WO2020070081A1

WO2020070081A1 - Device for treating disorders of the nervous system

Info

Publication number: WO2020070081A1
Application number: PCT/EP2019/076490
Authority: WO
Inventors: Frédéric GUEZ
Original assignee: Guez Frederic
Priority date: 2018-10-03
Filing date: 2019-09-30
Publication date: 2020-04-09
Also published as: EP3860542A1; FR3086864A1; FR3086864B1

Abstract

The invention relates to a therapeutic device (10) comprising a mattress support (14) and automated means (11, 12, 15) capable of oscillating the support (14).

Description

Device for the treatment of nervous system disorders

The invention relates to the treatment of disorders of the nervous system, in particular psychomotor disorders.

Treating psychomotor disorders consists, for example, in working on the integration of archaic reflexes, in reducing the tremors of a person suffering from Parkinson's disease or the symptoms of dyskinesias.

We already know in the state of the art methods of treatment by manual manipulation of the body of a patient, for example by manual pumping of certain areas of the body. However, depending on the duration of the sessions, this type of manipulation can be very demanding for the therapist, in particular if the area being manipulated is highly spastic or hypertonic. It is difficult to make the manipulations last long enough for the sessions to be effective.

Furthermore, in "Body software for therapeutic movements in functional neurology", Doctor Régine Zékri-Hurstel offers manual manipulations based on a binary or ternary rhythm aimed at stimulating certain skin receptors in order to reproduce certain phases of the development of an embryo on a patient's body. It is important to be able to make the manipulations last and maintain the required rhythm.

Furthermore, the stress level of the treated patients is often high, in particular because of their dependence on other people, dependence due to their disorders. However, a high level of stress decreases the ease of learning of a treated patient, and disrupts the limbic system.

The invention particularly aims to improve the effectiveness of treatments for psychomotor disorders by manual manipulation. It's also about reducing patient stress.

To this end, the invention relates to a therapeutic device, comprising:

- a mattress support; and

- automated means able to oscillate the support.

Thus, the device can oscillate the body of a patient who is lying or sitting on the mattress. These oscillations generate a counter-force to the therapist, who, instead of generating a force on the patient, controls the counter-force. It therefore makes less effort and less fatigue. He can focus on the patient's position, his areas to be treated and the depth of his support for the patient. The therapy sessions manipulation can therefore last longer and be more effective, in particular manipulations based on repetitive movements inspired by the aforementioned theories. In addition, these oscillations in themselves reduce the patient's stress. Indeed, they reproduce on the patient a strategy applied by chameleons to induce predators in error by making them confuse the chameleon with a tree leaf, strategy which consists in producing a repetitive movement and which also ends up reducing stress of the chameleon. Since humans and chameleons share a phylogenetic relationship, that is, we share genes encoding similar functions, the assumption that this type of behavior can influence stress in human patients is l 'one of the sources of the invention, hypothesis validated in the clinic. As a corollary, numerous studies on embodied cognition have demonstrated that movement promotes the perception of metrics (we will refer to this subject in the work of Francisco Varela) and that the activation of mechanoreceptors reduces the perception of pain and therefore reduces the stress level. This is the theory of "spoiling control": when the mechanoreceptors are activated simultaneously with the nociceptors, the inhibitory interneurone is activated, thus decreasing the activity in the ascending path of pain.

Furthermore, this device can be integrated into different elements, such as a therapeutic table, a medical bed, for example in a geriatric ward, in a retirement home, or even for a patient in a coma, in a bed for airplanes, or in an armchair. The environment in which it is integrated can be adapted to the type of patient targeted, such as humans of any weight, as well as animals such as dromedaries or horses.

The device could also be integrated into objects which are not intended to allow therapeutic treatment, but which require the generation of oscillations.

Preferably, the means are capable of producing oscillations comprising a back-and-forth movement in a direction parallel to a main axis of the support.

Thus, the patient is positioned in different ways around this axis, so as to facilitate the manipulations and generate the desired effects of neurological, vascular or even endocrine types. To designate this movement, one can also speak of longitudinal rhythmic movement, or alternatively rectilinear translation.

Advantageously, the means comprise a connecting rod-crank system.

[00014] Thus, the system transforms a rotation in translation in two directions support alternatives.

Preferably the means comprise an electric motor.

Advantageously, the means comprise a pneumatic motor.

Preferably, the engine is immersed in oil.

Thus, the engine noise is reduced, which improves the comfort of the therapist and the patient.

Advantageously, the device comprises a control member capable of varying the frequency of the oscillations.

This organ can for example be a pedal on which the therapist will interact with his foot, but it can also be a portable organ for the therapist or even the patient himself, for example if he performs a session of 'oscillations. It can also be a remote control.

[00021] Thus, the frequency of the oscillations is adjusted as a function of the pathologies to be treated, of the patients and of the manipulations that the therapist wishes to perform on the patient.

Preferably, the device comprises means for adjusting the amplitude of the oscillations.

The invention also relates to a therapeutic table, comprising:

- a device as described above; and

- a mattress intended to accommodate a human or animal patient, the mattress being mounted on the support.

[00024] Thus, the therapeutic table can be used by therapists or veterinarians to treat psychomotor disorders of patients, whether human or animal. Of course, the table is adapted to the type of patient targeted.

Advantageously, an amplitude and / or a frequency of the oscillations can be adjusted so that the patient remains in a position of grip relative to the mattress.

Thus, the oscillations must not cause friction or sliding of the patient on the mattress. Indeed, these frictions would generate unpleasant sensations or even pain for the patients, which would erase the benefits obtained by the oscillations. The force transmitted from the mattress to the patient must therefore not leave the friction cone as defined by Coulomb's law. In other words, the tangential component of this force must not exceed the limitTO such as defined in Coulomb's law. The criteria taken into account, other than the frequency or amplitude of the oscillations, are in particular the material of the mattress and its shape, so that for each mattress, tests are necessary to determine which is the maximum amplitude or the maximum frequency permissible oscillations for said mattress. Thus, in the event of a change of mattress material, it may be necessary to adapt at least one of these parameters.

Advantageously, the table is intended for use for therapeutic purposes.

It can thus be suitable for any type of manual therapy and for any type of therapist, such as physiotherapists, osteopaths, chiropractors, rehabilitators, practitioners in functional neurology, but also veterinarians and specialists in animal pathologies.

Advantageously, it is intended for use in the treatment of psychomotor disorders.

We think in particular of the treatment of patients with fibromyalgia, cerebral palsy, or parkinson's disease.

Advantageously, it is intended for use in the treatment of stress.

It can also be provided for use in the treatment of jet lag syndrome.

Otherwise called "jet lag" or "circadian arrhythmia", this syndrome concerns a physiological condition which results from a rapid journey through several time zones, generally by plane, where the internal clocks are offset. It is thus possible to provide the planes with such a table, suitable for airplane travel with its constraints of weight, available space and electrical supply in particular. These tables can thus correspond to airplane beds arranged to integrate the device according to the invention. Such tables can also be integrated at airports.

It can also be intended for use in the treatment of musculoskeletal disorders.

It can also be intended for use in the treatment of the consequences of a sedentary lifestyle in the elderly, in particular in a retirement home.

It can also be provided for use in performance aid physical.

[00037] Thus, it can be used for the release of nitric oxide (n-NOS) in human or animal subjects.

It can also be intended for use in the treatment of proprioception disorders.

The table can also be provided for use in the treatment of animal pathologies, for example due to sedentarism and senescence.

In particular, such a table can be useful for veterinary treatments in horses or dromedaries, provided of course that it is adapted to the weight and dimensions of these animals.

The invention also relates to a method of therapeutic treatment, in which automated means start / stop and or program in advance the oscillations of a table as described above.

Advantageously, beforehand, automated means determine a value of frequency of the oscillations, and preferably a value of duration of the oscillations, as a function of at least one of the following parameters:

- a position of the patient on the mattress;

- a quality of vascularization of the patient; and

- the patient's stress level.

Thus, thanks to an algorithm provided by the invention, the therapist or the patient himself only has to enter certain data concerning the position of the patient on the table, the level of vascular transport and the level of stress. The frequency and duration of the oscillations are adjusted based on this data automatically. A number of necessary sessions, or even a complete treatment schedule, can also be provided based on this data. To determine the treatment corresponding to the combinations of each criterion, tests were carried out and the results are continuously updated according to the condition of the patients to improve the relevance of the algorithm.

By patient position, we first designate the lying or sitting state of the patient on the table. Oscillations do not have the same effects on a seated or lying patient, if only by the distance between the head of a seated patient and the oscillating support. In addition, the position also designates the way in which the patient is supported on the mattress, for example which areas of his body are in abutment supported on the mattress. Depending on their pathologies, a patient will not be supported in the same way so that another on the mattress, and the friction cone will also be different. It is also a question of checking whether the patient is standing on the axis of the oscillations or not. Other positioning criteria can of course be taken into account.

By quality of vascularization, we mean the ease with which blood circulates in the patient. We also speak of "diaphragmatic aperture".

The invention also relates to a computer program, comprising code instructions capable of controlling the implementation of the steps of a method as described above when it is executed on a computer.

It may in particular be a mobile application made available to a user wishing to be treated by oscillations. By entering the different data in the application, the oscillations are adapted to the user.

The invention also relates to a method of making the previous program available for downloading on a communication network.

Finally, the invention also relates to a device comprising telecommunications means and the previous program.

It can for example be a smartphone or a tablet.

Brief description of the figures

The invention will be better understood on reading the description which follows given solely by way of example and made with reference to the appended drawings in which:

[Fig. 1] is a perspective view of a device according to an embodiment of the invention in a first position;

[Fig. 2] is a perspective view of the device of Figure 1 in a second position;

[Fig. 3] is a bottom view of this device;

[Fig. 4] is a view of a table according to a first embodiment and without mattress;

[Fig. 5] is a side view of the table of FIG. 4 in the low position and with a mattress;

[Fig. 6] is a view of the table in FIG. 4 in the high position and with a mattress;

[Fig. 7] is a rear view of this table;

[Fig. 8] is a side view of this table; [Fig. 9] is a perspective view of this table;

[Fig. 10] is a detailed view of the device of the table of FIG. 4;

[Fig. 11] is a view of a screen of a control member of the table in FIG. 4;

[Fig. 12] schematically illustrates Coulomb's law applied to the invention;

[Fig. 13] illustrates a system according to an embodiment of the invention;

[Fig. 14] illustrates an embodiment of a method according to the invention;

[Fig. 15] illustrates a table according to a second embodiment; and

[Fig. 16] illustrates the table of Figure 15 in a variant.

detailed description

The device 10 of Figures 1 to 3 is an oscillating device, that is to say intended to accommodate an element to be oscillated by back and forth, such as a mattress. It has a connecting rod-crank system comprising a connecting rod 12 and a crank 11, the connecting rod being mounted in pivot connection with an edge of the crank 11. The connecting rod 12 is also mounted in pivot connection with a frame 13 itself mounted fixed to a set of bars forming a support 14, the support being intended to accommodate for example the mattress. The crank 11 is mounted fixed relative to a frame 15, while the support 14 is mounted movable in rectilinear translation along the axis X relative to this frame. Thus, a rotation of the crank 11 generates a rectilinear movement of the support 14 relative to the frame 15. The connecting rod 11 being mounted at the edge of the crank, a complete rotation of the latter generates a back and forth movement of the support 14 along the X axis, until it returns to its initial position. Figure 1 also illustrates the device in the retracted position when the connecting rod 12 is located on the proximal edge of the crank 11, Figure 2 the device in the extended position when a half-rotation has put the connecting rod on the distal side of the crank 11. A rotation of the connecting rod 11 generates a round trip, and a continuous rotation of the crank 11 therefore generates oscillations of the support 14, in this case an alternating rectilinear movement parallel to the axis X. To rotate the crank 11, the device 10 has an electric motor 25 of the conventional type for those skilled in the art and placed below the crank 11.

This device 10 could be integrated and adapted to many environments requiring the generation of oscillations. In this case, it is integrated into a therapeutic table 100, illustrated in FIGS. 4 to 9. This table 100 therefore comprises the device 10 and a mattress 16 mounted on the device 10 by means not illustrated so that a movement of the support 14 generates the same movement of mattress 16. The mattress 16 is here adapted to accommodate a human subject in the lying position. It complies with medical standards for mattresses intended for therapeutic tables. Its material comprises compact laminate, that is to say a stack of layers of kraft paper impregnated with thermosetting resin, the layers having been polymerized at high temperature and at high pressure. This material is hard, homogeneous, non-porous, seamless, seamless and without breaking of any kind for patient comfort. It is resistant to heat, scratches, cracks, impact, abrasion, stains, household solvents and chemicals. It does not generate any microbial migration and is therefore suitable for food contact. The mattress of this embodiment conforms to standard EN 483-4 and is of "CGS" quality (compact standard grade). It is also easy to clean. Any type of mattress could of course be suitable for device 10, which is not specific to a particular type of mattress and can be adapted to other elements to be moved or oscillated.

The table 100 further comprises means for adjusting the height of the support 14 by means notably of scissor pillars 17, of a piston fitting 22 connected to the support 14 and of a manual adjustment interface for a user not illustrated, knowing that any type of conventional interface for those skilled in the art, making it possible to adjust the height of the support 14, may be suitable. The table 100 also includes a floor frame 18 provided with four legs 19 distributed around the table and two casters 21 at the end of the table, allowing it to be moved easily if necessary.

The length of the table, from one foot from one end to one foot from the other, is 1950mm. Its width is 700mm. In the low position in Figure 5, it is 450mm high, and can go up to 830mm in height in Figure 6. Of course, other dimensions are possible, so as to adapt the table to different types of subjects: medium-weight humans, heavy humans, different types of animals, etc.

The table 100 also includes a control member in the form of a pedal 23 visible in Figures 4 to 9, or in the form of a remote control 23bis visible in Figure 10. The pedal 23 allows the therapist to control the oscillations of the table 100, that is to say of the mattress 16 via the support 14. Thus, while manipulating with the hands a subject which would be positioned on the mattress, the therapist can, with one foot on pedal 23, start or stop the oscillations and vary their frequency as desired. The remote control 23bis can be useful to the therapist in the same way, but also to a patient who would have the possibility of being on the table 100 and controlling the oscillations himself. A patient could therefore perform an oscillation session independently. The screen 24 is an interface which makes it possible to check several parameters, for example the frequency of the oscillations, the duration of the session, etc. It also makes it possible to fulfill the functions of the control member 23 or 23bis, namely to control the oscillations. It is also an interface making it possible to interact with a computer program 51 determining oscillation sessions as a function of input parameters and which will be described below.

When the motor 25 is operating, the mattress 16 oscillates in a direction parallel to the axis X via a back-and-forth movement. The amplitude of these oscillations is adjusted beforehand so that a patient positioned on the mattress cannot slide on the mattress during changes of direction of the latter. Thus, as illustrated in FIG. 12, the force F, or sum of the forces transmitted by the mattress to the patient 30 during this movement, must not come out of the corresponding friction cone 31 defined by Coulomb's law. In other words, the tangential component T of this force F must remain below the limit T0 of Coulomb's law. The objective is thus to avoid unpleasant friction of the patient, which would counterbalance the beneficial effects of the oscillations. To be certain that the force F remains in this cone 31, tests have been established as a function of the material of the mattress 16. The maximum amplitude, and possibly also the maximum frequency of the oscillations, must therefore be adapted as a function of the material of the mattress , if it changes.

In this case, the amplitude of the oscillations, that is to say the distance traveled by the support in one direction, is 35mm. This distance is adjustable and could of course be different.

FIG. 13 illustrates a system 50 comprising the table 100, a conventional telecommunications network 52 for those skilled in the art such as the Internet and a smartphone 52 comprising a mobile application 51 intended to be used by a human patient 30 or by his therapist. The mobile application 51, which could also be located in a tablet or correspond to computer software, allows the patient or his therapist to enter parameters corresponding to the patient. These parameters are the position of the patient on the mattress 16, the types of support of the patient on the mattress 16, the quality of vascularization of the patient, and the stress level of the patient. The program 51 deduces therefrom a complete processing, for example a number of oscillation sessions to be performed in a predetermined time, of a duration and of one or more predetermined frequencies. It is possible to interact with this program 51 also through the interface 24 or through the control members 23 or 23 bis. In other words, this program is not specific to a separate mobile application and can be an integral part of the table 100. We will now describe an implementation of a therapeutic treatment method according to the invention, using the table 100 and the program 51, on a human patient 30, and with reference to FIG. 14.

In a first step, the patient 30 is positioned on the mattress 100, for example lying down as in FIG. 11.

In a second step, the therapist uses the control interface 24, or the patient his smartphone, to enter parameters in the program 51. In this case, it is a question of indicating that the patient 30 is lying on the back. It could of course be in another position, such as sitting or on one side.

We then indicate the type of patient support in this position: which areas of the body are in contact with the mattress, such as the skull, shoulders, calves, heels, etc.

The quality of vascularization, or diaphragmatic opening, is estimated or measured by conventional means which will not be described here, and also integrated into the program, for example in the form of a note.

This is also the case for the patient's stress level.

Finally, it is verified that the patient is positioned in the X axis or that it is not, certain pathologies preventing it. This information is therefore also provided to the program 51 by the therapist or the patient himself.

From there, in a third step, the program 51 offers a first oscillation session adapted to the patient. Thus, the more the number of supports is reduced, the lower the level of vascular transport, the high stress level and the position offset relative to the X axis, the more the number, the duration and the frequency of the oscillations proposed by software 51 are going to be high.

For example, for a patient lying on his back, whose mattress supports are only the head, back and heels, whose diaphragm is closed, whose stress level is 3 on a scale of 5 and which is not in the X axis, the program will offer a series of 180-minute sessions at a frequency of 99 oscillations per minute and this twice a week. By manipulating the interface or the controls, the patient or the therapist can then start one of these sessions.

Of course, one can imagine other results corresponding to this combination of data. One can also imagine that other factors could be taken into account by the program 51. The oscillations in themselves make it possible to reduce the patient's state of stress. This is important because the patient's stress disrupts the limbic system. In addition, it is more difficult for a patient to progress under stress. Without manual manipulation, the oscillations therefore already have the effect of at least reducing the anxiety of a user, which can have many applications.

The oscillations also facilitate the therapist's manipulations. The manipulations to treat psychomotor disorders, such as those proposed in the work of Doctor Régine Zékri-Hurstel already mentioned, by binary or ternary rhythm, tire the therapist who can only exercise these manipulations for a few minutes on a classic table. The automated oscillations here therefore act as a counter-force allowing the therapist to manipulate the patient while tiring less and therefore to improve the effectiveness of these manipulation sessions. Thus, in addition to the effects of the oscillations alone, the patient benefits from longer and effective manipulations by the therapist.

The table 200 of Figures 15 and 16 differs from the table 100 by the presence of a mattress 28 comprising a removable head 29 in connection with the table 200 by means of an electric or hydraulic piston, as well as by the association of seats 26. The motor 27 of this table is pneumatic and is immersed in oil so as to be silent. It is also used to adjust the height of the support.

The mattress 28 is 210 centimeters long by 80 centimeters wide and includes two accessories 32 of eight centimeters of high density foam which can be placed in various places around the mattress. Their positions are also different in Figure 12 and Figure 13.

While the table 100 is more suited to patients weighing less than 100 kg, the table 200 corresponds to heavier patients.

Of course, the elements of the tables 100 and 200 can be combined as desired by the skilled person, and the table 200 can be used in the implementation of the method described above.

The invention therefore makes it possible to reduce the stress of a human subject and also to treat certain disorders such as psychomotor disorders. Among them are particularly targeted the delays in psychomotor acquisitions (cerebral palsy, autistic specters etc.) of genetic and / or hypoxico-anoxic origin, as movement therapies, such as those taught by Doctor Régine Zékri- Hurstel, aim to treat. As other therapies targeted by the invention, we can cite the preamble of the study carried out by Farid MATALLAH (http://auriol.free.fr/psychosonique/rythme/rythme-Farid.htin) on the current of cognitive psychology which has developed since the 80s and which mentions in particular Paul Fraisse: 1974 "Psychology of rhythm" , Jones (1976), Jones & Boltz (1989), Large & Jones (1999): "the theory of dynamic attention", Antonio Damasio: 1994 "L'Erreur de Descartes", Berthoz: 1997, "Le sens du movement "or

Francisco Javier Varel. Finally, we can mention the therapies inspired by MacLean's theory of the cerebral trinity. The invention thus makes it possible inter alia to increase the effectiveness of therapies inspired by these movements and which are based on manual manipulations in rhythm.

The invention can also be used to treat other disorders such as jet lag syndrome, or "jet lag".

The invention can finally be used, with adaptation of dimensions and materials, to treat animals, for example psychomotor disorders in animals or states of anxiety.

The invention is not limited to the embodiments presented and other embodiments will be apparent to those skilled in the art. It is in particular possible to provide the table with an osteopathic pillow in accordance with patent EP1691648 so as to improve the comfort of the patient.

The table may also have removable safety barriers so as to reduce the risk of the patient falling.

Any engine useful for the invention can be electric, pneumatic and whether or not immersed in oil.

Claims

1. Therapeutic device (10), comprising:

- a mattress support (14); and

- automated means (11, 12, 15) capable of causing the support (14) to oscillate.

2. Device (10) according to the preceding claim, wherein the means (11, 12, 15) are capable of producing oscillations comprising a back and forth movement in a direction parallel to a main axis (X) of the support (14).

3. Device (10) according to any one of the preceding claims, in which the means (11, 12, 15) comprise a connecting rod-crank system (11, 12).

4. Device (10) according to any one of the preceding claims, in which the means (11, 12, 15) comprise an electric motor (15).

5. Device according to any one of the preceding claims, in which the means comprise a pneumatic motor.

6. Device according to any one of claims 4 to 5, wherein the engine is immersed in oil.

7. Device (10) according to any one of the preceding claims, comprising a control member (23, 23bis) capable of varying the frequency of the oscillations.

8. Device (10) according to any one of the preceding claims, comprising means for adjusting the amplitude of the oscillations.

9. Therapeutic table (100; 200), comprising:

- a device (10) according to any one of the preceding claims; and

- A mattress (16) intended to accommodate a human (30) or animal patient, the mattress being mounted on the support (14).

10. Table (100; 200) according to the preceding claim, wherein an amplitude and / or a frequency of the oscillations can be adjusted so that the patient remains in a position of adhesion relative to the mattress.

11. Table (100; 200) according to any one of claims 9 to 10, for use for therapeutic purposes.

12. Table (100; 200) according to the preceding claim, for use in the treatment of psychomotor disorders.

13. Table (100; 200) according to claim 11, for use in the treatment of jet lag syndrome.

14. Table (100; 200) according to claim 11, for use in the treatment of animal pathologies.

15. Therapeutic treatment method, in which automated means (15, 51) start / stop and or program the oscillations of a table in advance

(100; 200) according to any one of claims 9 to 14.

16. Method according to the preceding claim, wherein, beforehand, automated means (51) determine a value of frequency of the oscillations, and preferably a value of duration of the oscillations, as a function of at least one of the following parameters:

- a position of the patient (30) on the mattress (16);

- a quality of vascularization of the patient; and

- the patient's stress level.

17. Computer program (51), comprising code instructions capable of controlling the implementation of the steps of a method according to at least one of claims 15 to 16 when it is executed on a computer.

18. Method of making the program (51) of the preceding claim available for downloading on a communication network.

19. Device comprising telecommunications means and the program of claim 17.