stance phase is the stance limb progression or single limb support.
  • the ankle serves as a rocker allowing the limb to advance over the stationary foot.
  • the forefoot then provides a rocker allowing the foot and limb to roll forward.
  • initial contact of the contralateral foot initiates limb loading and weight acceptance, during which double support by both legs begins again.
  • swing phase or limb advancement there is a pre-swing where actions of the ankle and hip of the unloaded limb initiate knee flexion and preparation for swing. During initial swing, the muscle action at the hip, knee, and ankle lifts the foot and advances the limb.
  • FIGs. 2A - 2C exemplify an embodiment of a modular rehabilitation system 10, which includes a hip component 100, an ankle and/or foot component 300, and a knee component 200 connected to the hip component 100 and the ankle and/or foot component 300.
  • Each of these components 100, 200, 300 may be used individually or combined synergistically to improve an individual’s gait.
  • all components 100, 200, 300 may be employed together on the affected or impaired side, and as the individual recovers or improves components 100, 200, 300 can be selectively removed as they are no longer needed.
  • the components 100, 200, 300 may not be directly secured to one another, but may be employed together simultaneously.
  • the components 100, 200, 300 may be co-dependent upon one another.
  • the knee component 200 may have a lockable hinge 204 operable or activated by the ankle and/or foot component 300.
  • the major hip motions during gait occur in the plane of progression, and include an arc of extension through stance, reaching 10 degrees hyperextension in terminal stance. A similar arc of flexion occurs from pre-swing through mid-swing.
  • the hip extensor muscles begin with the hamstrings in terminal swing and proceed to the gluteus maximus and adductor magnus during the loading response.
  • the gluteus maximus - gluteus minimus complex and the tensor fascia lata provide lateral stability in stance.
  • Hip flexion results from serial activation of the adductor longus, iliacus, sartorius, and gracilis.
  • Hip flexion weakness can reduce the ability of the individual to advance the leg into swing phase and can indirectly reduce the ability to provide toe clearance through elevation of the knee.
  • the hip orthosis proposed here in one configuration allows for the harvest of hip flexion power from the sound side (the unimpaired leg); this is then transmitted to the affected side to drive the affected hip (the impaired leg) into flexion.
  • the hip component 100 of the modular rehabilitation system 10 is provided to solve these problems. Utilizing the individual’s normal motion to provide actuation of an impaired limb advantageously reduces cost, bulk, and manufacturing and operational complexities of powered orthoses.
  • the hip component 100 aims to improve gait by assisting with initiating swing phase, and reducing circumduction or scissoring of the affected side.
  • the hip component 100 may be used in combination with the ankle component 300 to improve gait through enhancing advancement of the limb and improving toe clearance.
  • the ankle component 300 may be optionally configured to provide some improved knee stability during mid- to late-stance phase through the transmission of ground reaction forces.
  • the hip component 100 may be used in combination with the knee component 300 to lock the knee during weight bearing while also preventing hyperextension.
  • the hip component 100 operates to provide support during level walking and maintaining a standing position.
  • the hip component 100 can use energy from the sound, healthy leg HL to provide hip flexion of the impaired leg IL during swing phase.
  • the hip component 100 can correct excessive hip/abduction and adduction of the impaired limb IL to enable an optimal hip abduction/adduction for gait.
  • the hip component 100 provides reciprocal gait, particularly due to action of the healthy leg HL, by shifting body weight forward and laterally, with the healthy leg HL driving the impaired leg IL.
  • the hip component 100 drives the impaired leg IL into flexion during the swing phase of gait, thereby maintaining a more normal gait pattern and assisting the impaired leg IL through the stages of gait.
  • the hip component 100 preferably comprises a posterior component 102 arranged to store energy and to initiate a swing phase.
  • the posterior component 102 is an elongate torsional bar extended between right and left lateral sides of an individual and about the individual’s back.
  • the posterior component 102 is preferably a rigid or semi-rigid torsional bar.
  • Orthotic hinges 108, 109 may be arranged proximate the individual’s trochanter and positioned in various positions of flexion or extension and may be fixed in that position or be maintained with partial range-of-motion control while being allowed to swing freely as deemed necessary by the clinician.
  • the posterior component arranged in the depicted embodiment as a torsional bar 102 is arranged so that as each leg moves into flexion and extension, the torsional bar 102 torsionally twists in the sagittal plane.
  • the pelvis can articulate independently from the hip. In accordance with pelvic motion, the torsion from the torsional bar 102 twists generally downwardly on one end, and generally upwardly on another end depending on movement of the healthy and impaired legs HL, IL, to return to a rest position.
  • Torsion in the posterior component 102 may be modified according to the location of the struts 110, 111 relative to one another.
  • a force is generated during the swing phase by the healthy leg HL which can aid in propelling the impaired leg IL into swing phase.
  • force incurred by the posterior component 102 can be modified.
  • the sound-side orthotic hip joint (thigh) position is set relatively extended relative to the affected-side orthotic hip joint (thigh) while the orthosis is at rest, and the sound side hinge motion is blocked from further flexion while the affected side hinge motion is blocked from further extension. Then when the system is donned and the individual is asked to stand with legs vertically parallel, this would create a reactive torsion of the posterior component 102.
  • the modular rehabilitation system 10 and the hip component 100 first create pressure generated on the anterior thigh of the sound side with a concomitant torsion of the posterior component 102 which transmits that torsion to the affected side via“preloaded” pressure on the posterior thigh of the affected side.
  • the greater the differential relative angle between the sound and affected side positions (as defined by a position of the struts 110, 111), the greater the torsion and flexion force enhancement created for the affected side.
  • the affected thigh may be provided with controlled flexion enhancement.
  • the posterior component 102 particularly when adapted as a torsion spring, may be provided from a selection of different torsion springs or even stacked springs that could be used according to the degree of torsional stiffness required.
  • the posterior component 102 may be advantageously selectively added to or removed from the hip component 100 depending on the torsion required for an individual.
  • Other means may increase or decrease torsion, including overlaying different torsion springs, or other known means. An individual’s need for actuation of an affected leg may thus be accommodated simply and effectively.
  • the hip orthosis 100 would then provide resistance to flexion (or slight extension force against the flexion movement), decelerating the thigh segment and allowing the calf segment to continue on to full knee extension.
  • the hip orthosis 100 provides both active thigh flexion and passive knee flexion assistance during initial swing phase and early swing phase on the affected side IL, followed by active thigh and passive knee extension assistance as the affected side IL swings past mid swing phase.
  • the link to the sound side HL via posterior component 102 enhances stability of the affected knee in early stance phase.
  • several gait enhancements may be made.
  • the hip component 100 may be secured onto the individual according to a variety of ways.
  • the hip component 100 has first and second cuffs 104, 105 extending from the posterior component 102 by the first and second struts 110, 111 and attaching to the individual’s thighs.
  • the first cuff 104 is a dorsal cuff, such that the dorsal cuff comprises a rigid or semi-rigid element 132 and a strap 134 connecting to opposed sides of the dorsal cuff 104.
  • the second cuff 105 is a ventral cuff arranged similarly as the first cuff 104 although the rigid or semi-rigid element and strap are reversed.
  • the dorsal cuff 104 is adapted to secure about an impaired hip or leg
  • the ventral cuff 105 is adapted to secure about a healthy hip or leg.
  • the arrangement of the dorsal and ventral cuffs is exemplary and not limiting. It can be seen in the depicted embodiment that the arrangement of the dorsal and ventral cuffs is arranged to harness energy from a forward motion of a healthy leg as the front of the healthy leg presses forward, and by the operation of the torsional bar 102 to transfer the harnessed energy to the impaired leg by pressing on a back of the leg.
  • the first and second cuffs 104, 105 are pivotally mounted to the first and second struts 110, 111 by first and second lower pivots 128, 129.
  • the first and second cuffs 104, 105 are arranged to rotate in the sagittal plane.
  • the hip component 100 may be provided in combination with a lumbar support 106 connected to the posterior component 102, and arranged to extend circumferentially about an individual.
  • a lumbar support is taught in U.S. patent application publication no. 2017/0007435, published on January 12, 2017, and incorporated herein by reference.
  • the hip component 100 may have first and second ROM hinges 108, 109 arranged proximate to an individual’s hip-joint center of rotation.
  • the first and second ROM hinges 108, 109 are preferably connected to the posterior component 102 and to the first and second struts 110, 111.
  • the first ROM hinge 108 includes at least first and second range of motion stops 120, 122, such that the first and second range of motion stops 120, 122 limit rotation R of the first strut 110 relative to the posterior component 102.
  • the first ROM hinge 108 is connected to the posterior component 102.
  • An anterior belt 112 can secure to the posterior component 102, and may be configured with the posterior component 102 to extend circumferentially about an individual.
  • the anterior belt 112 is connected to the posterior component 102 by a belt connection 130.
  • a strut hinge 114 may be defined on the first strut 110.
  • the first strut 110 may have first and second strut segments 116, 118 connected to one another by the strut hinge 114.
  • the strut hinge 114 aids in abduction/adduction adjustment.
  • the first and second struts 110, 111 and the ROM hinges 108, 109 may be similar to those described in U.S. patent application publication no. 2016/0228277, published on August 11, 2016, and incorporated herein by reference.
  • a corresponding hinge may likewise be defined on the second strut 111.
  • the ROM hinge 108 slidably secures to the posterior component 102 along a slider mount 124, between at least first and second positions (I, II).
  • the first and second ROM hinges 108, 109 are pivotally secured to the posterior component 102 by first and second pivot elements 126, 127.
  • the adjustment of the ROM hinges 108, 109 enables better location of the ROM hinges 108, 109 according to the individual’s trochanter, and the ROM hinges 108, 109 are adjustable relative to anterior and posterior positions.
  • the ROM hinges 108, 109 also enable flexion/extension adjustment to decrease/increase pre-tension and to provide more or less moment during swing phase.
  • the positions of the ROM hinges 108, 109 may serve as stops to the posterior component 102, such that the ROM hinges 108, 109 serve as terminal points by/at which the posterior component 102 twists. Once the posterior component 102 twists to a certain degree, it returns to twist at the other side.
  • the features described herein provide an improved hip orthosis that not only aids an individual impaired by a stroke or other pathologies by using a healthy leg to provide a driving force for an impaired leg, but also allows for an orthosis with reduced bulk, cost, and maintenance compared to powered hip orthoses.
  • the hip orthosis of the disclosure is combinable in a modular fashion with a knee component and/or an ankle-foot component to form a modular rehabilitation system according to embodiments of the disclosure as needed according to an individual’s recovery.
  • FIG. 6 shows a knee component 200 arranged in cooperation with an ankle-foot component 300 according to an embodiment of the disclosure.
  • the knee component 200 is preferably arranged to lock at the knee so it remains locked until there is rollover onto the toe of the foot which unweights the heel. This enables the late stance phase to remain relatively stable since the ground reaction force should reside anterior to the knee joint.
  • a locking mechanism 232 may generally employ a pneumatic bladder provided in combination with the ankle foot component 300 that extends a lever into the knee joint, which pushes a locking plate into a position to lock the knee.
  • the locking plate is spring loaded to move into a free-motion position, but if the knee is loaded, the locking plate is bound in place locking the knee. Once the knee is fully extended, the plate frees up and the springs pull the locking plate out of the way so the knee joint can freely flex.
  • knee joint Two conditions are desirable for the knee joint to lock: 1) knee extension position and 2) load on the heel. Three conditions are desirable for the knee joint to unlock: 1) knee extension, 2) no load on the heel, and 3) no flexion moment on the knee joint.
  • the knee component 200 may bind the locking mechanism 232 into a locked position even if load is removed from the heel until the knee flexion moment is removed.
  • a line system 206 connects the ankle component 300 to the hinge lock 232, and the line system components 222, 224, 226 are adapted to actuate the hinge lock 232 when the knee hinge 204 is in extension.
  • the line system 206 relies on hydraulic or pneumatic actuation. This may be a closed system once the bladder 238 is connected to the knee joint via the line system 206, which may comprise a quick disconnect connector.
  • the lever 236 will be retracted, the plate 234 would no longer be bound in the interference position, and the spring 246 will automatically pull the plate 234 out of the interference position, thereby unlocking the knee hinge 204.
  • the spring 246 biases or predisposes the hinge to an unlocked position.
  • the knee joint must be placed in full extension at heel strike, then the lever 236 (because of a load on the heel/bladder compresses the air in the bladder 238) drives the knee joint plate 234 into the locked (interference) position.
  • the spring 246 pulls the plate 234 back into the non-interference position.
  • the heel bladder 306 is necessary for proper knee lock/unlock function.
  • Other arrangements for locking and unlocking the knee joint are likewise envisioned by the disclosure and the depicted embodiment is by no means limiting.
  • the ankle-foot component 300 may be a ground- or floor-reaction orthosis so that when the individual moves from a foot-flat position to the midstance of gait, the ground reaction force on the ankle-foot component 300 creates an extension moment at the knee. This ankle- foot component 300 stabilizes the knee in stance phase.
  • the footplate 304 includes a first plate 312 and a second plate 314, such that the first and second plates 312, 314 are connected to one another at their first ends 313, and the first and second plates 312, 314 define a clearance 317 from one another at their second ends 315.
  • the first and second plates 312, 314 are displaceable relative to one another at their second ends 315 such that the first plate 312 is cantilevered from its first end 313 relative to the second plate 314 at its second end 315, the clearance 317 being variable along a length of the footplate 304 according to displacement of the first plate 312 relative to the second plate 314.
  • a bladder 306 connects to the second ends 315 of the first and second footplates 312, 314 and is within at least a portion of the clearance 317.
  • the bladder 306 is connected to the line system 206 of the knee component 200.
  • the ankle hinge 302 may couple a first strut 316 to the component body 310 and a second strut 318 connecting to the footplate 304.
  • the ankle hinge 302 may define a hinge opening 320 for receiving a locking mechanism 320, 330.
  • the locking mechanism 320, 330 comprises at least one locking element 321, 331 arranged to lock the first and second struts 316, 318 relative to one another.
  • the locking mechanism 320 defines first and second rotatable members, or rings 322, 324 arranged concentrically and rotatable relative to one another, and a magnet lock 321 maintaining the first and second rings 322, 324 in a first position for resisting movement of the first and second rings 322, 324 relative to one another.
  • the magnet lock 321 defines first and second magnets 326, 328 each supported by the first and second rings 322, 324, respectively.
  • the first and second magnets 326, 328 are attractable relative to one another.
  • the first and second rings 322, 324 are aligned with one another in a first position, and the first and second rings 322, 324 are rotatable relative to one another when in a second position resulting from the first and second magnets 326, 328 being out of alignment.
  • the out-of-alignment position and rotation correspond to an unlocked state in which the footplate 304 may rotate relative to the component 310, with the ankle and foot correspondingly rotating relative to each other.
  • the locking mechanism 330 defines first and second rotatable members, or rings 332, 334 arranged concentrically and rotatable relative to one another.
  • a detent mechanism 331 maintains the first and second rings 332, 334 in a first position for resisting movement of the first and second rings 332, 334 relative to one another.
  • the detent mechanism 331 includes a housing 338 supporting a biased detent element 336 by a biasing element 340 arranged toward a detent 342 provided by the second ring 334, the detent 342 arranged to receive the biasing element 340.
  • the detent mechanism 331 is preferably carried by the first ring 332.
  • the biased detent element 336 may be a ball biased by a spring forming the biasing element 340 within the housing 338 and biased toward the second rotatable member or ring 334.
  • the first and second rotatable members or rings may be formed from or connected to the first and second struts 316, 318.
  • the locking mechanisms 320, 330 may be arranged such that when the mechanisms are unlocked the ankle hinge 302 allows movement of a foot relative to an ankle only at preferred times and positions, while ensuring that the foot is locked relative to the ankle at preferred times, e.g. during a stance phase or during portions of a swing phase.
  • the modular rehabilitation system disclosed herein aids an individual suffering from impairment from a stroke or related pathologies by providing a modular and adjustable system of orthoses suitable for the hip, knee, and/or ankle foot regions, the orthoses being independently functional and combinable with each other as needed and tunable to an individual’s particular needs.
  • An individual may utilize only the hip orthosis if needed, or the hip, knee, and ankle foot orthoses, just the ankle foot orthosis, or the knee and ankle foot orthoses, as required during treatment.
  • the rehabilitation system overcomes the problems associated with powered orthoses and provides a solution having reduced bulk, cost, and operational and manufacturing complexity.

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  • Health & Medical Sciences (AREA)
  • Epidemiology (AREA)
  • Pain & Pain Management (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Rehabilitation Therapy (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Rehabilitation Tools (AREA)

Abstract

Un système de rééducation modulaire (10) comprend un composant de hanche (100) ayant un composant postérieur (102) agencé pour initier une phase d'oscillation, un composant de cheville (300), et un composant de genou (200) relié de façon amovible à l'élément de hanche (100) et à l'élément de cheville (300). L'élément de hanche (100) est conçu pour fonctionner indépendamment de l'élément de cheville (300).
PCT/US2019/020498 2018-03-05 2019-03-04 Système de rééducation modulaire WO2019173184A1 (fr)

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US201862638509P 2018-03-05 2018-03-05
US62/638,509 2018-03-05

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Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20140142475A1 (en) * 2010-09-27 2014-05-22 Vanderbilt University Movement assistance device
US20140358053A1 (en) * 2013-05-31 2014-12-04 Case Western Reserve University Power assisted orthosis with hip-knee synergy
US20160228277A1 (en) 2013-01-24 2016-08-11 Ossur Hf Orthopedic device for treating complications of the hip
WO2016146960A1 (fr) * 2015-03-19 2016-09-22 Phasex Ab Articulation universelle modulaire avec procédé de contrôle harmonisé pour exosquelette d'assistance
US20170007435A1 (en) 2015-02-27 2017-01-12 Ossur Iceland Ehf Spinal orthosis, kit and method for using the same
EP3225363A1 (fr) * 2014-11-27 2017-10-04 Marsi Bionics, S.L. Exosquelette pour assister les mouvements humains

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20140142475A1 (en) * 2010-09-27 2014-05-22 Vanderbilt University Movement assistance device
US20160228277A1 (en) 2013-01-24 2016-08-11 Ossur Hf Orthopedic device for treating complications of the hip
US20140358053A1 (en) * 2013-05-31 2014-12-04 Case Western Reserve University Power assisted orthosis with hip-knee synergy
EP3225363A1 (fr) * 2014-11-27 2017-10-04 Marsi Bionics, S.L. Exosquelette pour assister les mouvements humains
US20170007435A1 (en) 2015-02-27 2017-01-12 Ossur Iceland Ehf Spinal orthosis, kit and method for using the same
WO2016146960A1 (fr) * 2015-03-19 2016-09-22 Phasex Ab Articulation universelle modulaire avec procédé de contrôle harmonisé pour exosquelette d'assistance

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