WO2023134824A1 - Equipment for carrying out training practices or training methods, medical treatments, therapies or the like, in particular in connection with the human body - Google Patents

Abstract

The invention relates to devices for carrying out training practices or training methods, medical treatments, therapies or the like, in particular in connection with the human body.

Description

Equipment for carrying out training procedures or methods.

Curative treatments, therapies or the like, especially in connection with the human body,

The present invention was initially based on my own observations, findings, findings and experiences in connection with the use of rollators, when it became apparent that the condition or the complaints of many users did not improve, but on the contrary, with them the duration of use of such rollators worsened and even further complaints and malaise were added.

The own considerations made in the following list of references, as well as a study of the relevant state of the art also listed in the list of references:

bibliography

AOK-Bundesverband Gbr (2022): An overview: Primary, secondary and tertiary prevention measures | dossiers | Background precaution | AOK Federal Association. Available online at https://aok-bv.de/background/dossier/praevention/index_17699.html, last updated on 01/07/2022, last checked on 01/07/2022.

Bandura, A (1977): Self-efficacy: toward a unifying theory of behavioral change. Psychological review. 84 volumes.

Beard, David J.; Rees, Jonathan L.; Cook, Jonathan A.; Rombach, Ines; Cooper, Cushla; Merritt, Naomi et al. (2018): Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomized surgical trial. In: The Lancet 391 (10118), pp. 329-338. DOI: 10.1016/S0140-6736(17)32457-1.

Frendel, Antonia (2015): ACTIVITY OF SHOULDER AND TRUNK MUSCLES UNDER DIFFERENT CONDITIONS OF HUMAN WALKING. Available online at https://vwvw.physiologie.uni-kiel.de/de/dissertetten-1/Frendel.pdf. Gnass, I.; Bartoszek, G.; Thiesemann, R.; Meyer, G. (2010): Acquired contractures of the joints in old age. A systematic literature analysis. In: Z Gerontol Geriet 43 (3), pp. 147-157. DOI: 10.1007/s00391-009-0089-6.

Götz-Neumann, Kirsten (2016): Understanding walking. Gait analysis in physiotherapy. 4th edition. Stuttgart, New York: Georg Thieme Verlag (physio textbook). Available online at https://www.thieme.de/rnedias/sys_master/8872257191966/9783131323743_muster- seite_58_67.pdf?mime=application%2Fpdf&realname=9783131323743_muster- seite_58_67.pdf.

jasmine lamp; Katrin Michalk; Lotte Roeder; Caroline Munsch; Jonas Marquardt (2017): Subjective gait security in old age. In: Gerontology and Geriatrics. DOI: 10.1007/s00391-017-1288-1.

Jöllenbeck, Thomas; S C H O N L E. C.; PI E T S C H M A N N, J.; WAW E R, c. (2013): Walking with a rollator corresponds to a full load. In: Orthopedics & Rheumatism. Available online at https.7/link.springer.com/search?query=Gehen+am+Rollator+corresponds+to+a+full load.

Kohlenberg, Kirsten (2017): Promoting healing-supporting confidence in the physiotherapeutic process. Bachelor thesis. HAWK Hildesheim, Hildesheim.

Liu, Hao; McGee, Margaret; Prati, Victor; Garrison, Kevin; FU, Qiuyu (2009): Comparison of Standing Balance Parameters Between Rolling Walker Users and Potential Rolling Walker Users: A Pilot Study. In: Physical & Occupational Therapy In Geriatrics 27 (4), pp. 298-309. DOI: 10.1080/02703180902750930.

Schmidt, W (2020): Movement system - basics. In: Dual Series - Anatomy, pp. 221-242. initially led to the realization that the cause of such complaints is the ingestion and the long stance of the user in a stooped position. The illustration shown below may make this clearer:

Constriction of the chest in a forward bent push position (flexion pattern) using a conventional walker.

Fig. 1: Posture to be observed when pushing a rollator, person in a flexed pattern (flexed posture). Constricted lower chest space means less ventilation in the lower ones

Lung sections, (own illustration)

5

A flexed thoracic spine in kyphosis constricts the lower thoracic space and the lower sections of the lungs are less ventilated, which is a non-negligible factor on immediate health in terms of the prevention of respiratory diseases. In particular, however, the following pain scenes indicated here arise in a forward-bent pushing position (flexion pattern) of the walker:

Fig. 2 In a bent, kyphosed posture, pain occurs in the area of the Achilles tendon or the tibia (shinbone), for example, due to the unphysiological posture and use of the joints. Knee joint pain, hip TSG (sacroiliac joint) pain or discomfort, pain in the spine, shoulder joints and cervical spine are also common.

This pain is caused by such a passive posture on uneven ground, e.g. B. cobblestones reinforced, since then the compensating element muscle power is not activated. Such rollators have become known, for example, by the

US 20150216757 A1, SE 01000192 A1 and US 20050156395 A1.

The figure below also shows such a conventional rollator.

Further observations and considerations then led to the task, very general and comprehensive, of creating procedures, methods and facilities for the prevention, treatment and therapy of health problems that serve in particular to restore, preserve and promote human health Preservation, promotion and improvement of exercise, with all the positive effects on the most diverse interacting levels of the human body, from the cellular and structural level to bio-psycho-social aspects and sensorimotor self-determination. A part of the task of the present invention is concerned with avoiding the disadvantages of conventional walkers through improvements and additional configurations, namely the preservation and promotion of human health by maintaining and promoting movement with all the positive effects on the most varied interacting levels or organs of the human body, from the cellular and structural level through to bio-psycho-social aspects and sensorimotor self-determination. In addition, further application possibilities for walkers are to be developed, namely also through the use and application of the improvements mentioned above in connection with walkers and additional configurations in other devices, such as treadmills and other training devices. Furthermore, the structures weakened and stunted by the stooped posture in connection with rollators, but also by other activities, starting with the cell via ligaments, tendons, fascia and muscles, as well as one-sided stressed joints and related structures should be positive influenced, regenerated and strengthened and the nervous supply improved. In addition, the lymphatic regulation in the body is supported.

The invention consists first of all in the realization that the problems mentioned are eliminated, improved, prevented and can be treated preventively by providing certain precautions and means - which are explained in the following initially in connection with, but not limited to, the example of a walker. if the persons affected are able to maintain an upright posture and/or, better both together, a physiological use of the arm during the corresponding activities, for example when using a walker, or is or is to a certain extent forced to do so, as shown schematically below is: Fig. 3: Upright posture with the walker - use with additional modification through physiological use of the arms. (Own representation)

The invention also consists in the provision of facilities, devices, means and the methods that can be carried out in connection therewith

This additional modification may be designed by adding guides (on top of or in place of the stationary handles used hitherto) that allow a predetermined trajectory for both swinging arms at a height that supports or requires a more upright posture of the spine, than with the previous rollators. An adjustment and locking option is advantageously provided in terms of the height, the slope and the angle of the two guides to one another. These tours, e.g. B. in the form of running rails, can also have a course deviating from a straight line. The guides can B. sliding or rolling guides, with the sliding or rolling bodies handles are connected. The two handles can also be connected to one another via a Bowden cable, e.g. B. over their souls, while the shell is connected to the guides. This ensures synchronous and counter-rotating arm movements. Such an additional modification is described in the accompanying figures.

It can also be advantageous between the handles and the guides brakes such. B. adjustable mechanical friction brakes or magnetically effective brakes to allow different loads. The connection of the user to a rollator-based system via a belt, as described below, is advantageous in the vast majority of cases.

A further embodiment according to the invention based on a walker is characterized in that the walker can be driven actively via arm movement.

Another embodiment according to the invention consists in that arm and leg movements can be coordinated in particular by means of a pivotable lever arrangement using a two-armed lever arrangement. There is one lever for the left arm and left leg and another two-armed lever for the right arm and right leg. The legs can be connected in the lower area to the lower lever area and a handle is formed on each of the upper ends, beyond the pivot point of the two-armed lever.

The invention is explained in more detail with reference to FIGS. 1 to 12:

1-4 show a rollator according to the invention for coordinated arm movement RA

Bicycle brakes and grips are provided here.

The brake cable is not shown; as is known, it acts on the rear wheels. The user has to learn that when the left foot is put forward, the right arm must go forward at the same time. The use of this device must be trained.

Description of parts:

RA01 is the adjustment tube for height adjustment -> adjustment to body size

The inner workings are described on the sectional drawing:

RA02 in the sectional drawing is the holder base on which the holder RA03 for the angle adjustment (approx. 15°) is attached.

RA04 is the guide rail in which the trolley RA05 runs back and forth. The RA06 adapter is screwed to the trolley using a cylinder head screw.

The handle holder RA07 is screwed to the adapter so that it can be tilted. The sectional drawing shows that the handle can be tilted by 180°.

RA08 handle with brake is slidable and rotatable -> manageable

In the carriage there is a hole for the Bowden cable wire RA09, which can be clamped using a screw that is not shown here.

RA10 Bowden cable jacket connects the two guide rails RA04 via the Bowden cable holder RAH and guides the Bowden cable wire.

Corresponding ergonomic handles for rheumatics and other diseases can be used, including those for prosthesis wearers of the upper extremities. The use of anti-vibration metal to attach the handles allows more degrees of freedom in the wrist.

If the left handle goes forward, the right handle goes backwards and vice versa.

This function can also be controlled with a hydraulic system instead of the Bowden cables.

The system can also be connected to the user via a waist belt and ensures better guidance of the rollator and offers ergonomic support, the pelvis guides the forward movement. It may also preferably be provided with a quick release/automatic release in the event of a fall.

5-9 show a rollator drive RAA (rollator arm movement drive), the arm movement is used to ensure the forward movement of the device.

A flat band is also attached to the roller carriage, which acts on a freewheel (GMN = company freewheel overrunning clutch) via a deflection roller. Pulling the arm backwards causes the GMV freewheel to rotate clockwise. As the arm moves forward, the tape is wound onto the freewheel (one freewheel each on the left and right).

The gear wheel is driven clockwise via shafts.

This gear transmits the driving force to the differential gear (counterclockwise), whereby the gear and the differential gear must be mounted centrally on the rollator.

The differential gear directs the power via shafts to one pulley each on the left and right. A second belt pulley on the wheel is driven by a toothed belt and thus propels the rollator forward.

The reverse movement is given by the fact that the GMV freewheel runs freely. He also runs freely forwards. It only works if you actively drive it with arm movements.

The stride length can be adjusted by changing the size of the pulleys. Advantageously, a tensioning pulley is also provided for belt tensioning.

The differential gear ensures that the rollator can also take a curve, because then both wheels must be able to rotate at different speeds.

10-13 show a "walker leg and arm movement coupled" system _J , accordingly, the reference numbers here begin with "RB":

Starting from the top, you can see the handle with brake RB07, which, like the "Rollator arm movement RA", can be tilted by 180 degrees using an adapter RB05 and (RB06 handle holder).

The handle can also be slid and locked horizontally forwards or backwards, depending on what the operator's posture is or should be.

The length can be adjusted to the body size using the RB04 grip tube.

Leg movement is transferred to arm movement or vice versa via the RB03 base tube. The RB02 joint can be adjusted in height on the RB01 support rail. In addition, the base tube, which coordinates arm and leg movements, can be adjusted in height and locked in this joint. This is a prerequisite for adapting the stride length and arm swing to the user.

Adjusting and locking the joint downwards makes the step smaller.

To prevent RB09, the leg stirrups, from dragging on the ground, the holding tube RB03 must be pulled up again. → If a user has thick feet, it must be set higher → With thick legs, the leg stirrups RB08 must be pulled further apart and with thin legs further together

RB09 a and b are the rear leg stirrups, foldable for entry

There is a small lever on the rear bracket right next to the support tube pointing down 45 degrees. This is pulled up via a Bowden cable by actuating a brake handle. This folds the rear leg stirrup upwards .

This allows the user to enter. Then the brake lever is released again and the leg bar snaps down again and the leg is thus between the front and rear bars. This rules out the ambling gait (arm and leg on the same side forward). (Ski binding - safety feature that the brackets fold away if there is a risk of falling) The leg roll should be rotatable so that no chafing occurs when walking.

The RB01 rail must be attached to the rollator, depending on how the rollator is constructed.

The RB04 tube may have to be bent forward so that the arm movement can also take place in front of the body, to be decided individually. The kink could also be optional in RB01.

As is known, the brake shoes acting on the rear wheels via the Bowden cable are not shown here. In particular, with this modification of the rollator according to the invention, the arms help the legs to move and vice versa, the legs help the arms. However, in the other embodiments according to the invention, force can also be generated jointly from the upper and lower extremities, which is available for a longer walking distance. Furthermore, this linking of the upper and lower extremities strengthens the physiological gait pattern, which can also contribute to an extension of the walking distance. This in turn has positive effects, like endurance training, for the cardiovascular system and the respiratory system. Improved mobility has a direct positive influence on the subjectively perceived quality of life.

The device can also be used to train people who are fitted with prostheses, also in connection with the rehabilitation of corona patients.

As an additional option, the devices according to the invention can be used to train the physiological gait pattern by adapting the step length when walking. This can be done, for example, by rhythmically counting in time, one two - every time you put your foot down, but also by using a beat part, electronically via a mobile phone, possibly with headphones, or by rhythmic light signals. When walking to the beat, the body tries to adjust and synchronize its stride length.

Furthermore, the training of the physiological gait pattern of the upper and lower extremities also offers the chance of a physiological use of the foot with all the advantages in terms of standing and training: o the foot-lifting muscles, in order to avoid stumbling and reduce the risk of falling o to train the foot muscles, to prevent sagging of the arch of the foot o and freedom of movement in all functional directions dorsal extension, plantar flexion, pronation and supination to maintain all combined directions including toe mobility. These desires are important, among other things, for maintaining balance (even without a walker). It also enables the body to react adequately to uneven surfaces and also reduces the risk of falling. With the apparatus according to the invention and using the proposed treatment methods and applications, training, for example in convalescence, is also possible with different degrees of difficulty, stress levels and different mobility requirements.

These different requirements result from whether the training is standing or walking and accordingly whether the arms are set dynamically or statically.

Some exercises are presented here as examples:

squats on the bed B. for back and leg strengthening, contracture and thrombosis prophylaxis, strength building and to regain confidence in your own body.

Fig. 6: Knee, foot, hip mobilization and strengthening of the adjacent muscles as well as training in an upright posture with all the positive effects of prophylaxis against pain caused by immobility, e.g. back pain (own drawing)

Another special feature of the invention is that the possibility of static and dynamic grip functions enables combined training, even with partial weight loading of the legs while standing plus dynamic arm training through to physiological gait.

In addition to the training effect itself, the training progress can be achieved according to the invention by exercises with different levels of difficulty that build on one another. This promotes the training motivation of the users and promotes the feeling of having their own influence on their health with all the positive consequences that result from this. It is advantageous to describe all these effects in a brochure or to show them in a video, as they are not self-explanatory for the layperson are.

Furthermore, according to the invention, training is possible, for example as shown below:

Fig.7 : Training in two difficulty phases (own drawing)

1. Dynamic legs with static arms

Training the legs with fixed/clamped hand grips, e.g. for mobilization after lying in bed

The forefoot remains standing and the heels lift off alternately => an extremely good exercise as:

thrombosis prophylaxis

Endurance training strengthens the cardiovascular system

Deepened breathing stimulus through movement

coordination training

weight training

contracture prophylaxis

2. Dynamic legs with dynamic arms

With arm use, right knee and left arm go forward at the same time, see above, plus coordination of arms and legs

Training stimulus for functional walking Continue training the cross movement, reciprocation movement, while walking or standing, if at the same time the knee and arm of the opposite side are to be used forward

Fig. 8 The users are given gauntlets, e.g. made of elastic material in predetermined colors, possibly with Velcro, in order to have a visual control of their physiological, reciprocal gait pattern. (own drawing)

On the right half of the body z. B. green cuffs, on the wrist/forearm and optionally on the thigh or and lower leg/foot.

On the left half of the body come differently colored, e.g. B red gauntlets same placement as left.

There must always be a red and a green color in front at the same time.

Different colors can also be used in such a way that one color marking is applied to the one alternately moving limb and the other marking in the other color to the other alternately moving limb. This avoids pacing when practicing independently.

A gait in which the right arm swings forward at the same time as the right leg can be prevented in this way, especially under physiotherapeutic guidance. The study situation is already clearly in favor of using a conventional rollator Training phase under expert guidance. This is also relevant to training and health for the roll-up door modification. In this application, as in all other new devices, applications, application processes, methods, knowledge, and considerations described in connection with and in the present application, the production, the provision and the use of corresponding instructional videos and suggestions, subject matter of the scope of the invention or inventions.

Use of ergonomic handles

The use of ergonomic handles from different care areas, such as rheumatism, is possible.

In addition, it is planned to equip the handle for the user on the trolley with an anti-vibration metal. Metal - rubber - metal allows for a flexibility of the grip of about 15 degrees and thus allows more play in the wrist area. If the user feels insecure due to these degrees of freedom, the anti-vibration metal should be replaced with a less to rigid handle suspension.

Use of the additional modification in the therapy area

The physiological gait is led by the pelvis and breastbone (sternum). Therefore, for training the upright physiological gait in the therapy area, an additional bracket on the rollator is possible with a lap belt or a firmer pelvic position, which with a bracket upwards allows a height-adjustable pilot, e.g. B on the sternum to give the patient a tactile stimulus on the pelvis and sternum as orientation for upright physiological walking.

Further aspects covered by the invention relate to secondary prevention, so that diseases can be detected as early as possible and their progression can be prevented (AOK-Bundesverband Gbr 2022). In addition, this additional modification can also be used in tertiary prevention "to delay, limit or completely prevent consequential damage to an illness that has already occurred" (ibid.).

The use of this innovative additional feature can be started before postural control is limited in order to achieve the best possible training result. It can therefore be used preventively at a time when walking distances are being reduced due to fatigue, in order to maintain the training stimulus of walking for the whole body, including the cardiovascular system and lungs.

In an extension of the invention, it is intended to create a conversion kit for a treadmill for training reciprocal walking or reciprocal arm movement on the treadmill with arm movement in the running rails.

Another problem that can be solved according to the invention arises by means of the new devices:

Immobility of the upper body is trained and honed in by walking on a conventional walker in a fixed arm position, thereby training the functional gait pattern. This was previously the only option of assisted walking for people who could no longer walk their distance. Now, with the invention, both maintaining and promoting the upright posture, reciprocal walking with all the resulting positive effects on health, prevention through maintaining and promoting mobility can be achieved, as well as a

Reducing the risk of falls. A fall often also means a loss of self-confidence, therefore promoting the expectation of self-efficacy (the confidence in oneself to have an influence on the situation, in this case on one's health). The new feature is a contribution to participation and an increase in quality of life.

The invention and the devices can also be used preventively and curatively. Expert instruction and adjustment of the body-related elements is extremely important for a good training result and the achievement of goals. According to the study, expert instruction is also required despite the fixed holding function of a conventional rollator.

1. "Free mobility in the joints, especially in the extremities, is a basis for unrestricted mobility and autonomy in old age" (Gnass et al. 2010).

2. It should be said that a rollator can in principle contribute to maintaining walking, participation and a self-determined life. From a geriatric perspective, walking with a rollator is always better than not walking at all.

3. Jöllenbeck and Wawer et al. in their study on biomechanical gait analysis on the rollator with patients* who were assigned a partial load "from 10 kg to pain-adapted full load" (Jöllenbeck et al. 2013) on the rollator in a rehabilitation clinic after fitting with an endoprosthesis or after a fracture 15 participants were examined, "(eleven women, four Men, MW: 78.7 years, 1.67 m, 78.1 kg)" (ibid.). The walking distance was between 0.4 and 1.9 km/h, with the legs bearing "related to the KG - on average left 99.2%, right 97.4%" and "the average supporting force left 18.6 N, right 30.8 N" (ibid.). This study indicates that a The rollator cannot generally be used to reduce the weight on the legs."However, a relief in the sense of a partial load is in no case achieved. Rather, the maximum relief applied over both arms is only 4.6 kg and over the entire load cycle considered almost constantly only 4.7%, ...which de facto corresponds to a full load, in which the rollator is only pushed as an aid to balance" (ibid.).

The authors only state a slower increase in force due to the reduced walking speed in the phase in which the foot is put down (ibid.).

4. Anyone who generally aims to relieve the legs with the aim of carrying less body weight on them in the sense of a partial load is therefore not adequately provided with the use of a conventional walker or with the modification. In practice, it has been shown that most people who use a rollator because of their age need it because they find it difficult to straighten up, the step length has become significantly shorter and or they no longer walk longer distances that are part of their living environment alone can handle. There may also be a fear of falling.

5. A survey of people who do not yet use a rollator showed that the majority of those surveyed see the use of the rollator as the "beginning of the end". One of the most frequently given reasons is that they do not know anyone who "got rid of" his walker in old age. The hurdle to using a rollator seems to be even higher for men than for women. Users report that once they have decided to use the rollator, they get used to it in a short time and it quickly becomes obsolete daily companion, although some short distances would also be possible without the rollator. Confidence in one’s own ability to walk falls, among other things, as a result of declining confidence in one’s own abilities, which is seen in many studies as a predictor of unsteady gait (Jasmin Lampe et al. 2017). Human walking is a complex process that depends on the skeletal muscles (Frendel 2015). The nervous system controls movement. "Through electromechanical coupling, the electrical excitation on the muscle cell membrane leads to the development of force in the muscle" (Schmidt and Lang 2007) in Frendel, 2015. This force is transmitted to the parts of the skeleton by tendons, ligaments and the muscle itself. the muscle attaches (Frendel 2015).The muscle tension runs between the insertion and origin of a muscle and thus has an effect on the position of the bones and joints and their systems involved.The musculature of the supporting apparatus works with the principle of the agonist and antagonist . The agonist is the working muscle that is currently contracting. In order to allow movement, the associated antagonist relaxes and lengthens as an opponent (ibid.) Using the example of the biceps muscle: If the biceps muscle is used to bend the elbow (flexion) tense, the biceps function as an agonist.The prerequisite for an elbow flexion movement is that the triceps, here in the function of the antagonist, relax and lengthen and stretch as the elbow flexes. If, on the other hand, the elbow is actively stretched, the triceps functions as an agonist, which contracts and the biceps becomes the antagonist. This interplay of the musculature of agonists and antagonists, which act as opponents, takes place throughout the body during movement. Muscles are also interconnected in muscle chains as functional units (Schmidt 2020). When a contraction occurs, muscles are connected one after the other as a muscle chain links. “In antagonistic chains, on the other hand, the contraction of one link leads to the tension of the other. The force of contraction is increased by this prestressing before the subsequent contraction. If the two links of an antagonistic chain contract at the same time, they can fix the joint in any position" (Schmidt 2020). This is also called co-contraction in the muscles. If this interplay of the muscles is overridden by purely static contraction , as when statically holding on to the handles of a conventional rollator, a functional restriction with far-reaching consequences for the entire body is practiced and through repetition ground in. The arms then no longer work dynamically in the swinging movement, but go into it a static muscle activity of holding into the co-contraction described above. Among other things, the natural lengthening and shortening of the muscles is no longer queried and these are not trained in their original function Muscles in muscle chains - the strong muscles help the weak - is no longer queried. This makes clear the complex system with which movement and walking are connected. If sub-systems are switched off or no longer required by the demands on the body, this has far-reaching effects on the entire body, the movement system, on sub-systems and this especially on the shut-down areas and adjacent areas. Using a conventional rollator, immobility of the upper body is trained and the functional gait pattern is trained.

Effect of holding both hands at the same time when pushing a walker, derived from physiology. In the joints themselves, synovial fluid is formed as a result of movement, and cartilage nutrition depends on the alternating demands of pressure and tension on the joint. With a conventional rollator, the person using it goes into a supporting and holding function of the arms (cocontraction). This static position (among other things, there is no longer any interplay between agonists and antagonists) reduces the production of synovial fluid and also the removal of inflammatory substances in the joint to the outside, for example. In the static function of holding and supporting, the joint only experiences pressure and no tension, which means that the nutrition of the cartilage, which is dependent on changing demands such as pressure and tension, is negatively influenced. The formation of synovial fluid is neither stimulated nor are inflammatory substances, if present, distributed and transported away, which would, however, prevent inflammation in the joints. If a rollator is pushed in front of you, the pressure on the shoulder joint appears to be rather low when viewed from the outside. However, if the pressure on the shoulder joint from supports is considered as opposed to free swaying, in which tension affects the shoulder joint, the difference in loading in the requirement becomes clearly visible.

Due to the rather passive support of the arms, the upper arm head is pressed under the acromion (due both to the co-contraction in the muscles and to the temporal component of the use of the walker and the general reduction in strength with age). According to studies, a narrowing of the shoulder joint is the most common cause of shoulder impingement syndrome. "An impingement syndrome of the subacromial area is responsible for up to 70% of all shoulder problems" (Beard et al. 2018). A study published in the journal "The Lancet" and published by well-known shoulder experts in an expert journal 2018 has been published.

source unknown

In physiotherapy practice, rollator users very often complain about shoulder pain. This is increasingly reported on sloping footpaths or uneven floors due to one-sided loading. All rollator users report pain in their arms and shoulders after walking on cobblestones or similar. This creates pressure, similar to hammering, on passive shoulder joint structures.

Functionally, it is obvious that an active use of the muscles in the shoulder and trunk reduces the pain level through the changing demands of swinging in the arm movement. However, this has not yet been investigated in connection with the use of rollators.

Arm swing and trunk mobilization

The swinging of the arms is responsible for mobilization in the upper trunk (Götz-Neumann 2016). The movement in the spine is performed when walking as a continuous movement of the pelvis and the reciprocal movement of the upper section of the upper body (ibid.). If this (movement and confusion) is no longer queried or even largely eliminated, for example through the static posture of the arms when using a conventional rollator, this has a negative effect on the straightening of the upper body. The functions of the spine are no longer exhausted, the recruitment of the muscles in the back and abdominal area (among other things, these form the muscular corset for upright posture) are no longer trained and the maintenance stimulus is absent. The nourishment of the cartilage and the intervertebral discs and last but not least the mobility of adjacent joints, such as the rib vertebral joints, are reduced by restricted rotation or, in the worst case, at least during the use of the rollator, they are absent. Depending on the adaptation of the gait pattern of the user to the pushing and holding process with the rollator, the posture used there is often continued while walking freely with far-reaching consequences for the gait pattern and the functions described above. The cervical spine is also negatively affected by the prevention of further movement in the trunk due to more passivity.

If all of these demands on the body while walking are interrupted for a longer period of time by continuous static work and additional fixing of the musculature in the supporting or holding function, important functions in the body degenerate. If people who walk a lot with a conventional rollator are observed walking freely, e.g. in the apartment, it becomes clear that they often do not rotate (turn) their upper body even when walking freely and rather fall into an on-block position, also use the arm swing less or even stop it (often it then looks as if the conventional walker users* are carrying a closet in front of them). Since the stride length normally affects the arm swing when walking and shuffling people in turn have almost no arm swing at all, it can be observed that this structure is also disturbed when using the conventional walker with non-moving arms, see (Götz -Neumann 2016, p.100 ff ).

In summary, it can be said that when using a conventional rollator, immobility of the upper body is accepted in favor of mobility in the legs due to the support and holding function of the firmly positioned arms. As a result, degenerative processes in the upper body are supported by immobility, diseases that are promoted by immobility arise and an increasing insecurity when walking is supported.

balance and postural control

The study by (Liu et al. 2009) describes three main areas that rollator users can influence. On the one hand, the lack of training in walking with the rollator, incorrect height adjustment of the rollator and poor posture while walking. In particular, poor posture and incorrect height adjustment could be associated individually or in combination with a lack of postural control. They call for older people with balance deficits in the medical rollator prescription, balance training and training in how to use the rollator (Liu et al. 2009). Loss of upright posture has been linked to an increased risk of falls in many studies, but more studies are needed to investigate this. o as much support as necessary, as much personal activity as possible

The new additional modification to the rollator enables and supports arm swings and thus mobility in the upper body. The supporting and postural muscles in the trunk are stimulated by calling up the activity to maintain and train the ventral (abdominal) and dorsal (back) muscles. Because the handles can also be locked, combined use is also possible. If users feel able to support their gait with their arm movements, the mobile handles can be used. If there is an insecurity in walking due to uneven terrain or fatigue, it is possible to lock the handles and the rollator can be used in the known way, in a supporting function via the arms, and by releasing the lock, e.g. after a recovery phase, it can be used again be turned into a mobile device. For example, during longer walks, it is advisable to use the functions alternately to prevent fatigue. It can be assumed that longer distances will remain manageable as a result. The users' self-motivation and self-efficacy expectation (SWE) is increased if the users have positive experiences on their paths and hikes. The concept of self-efficacy goes back to the Canadian psychologist Albert Bandura (Bandura 1977). “SWE describes the confidence in being able to master future challenges with the help of its own resources. As has been shown in numerous studies, SWE is positively correlated with health, health development and health-promoting behavior” (Kohlenberg 2017).

This takes you directly to the health concepts. There is a self-reinforcing cycle of expectation of self-efficacy.

Figure 1: Self-reinforcing cycle with high SWE: A high SWE increases the chances of achieving success through greater motivation, reduced stress and more endurance. The increased probability of success and positive contribution strengthen self-esteem, which results in a further increase in SWE. Figure based on Remmert (2014, p. 17)

(Kohlenberg 2017)

Neyer rollator as a training device while standing, load on both legs ½ body weight

For people who can stand on both feet, the new additional device on the rollator can be used as a training device while standing, e.g. B. in front of the bed, usable, so to speak, in the free wheel without drive on the rear wheels, to train the activity of the upper body and the arms in preparation for walking, eg after longer periods in bed. Technical solutions: The gear wheel would not be fixed, you could lift it out of the differential gear so that it can rotate freely. The resistance from the overrunning clutch remains as a training stimulus. Completely without drive means only inherent resistance of rail and trolley. In the combined arm-leg movement model, both leg stirrups could be folded up, also usable for boarding. Then you can also train standing up with this model.

Another idea of the invention deals with a specific connection or the establishment of a connection between the device and the person using the device. This type of connection can advantageously be used with devices such as the walkers described in the present application, but also with stationary devices, as well as, for example, with conventional walkers or similar devices. This invention is characterized in that between the person using such a device and the device there is a detachable connection or connection that is provided, in particular when a dangerous situation occurs, preferably when certain parameters occur, a connection or connection that releases itself. Such connection or connection options are described further below.

According to an additional idea of the invention, the contact areas or connection areas of the device, on which the body of the person using the device comes into contact with the device, can be adjusted to a specific region of this body, compared to the actual device both in the Height, in width, as well as forwards and backwards. A contact area of the body in the Pelvic and hip areas have been proven, whereby a specific application at least approximately on the left and on the right anterior superior iliac spine can be particularly advantageous. The system there seems to result in a functional leadership stimulus. .

Götz-Neumann, Understanding Walking, p.93

According to Götz-Neumann, the position of the pelvis is particularly important.

For example, when standing on one leg while walking, hyperextension of the hip joint is only possible by tilting the pelvis forward and rotating it backwards on the side of the supporting leg (Götz Neumann, 2016, Understanding Walking, p.82-96).

The pelvic area, particularly in the case of the rollator adaptation according to the invention, provides an orientation aid for the user at which point the thrust (force) for the gait is to be functionally generated. This supports the functional gait, but also for the or the user walks as upright as possible, with the center of gravity over the feet. This also avoids shifting the upper body forward and shifting the center of gravity forward when walking with the rollator, which significantly reduces the risk of falling.

The present invention is characterized in that the pelvic system is designed in such a way that the body of the user acts on or touches the device when walking at least approximately in the area of his two anterior superior iliac spines and continues to Body with the device is preferably releasably connected.

The loading or touching or contact points of the device are preferably designed to be at least approximately adaptable to the areas of the spina iliaca anterior superior of the user. This is expediently done in an adjustable configuration of these device-side contact or support points in their (at least approximately) horizontal distance from one another and/or in their height and/or in front or behind in relation to the person using them. Such a layout has been shown to ensure that the user targets these areas as the main landmark for a functional gait:

The pressure at the level of the anterior superior iliac spine on the pelvis is obviously additionally innervated, triggered, stimulated, supported or results in a corresponding reaction. As a result, it seems essential that the orientation takes place at least approximately on the anterior superior iliac spine and not somewhere on the body or torso. The connection or linkage could be rigid in some cases, but in most cases an at least somewhat flexible, such as elastic connection is more suitable, e.g. B. as a movable suspension or through flexible material, since the pelvis functionally moves forward on the side on which a step forward is taken and on the side on which a step is taken functionally backwards by about 5 degrees, by one To allow hyperextension of the hip in the standing leg when the other leg is moved forward, so the contact point is: pelvis, anterior superior iliac spine

As already mentioned, the connection described above can be attached to any rollator; B. a declaration of compatibility and approval of rollators equipped in this way can hardly be endangered because there is only a low risk potential if e.g. B. something was set incorrectly.

The connection can also be made, for example, via a manual, preferably detachable snap-in function.

Fastening with locks can also be carried out by a specialist, with counter nuts, cotter pins or the like.

Advantageously, a belt system can also be used, which partially surrounds the user from behind in the hip area and which has fastening areas at least approximately in the area of the device-side connection or support or contact points with which the user rests on the device Device can be connected and thus user and device are connected to each other. One of the belt areas on the device side can be firmly articulated on the device and the other belt area can be fastened via a detachable connection, which can also be released automatically under certain load conditions. However, both device-side connections (depending on the load) can also be self-releasing connections. For this purpose, magnetic locks can be used in an advantageous manner or other security locks that open with increased Release the load before or in the event of an accident and are adjustable, like ski bindings. Also

Velcro fasteners can be used.

A closure with an emergency opening can optionally also be provided, e.g. B a click closure. In the case of the versions in which the device can be unintentionally released by the user or can be released by the user himself, it is advantageous if the device is provided with a braking device which becomes effective automatically when the device is released.

The device can also be equipped with a signaling device, e.g. B. be equipped with an acoustic signaling device that reports when the connection between the rollator and the rollator user is loosened.

However, a vibration device can also be provided, which is designed to be activated automatically for a short time when the user is properly connected to the walker for the first time, so that the user notices that he is now securely connected to the walker.

However, a vibration device can also be designed to be activated automatically if the connection is unintentionally released. The vibration signal can be transmitted to the hands.

The model of a rollator according to the invention shown below by means of two photos F2 and F3 photographed from different perspectives corresponds in principle to the designs of the type shown and described in FIGS. 1-12, but without the wheel drives shown in FIGS. 5-8 , ie without any means of propulsion from the handles any running wheels of the rollator, therefore without drive gears,

freewheels, without differential gears and without drive pulleys or belts.

However, the other connection means 10 according to the invention are shown in the form of a special pelvic or hip connection for connecting or articulating the user with or to the rollator, namely a rigid support V at the front and an elastic connection H at the rear in the form of a belt G The front, rigid connection V consists - as seen from the user's side - of a left and a right support 11a and 11b, which are fastened in the lower area to a crossbeam 12, which in turn is attached to a left and a right longitudinal beam RA03 is attached. The supports 11a and 11b are directed obliquely towards the user. The slope can also be variably adjustable. Two fastening blocks 17a, 17b are fastened at a distance from one another on the two longitudinal beams RA03 below, between which in turn one adjusting rod 13 is provided and fastened to the blocks 17a, 17b. A locking or clamping sleeve 14 is provided between the fastening blocks around the adjusting rods 13, by means of which the hip connection 10 can be adjusted and clamped in the longitudinal direction.

In the present exemplary embodiment, an outer running rail LI of a drawer guide is fastened on the upper side of the left and the right of the longitudinal supports RA03. Inside each LI is an inner rail that can be slid in the longitudinal direction. On each of these inner A mounting block L3 is attached to each of the running rails L2, on each of which a handle RA08 is attached, each with a Bowden cable leading to a brake. As shown in FIGS. 1-8, between the two handles RA08 there is an equally effective Bowden cable, with a Bowden cable wire RA09 connected to the handles and a Bowden cable jacket RA10, which is fastened to the two longitudinal beams RA03 via blocks L4. The curved line appearing below the Bowden cable labeled RA09/RA10 is irrelevant, it is the shadow line of the Bowden cable.

Attached to the upper area of the supports 11a and 11b is a curved support beam 15 connecting them, which has two support areas 16a and 16b at its end areas, on which the user can at least approximately support himself with his two anterior superior iliac spine areas and can move or push the rollator. The distance between the two support areas 16a and 16b can be adjusted and locked, but this is not specifically shown here.

The height of the two support areas 16a and 16b is z. B. via the height adjustments shown in Figures 1-12 on or locked.

A longitudinal adjustment already described and shown and a mentioned inclination adjustment are given multiple adjustment possibilities of the pelvis or hip connection.

The belt G provided for connecting the user and the device has one of its attachment areas at least approximately in the area of the Supporting area 16a articulated at the front of the support beam 15, z. B. stapled, screwed o of the Velcro fastener which, associated with the support area 16b, is fastened to the front of the support beam

It has been shown that - depending on the skill of the user - when walking with a roliator alone with fixed or active arms, ie a rollator z. B with handles connected via a Bowden cable, the rollator may oscillate. He always breaks out in the opposite direction and then cannot keep a track. In a device according to the present invention, this oscillating movement is canceled by the power transmission to both rear wheels when a handle is pulled backwards. This means that the rollator can also be used with one hand.

According to the present application, going around corners with the rollator adaptation is made possible by a differential. The Bowden cable RA9/RA10 can even be omitted in the present application of the rollator adaptation if a (GMN) freewheel overrunning clutch is used, in which the trolley is brought back to the front, to the starting position, with the handle, e.g. B. by means of a spring which is tensioned, in particular pulled up, during the preceding backward movement of the handle.

It should also be expressly pointed out here that the GMN freewheel device mentioned in the present application documents is a design that is advantageous in certain applications, but that other freewheels can also be used that require a force - or torque transmission z. B. or in particular on one or more drive wheels, if a movement or a moment is applied to operating parts of the device in a certain direction by limbs, ie if z. B. via a handle a force or moment z. B is applied in the direction of pull, ie from a distance away from the torso to a position closer to the torso. During the backward movement, ie here the forward movement of the corresponding hand, the other hand, which may have to be moved reciprocally, is then driven via freewheeling in the same drive direction onto the drive wheels. Torque generation is also possible via thrust.

The invention is not limited to the exemplary embodiments shown and described, but also includes all within the meaning of Embodiments that have the same effect or are equivalent to the invention and/or treatment and/or application methods that can be carried out therewith. Furthermore, the invention has not yet been limited to the combination of features defined in the claims, but can also be defined by any other combination of specific features of all the individual features disclosed overall. This means that in principle practically every individual feature of the claims can be omitted or replaced by at least one individual feature disclosed elsewhere in the application. In this respect, the claims are only to be understood as first attempts at wording for one or more inventions contained in the application documents submitted.

The invention is even applicable to addressing a more upright gait in primates

Claims

Patent Claims:

1.) Device for carrying out treatment and therapy of and for health problems, such as the restoration, preservation and promotion of human health, esp. In connection with the human body, on the basis of a z. B. Walker-like equipment that can be moved relative to the same, from the distal end regions of the arms (hands or prosthesis) along a predetermined path of movement have means that these means are arranged at such a height that when actuated by the person using it requires or is forced to at least have a more upright posture than, in particular, when using a conventional rollator.

2.) Equipment, in particular according to claim 1, characterized in that the means are each designed as a handle for the left and right hand.

3.) Equipment, in particular according to claim 1 or 2, characterized in that the handles can be guided along a longitudinal guide.

4.) Equipment, in particular according to one of the preceding claims, characterized in that the handles can be moved in or on the longitudinal guide by means of a sliding or rolling element.

5.) Equipment, in particular according to one of the preceding claims, characterized in that the frictional resistance between the sliding or rolling element and the associated guide can be changed.

6.) Equipment, in particular according to one of the preceding claims, characterized in that the sliding or rolling elements are connected to one another via a transmission unit which causes a synchronous movement of the handles in opposite directions.

7.) Equipment, in particular according to one of the preceding claims, characterized in that the transmission unit is a Bowden cable.

8.) Equipment, in particular according to one of the preceding claims, characterized in that the transmission unit is a hydraulic connection.

9.) Equipment, in particular according to one of the preceding claims, characterized in that the pistons or the cylinders of each hydraulic piston/cylinder unit are connected to the hand grips and the cylinders are connected via a connecting line.

10.) Equipment, in particular according to one of the preceding claims, characterized in that the handles are each provided on either side of the user and can be pivoted about a pivot point by the user who is at least approximately in an upright position. Levers are provided.

11.) Equipment, in particular according to one of the preceding claims, characterized in that the levers are designed as two-armed levers.

12.) Equipment, in particular according to one of the preceding claims, characterized in that the pivot point is height-adjustable and lockable and the lever relative to the pivot point.

13.) Equipment, in particular according to one of the preceding claims, characterized in that the area of each two-armed lever facing away from the handle has a connection provision for connecting this area to the lower areas of one of the legs of the user .

14.) Equipment, in particular according to one of the preceding claims, characterized in that the levers each have a torque transmission unit and each drive an effective freewheel device in the opposite direction of rotation, which transmits the rotational movement to a differential gear whose Torque is transmitted via a torque transmission unit to each drive wheel of a multi-wheel running device in such a way that when one of the handles is pulled alternately, a torque in terms of propulsion can be transmitted to one of the two drive wheels.