WO2024010545A1

WO2024010545A1 - A robotic balance rehabilitation device

Info

Publication number: WO2024010545A1
Application number: PCT/TR2022/050927
Authority: WO
Inventors: Ramazan UNAL; Tugce ERSOY; Elif HOCAOGLU CETINSOY; Pinar KAYA CIDDI
Original assignee: Ozyegin Universitesi; Medipol Universitesi
Priority date: 2022-07-05
Filing date: 2022-08-31
Publication date: 2024-01-11

Abstract

The invention relates to a robotic balance rehabilitation device (100) for eliminating physiological and/or anatomical deficiencies, comprising a rehabilitation platform (10); and at least two arm supports (4) for providing support to a user standing on said rehabilitation platform (10). Accordingly, its novelty is characterized in that; it comprises a first rehabilitation unit (11) placed in a first region (1) of the rehabilitation platform for enabling said user to take steps in the rehabilitation platform (10); a second rehabilitation unit (21) placed in a second region (2) for enabling rehabilitation to be applied to at least one foot of the user; and at least two support units (41) provided to each arm support (4) for enabling the user to stand in balance on the rehabilitation platform (10).

Description

A ROBOTIC BALANCE REHABILITATION DEVICE

TECHNICAL FIELD

The invention relates to a robotic balance rehabilitation device for eliminating physiological and/or anatomical deficiencies.

PRIOR ART

Balance is the ability to control the body’s center of mass (CoM) deviation the support surface. The central and peripheral nervous system (CNS and PNS) integrates information from the visual, vestibular, proprioceptive, and cognitive systems, and through continuous sensory re-weighting; provides postural control in static and dynamic situations. The somatosensory function includes the senses of touch, vibration, pressure, proprioception, pain, and temperature. Impairments in this function negatively affect the ability to perceive, distinguish and recognize the senses in the body. Consequently, disorientation accompanied by abnormal movements, balance disorders, muscle weakness, and inability to maintain postural control. Especially in people with neurological disorders, since the integration of multiple sensory information is impaired, commands transmitted through nerves can be transmitted more slowly than normal. This situation causes balance disorders in people and even the possibility of falling. It has been observed that people with these diseases walk more slowly than their healthy peers and it is more difficult for them to reach a stable walking order.

Weak balance controls that patients encounter in their daily lives can be associated with inadequate sensory information processing, anticipatory and compensatory postural adjustments (APAs and CPAs). Since these adjustments can be improved through learning, the stability of the patient’s vertical posture can be improved and slow response times can be accelerated. Therefore, it is possible to observe improvements in both postural adjustments (proactive and reactive balance control) with effective fall prevention training. The most frequently used method for these developments is conventional physical therapy rehabilitation. In conventional rehabilitation methods, especially during gait rehabilitation, three or more physiotherapists may be needed to manually support the patient’s lower extremity and body. Another limitation is that the effectiveness of the rehabilitation during these practices depends on the personal knowledge and experience of the therapist. It is reported that the demand for physiotherapists is increasing continuously to match the number of patients due to increase in aging population worldwide. The use of robotic devices to address these challenges is encouraged to shift the adoption of rehabilitation clinics from conventional methods to robotic-assisted rehabilitation. Hence, high-quality therapy sessions can be achieved at a relatively low cost and with significantly less effort.

Perturbation-based balance training (PBT) is a type of exercise in which participants are intentionally disturbed to improve reactive balance reactions by training the individual neuromuscular responses. This training requires performing rapidly occurring sequential whole-body movements and applying large and sudden disruptive forces to stabilize CoM. With the development of balance reactions, an increase in the ability to respond to the loss of balance in unpredictable activities of daily living (ADL) and consequently a decrease in fall rate can be achieved.

In addition to the physiotherapist's manual pushes and pulls (lean and release test) in PBT studies, treadmill acceleration-deceleration and inclined/moving platforms have been implemented in recent years to mimic external perturbations in daily life. Although the PBT is an approach to decrease the fall rate, it is still far from the realistic condition. The limited type of perturbations performed with existing devices and techniques may reduce individuals' capacity of adapting and generalizing the effects of PBT training to ADL. On top of that different perturbation modalities in PBT programs can be considered highly important to train balance reactions to match with variety situations and motor tasks.

The robots used in the present art are generally designed to correct a single deficiency. Considering the design and development of robotic devices for lower extremity rehabilitation, there are mainly three types of system, i.e., wearable exoskeleton system, ankle platform and balance rehabilitation platform are proposed. For example, the most frequently used treatment method for the extremities is wearable robotic devices. Some of these are systems to increase the capacity or reduce the effort of the lower limbs of healthy people. They have been developed to support the activities of individuals with muscle weakness in daily life or for the rehabilitation of stroke patients. However, since the mechanisms underlying human movements and how the designed devices should interact with humans are not fully understood, there is no device that can effectively improve the user’s performance. The mentioned systems have difficulties in use because they have a rigid, bulky structure, and uncomfortable interfaces, restrict biological joints and are misaligned with natural joints. In addition, if the exoskeleton does not have enough Degree of Freedom (DoF) to work in harmony with human joints, it exerts a residual force on the human limb due to axial misalignment, and this may cause long-term injuries, as well as discomfort. Furthermore, the use of these robots by patients is not preferred in daily life because the appearance of these robots is coarse.

Another method is robotic devices developed for ankle rehabilitation. Platform-based robots are grounded and have movable end effector as a rehabilitation platform with one or more DoF. These types of systems employed for ankle joint focus only on improving the range of motion (ROM) of the joint rather than improving balance of the patient. Most of the platforms for the ankle joint are in parallel structure which provides sufficiently high-torque for plantar flexion/dorsiflexion, inversion/eversion, and supination/pronation movements of the ankle. These platforms are widely used to strengthen ankle joint movements and improve ankle proprioception. However, the end effectors of these parallel manipulators are large enough to accommodate only one foot and have a low weight carrying capacity compared to body weight. Therefore, it is not preferred to use them in balance rehabilitation after the ankle treatment is completed. Additionally, the end effector of the proposed systems are not endowed with sensor; therefore, pressure change measurement on the sole and sensory input under the foot cannot be performed during the ROM rehabilitation.

Posturography, measurement of CoM and balance variables, are tested through static or dynamic techniques for balance evaluation and rehabilitation. When compared to static situations, rehabilitation under dynamic conditions contributes more to the improvement of balance disorders and motor skills.

Dynamic platforms require instantaneous dynamic movements, forcing patients to adjust their balance during perturbation. These systems deliberately put patients in an unbalanced state while patient following the VR game, thus assessing their balance status based on CoM position. During the dynamic rehabilitation process, the angle of the platform can be controlled, and patients are requested to maintain their CoM and posture. Even though, ROM can be covered fully by gradually changing the angular position, this system cannot provide Assist-as-needed (AAN) paradigm (even if a patient performance improves, the system's level of assistance remains unchanged). Furthermore, weight transfer in balance training cannot be provided during PBT due to the lack of sensory input to the foot with these devices. Additionally, the VR environment is the only sensory input proposed with these devices; however, it has been stated in the literature that multi-sensory input is more powerful for mimicking and enhancement ADL. Since the said systems are designed for only one foot or standard balance training according to the standard measurements, they cannot provide personalized treatment. Rehabilitation of balance should be performed with the integration of ankle-foot, balance, and step phases in order to enhance activity-based neuroplasticity. In addition, since the commercially available platforms used in these systems are designed with different DoF restrictions, they may cause the patient’s condition to be adversely affected. The system that treats multiple postural disorder with a single device is not known in the present art.

The fact that all the process steps performed during the rehabilitation process are personalized ensures that the treatment process of the person is shortened considerably. Robotic devices used in the present art cannot offer personalized treatment for every patient. This may lead to dissatisfaction in patients, loss of time, and low motivation due to loss of time.

Application no. CN201410377261 discloses a lower limb rehabilitation training system based on a multi-position electric wheelchair. This system provides foot rehabilitation for the lower limb. However, balance and step rehabilitations are not provided.

As a result, all issues mentioned above made it necessary to make an innovation in the relevant technical field.

BRIEF DESCRIPTION OF THE INVENTION

The present invention relates to a robotic balance rehabilitation device to eliminate the above-mentioned disadvantages and bring new advantages to the related technical field.

An object of the invention is to provide a robotic balance rehabilitation device for eliminating physiological and/or anatomical deficiencies, that is designed to provide integrated balance rehabilitation (l-BaR).

Another object of the invention is to provide a robotic balance rehabilitation device that allows applying treatments according to users needs.

Another object of the invention is to provide a robotic balance rehabilitation device that allows users to be controlled remotely. Another object of the invention is to provide a robotic balance rehabilitation device to provide 1-BaR for users.

The present invention relates to a robotic balance rehabilitation device for eliminating physiological and/or anatomical deficiencies, comprising a rehabilitation platform; and at least two arm supports for providing support to a user standing on said rehabilitation platform, to realize all the objects that are mentioned above and will emerge from the following detailed description. Accordingly, it comprises a first rehabilitation unit placed in a first region of the rehabilitation platform for enabling said user to take steps in the rehabilitation platform; a second rehabilitation unit placed in a second region for enabling rehabilitation to be applied to at least one foot of the user; and at least two support units provided to each arm support for enabling the user to stand in balance on the rehabilitation platform. Thus, ankle rehabilitation, balance rehabilitation, and step rehabilitation can be performed with a single device.

A possible embodiment of the invention is characterized in that the first rehabilitation unit comprises at least one first foot plate placed in at least one first slot providing at least 2-DoF.

Another possible embodiment of the invention is characterized in that said first foot plate comprises a first movement provider to enable the step distance to be adjusted and moved for perturbation purposes.

Another possible embodiment of the invention is characterized in that the first foot plate comprises at least one first rehabilitation sensor to provide the measurement of the foot pressure of the user and at least one first rehabilitation haptic element to provide stimulation of the foot of the user.

Another possible embodiment of the invention is characterized in that the second rehabilitation unit comprises a manipulator with at least two DoF placed in the second region.

Another possible embodiment of the invention is characterized in that the said manipulator comprises at least one second foot plate to place the feet of the user; at least one second rehabilitation sensor to measure the foot pressure of the user, that is provided to the said second foot plate; and at least one second rehabilitation haptic element to provide stimulation of the foot of the user, that is provided to the second foot plate. Another possible embodiment of the invention is characterized in that the manipulator comprises at least one load region to enable the measurement of the user’s CoM.

Another possible embodiment of the invention is characterized in that the said load region comprises at least one load sensor.

Another possible embodiment of the invention is characterized in that the said support unit comprises at least one support sensor to enable the measurement of the force support required by the user and at least one support haptic element to provide the user with haptic feedback.

Another possible embodiment of the invention is characterized in that it comprises at least one biological signal measurement unit (electromyography of extremity muscles-EMG sensor) provided to be placed in predetermined positions on the user.

Another possible embodiment of the invention is characterized in that the rehabilitation platform comprises a sitting unit provided to a third region in an attachable way.

Another possible embodiment of the invention is characterized in that the said sitting unit comprises a chair comprising at least one sitting sensor to enable the force applied by the user to be measured when the user is seated and at least one sitting haptic element to provide the user with stimulation.

Another possible embodiment of the invention is characterized in that it comprises an adjusting mechanism provided to the said sitting unit for adjusting the distance of the chair to the second rehabilitation unit.

Another possible embodiment of the invention is characterized in that the rehabilitation platform comprises at least one third rehabilitation unit provided to a third region thereof in an attachable way.

Another possible embodiment of the invention is characterized in that the said third rehabilitation unit comprises at least one third foot plate placed in at least one second slot providing DoF in the two-dimensional plane.

Another possible embodiment of the invention is characterized in that the said third foot plate comprises at least one third rehabilitation sensor to provide the measurement of the foot pressure of the user and at least one third rehabilitation haptic element to provide stimulation of the foot of the user.

Another possible embodiment of the invention is characterized in that the third foot plate comprises a second movement provider to enable the step distance to be adjusted and moved for perturbation purposes.

Another possible embodiment of the invention is characterized in that it comprises a processor unit for providing rehabilitation treatment to the user.

Another possible embodiment of the invention is characterized in that it comprises a screen associated with said processor unit to enable the user to be guided and rehabilitated.

Another possible embodiment of the invention is characterized in that it comprises a communication unit associated with the processor unit.

Another possible embodiment of the invention is characterized in that it comprises a memory unit enabling the data associated with the processor unit to be stored for later use.

Another possible embodiment of the invention is characterized in that it comprises a user terminal associated with the communication unit.

Another possible embodiment of the invention is characterized in that the processor unit is configured for:

- allowing a first status data to be received from the sitting sensor by the user sitting on the sitting unit;

- providing the actuation of the sitting haptic element according to the first status data;

- allowing a second status data to be received from the second rehabilitation sensor by the user placing his/her feet on the manipulator;

- providing the actuation of the second rehabilitation haptic element according to the second status data;

- allowing the first process steps enabling the user to be guided according to the first status data and the second status data to be transmitted to the user via the screen;

- allowing the first status data and the second status data to be instantly stored in the memory unit; - allowing the first status data and the second status data recorded in the memory unit to be instantly transmitted to the user terminal via the communication unit.

Thus, the user can perform ankle rehabilitation.

- allowing a third status data to be received from the second rehabilitation sensor by the user standing on the manipulator;

- providing the actuation of the second rehabilitation haptic element according to the third status data;

- allowing a fourth status data to be received from the measuring and warning unit placed in the user’s body;

- allowing a fifth status data to be received from the biological signal measurement unit placed in the user’s body;

- providing the actuation of at least one vibration motor provided to the measuring and warning unit according to the fourth status data and the fifth status data;

- allowing a sixth status data to be received from the support sensor by the user holding on to the support unit on the arm supports;

- providing the actuation of the support haptic element according to the sixth status data;

- allowing the second process steps enabling the user to be guided according to the third status data, the fourth status data, the fifth status data, and the sixth status data to be transmitted to the user via the screen;

- allowing the third status data, the fourth status data, the fifth status data, and the sixth status data to be stored in the memory unit;

- allowing the third status data, the fourth status data, the fifth status data, and the sixth status data recorded in the memory unit to be instantly transmitted to the user terminal via the communication unit;

Thus, the user can perform balance rehabilitation.

- allowing the third process steps enabling the user to be guided from the third rehabilitation unit to the second rehabilitation unit, from the second rehabilitation unit to the first rehabilitation unit, to be presented to the user via the screen;

- allowing a seventh status data to be received from the third rehabilitation sensor while the user is in the third rehabilitation unit; - providing the actuation of the third rehabilitation haptic element according to the seventh status data;

- allowing an eighth status data to be received from the second rehabilitation sensor while the user is in the second rehabilitation unit,

- providing the actuation of the second rehabilitation haptic element according to the eighth status data;

- allowing ninth status data to be received from the first rehabilitation sensor while the user is in the first rehabilitation unit;

- providing the actuation of the first rehabilitation haptic element according to the ninth status data;

- allowing the seventh status data, the eighth status data, and the ninth status data to be stored in the memory unit;

- allowing the seventh status data, the eighth status data, and the ninth status data recorded in the memory unit to be instantly transmitted to the user terminal via the communication unit;

Thus, the user can carry out the step rehabilitation.

BRIEF DESCRIPTION OF THE FIGURES

A representative view of ankle rehabilitation and balance rehabilitation in a robotic balance rehabilitation device is given in Figure 1 .

A representative view of balance rehabilitation and step rehabilitation in a robotic balance rehabilitation device is given in Figure 2.

A representative view of a manipulator used in a robotic balance rehabilitation device is given in Figure 3.

A representative view of the measuring and warning unit and the biological signal measurement unit used in a robotic balance rehabilitation device on the user is given in Figure 4.

A representative view of the operating scenario of a robotic balance rehabilitation device is given in Figure 5.

DETAILED DESCRIPTION OF THE INVENTION The subject of the invention is explained with examples that do not have any limiting effect only for a better understanding of the subject in this detailed description.

The invention relates to a robotic balance rehabilitation device (100) for eliminating physiological and/or anatomical deficiencies. The said robotic balance rehabilitation device (100) is used for sensory feedforward and feedback balance analysis, rehabilitation, and support purposes. A robotic balance rehabilitation device (100) is configured to provide ankle rehabilitation, balance rehabilitation, and step rehabilitation.

As shown in Figure 1 and Figure 2, the robotic balance rehabilitation device (100) comprises a rehabilitation platform (10). The said rehabilitation platform (10) comprises at least two arm supports (4) to provide support to a standing user. There is at least one support unit (41 ) provided to each arm support (4) to help the user stand in balance on the rehabilitation platform (10). The said support unit (41) comprises at least one support sensor (411) to enable the measurement of the force support required by the user. A pressure sensor, a force sensor, etc. may be used as the said support sensor (411) in a possible embodiment of the invention. The support unit (41) further comprises at least one support haptic element (412) for providing stimulation of the arm muscles of the user. At least one vibration motor etc. is used as the said support haptic element (412) in a possible embodiment of the invention.

As shown in Figure 1 , the rehabilitation platform (10) comprises a first region (1), a second region (2), and a third region (3). The rehabilitation platform (10) comprises a first rehabilitation unit (11) for enabling the user to take steps on the rehabilitation platform (10) provided to the said second region (2). The said first rehabilitation unit (11) comprises at least one first foot plate (13) placed in a first slot (12) to have DoF in the two-dimensional plane in a possible embodiment of the invention. The first rehabilitation unit (11) comprises four foot plates placed in four slots provided side by side in a possible embodiment of the invention. The first foot plate (13) comprises a first movement provider to enable the step distance to be adjusted and moved for perturbation purposes. The said first movement provider provides the movement of the first foot plate (13) within the first slot (12) in a possible embodiment of the invention. There is at least one first rehabilitation sensor (14) placed in predetermined positions to enable the measurement of the foot pressure of the user on the lower platform of the first foot plate (13). At least one load cell is used as the said first rehabilitation sensor (14) in a possible embodiment of the invention. There is at least one first rehabilitation haptic element (15) placed on the lower platform of the first foot plate (13) to enable the user’s foot muscles to be activated. At least one vibration motor is used as the said first rehabilitation haptic element (15) in a possible embodiment of the invention.

As shown in Figure 2 and Figure 3, a second rehabilitation unit (21) is placed in the said second region (2) of the rehabilitation platform (10) for enabling rehabilitation to be applied to at least one foot base of the user. The said second rehabilitation unit (21) comprises a manipulator (22) specially placed for each foot base in a second slot (321 ) with DoF in the lateral plane. The said manipulator (22) is provided with 3 DoF features in a possible embodiment of the invention. The manipulator (22) comprises an upper platform (not shown in the figures), a lower platform (not shown in the figures), a support provider (not shown in the figures) extending from the center of said lower platform to the base, and at least one movement mechanism (not shown in the figures) that provides adjustably provided movement. The said upper platform comprises at least one second foot plate (221) for the user to place their feet. There is at least one second rehabilitation sensor (222) placed under said second foot plate (221 ). Load cells that measure the pressure applied to the foot of the user are used as the said second rehabilitation sensor (222) in a possible embodiment of the invention. The said load cells are placed in at least four regions regarded as dense regions in the literature below the second foot plate (221 ). At least one second rehabilitation haptic element (223) is placed in the said regions to provide stimulation of the foot muscles of the user. At least one vibration motor is used as the second rehabilitation haptic element (223) in a possible embodiment of the invention. The said vibration motors triggers the muscle by providing haptic feedback to the user. The manipulator (22) can be adjusted at different angle values within the ankle limits as a result of moving the movement mechanism by at least one linear actuator.

The manipulator (22) is provided to allow movement such that it is 0^e-20^e between the two feet of the user. As the angle between the foot span decreases, the difficulty level of the movement increases. Users first start the rehabilitation application with an easy angle of 20^e. It is aimed to reduce the angle value by 0^e as the foot muscles develop during rehabilitation. After adjusting the angle values, the position of the first foot plates (13) is manually fixed through at least one corner connector (not shown in the figures). In an alternative embodiment of the invention, the movement of the movement mechanism can be automatically adjusted. The said corner fixings can be automatically adjusted in another alternative embodiment of the invention. The upper platform comprises a foot fixing span (not shown in the figures). The said foot fixing span comprises the span through which the fastening straps used to fix the feet of the user pass when the user places their feet on the first foot plates (13). The manipulator (22) also comprises at least one load region that allows the measurement of the user’s CoM. The said load region comprises at least one load sensor (not shown in the figures). The said load cell is placed to form an imaginary equilateral triangle in a possible embodiment of the invention.

As illustrated in Figure 1 , there is a sitting unit (31) that is placed in the third region (3) of the rehabilitation platform (10) in an attachable way. The said sitting unit (31) comprises a chair (311 ) to enable the user to sit while performing ankle rehabilitation through the second rehabilitation unit (21). There is an adjusting mechanism (312) for adjusting the distance of the chair (311) to the ground and the second rehabilitation unit (21 ). The position of the user is adjusted according to the predetermined distances by the adjusting mechanism (312). The said adjusting mechanism (312) can be adjusted manually in a possible embodiment of the invention. In another alternative embodiment of the invention, the adjusting mechanism (312) can be adjusted automatically according to the predetermined value. The chair (311 ) comprises at least one sitting sensor (313) to enable measurement of the pressure applied when the user is seated. The said sitting sensors (313) are placed in the sitting area, in the back area, in the arm area, etc. of the chair (311) in a possible embodiment of the invention. It is preferred to use load cells, pressure sensors, etc. as the sitting sensor (313) in a possible embodiment of the invention. The chair (311) comprises at least one sitting haptic element (314) so that muscle activation can be induced during the user’s sitting. The said sitting haptic element (314) is placed in the sitting region, the back region, the arm regions, etc. of the chair (311) in a possible embodiment of the invention. It is preferred to use vibration motors etc. as the said sitting haptic element (314) in a possible construction of the invention.

As shown in Figure 2, there is a third rehabilitation unit (32) to enable the user to take steps on the rehabilitation platform (10), which is placed in the third region (3) of the rehabilitation platform (10) in an attachable way. The third rehabilitation unit (32) comprises at least one third foot plate (322) placed in a second slot (321) such that it has DoF in the two- dimensional plane. The third rehabilitation unit (32) comprises four foot plates placed in four slots provided side by side in a possible embodiment of the invention. Thus, the user can complete the two-step cycle in the third region (3). The third foot plate (322) comprises a second movement provider to enable the step distance to be adjusted and moved for perturbation purposes. The said second actuator provides the movement of the third foot plate (322) within the second slot (321 ) in a possible embodiment of the invention. There is at least one third rehabilitation sensor (323) positioned in predetermined positions to provide the measurement of the foot pressure of the user to the lower platform of the third foot plate (322). At least one load cell is used as the said third rehabilitation sensor (323) in a possible embodiment of the invention. There is at least one third rehabilitation haptic element (324) positioned on the lower platform of the third foot plate (322) to enable the user’s foot muscles to be activated. At least one vibration motor is used as the said third rehabilitation haptic element (324) in a possible embodiment of the invention.

The sitting unit (31 ) and the third rehabilitation unit (32) have at least one stair (33) that is placed in an attachable way. The said stair (33) allows the user to easily climb to the rehabilitation platform (10). The stair (33) may be directly attached to the third region (3) in a possible embodiment of the invention.

The rehabilitation platform (10) comprises the first region (1 ), the second region (2), the third region (3), and the arm supports (4). In the rehabilitation platform (10), the sitting unit (31) is placed in the third region (3) during the application of ankle rehabilitation. Optionally, the stair is placed on the sitting unit (31). In the rehabilitation platform (10), the stair is placed in the third region (3) to ensure that the user can easily climb the rehabilitation platform (10) during the application of the balance rehabilitation. In the rehabilitation platform (10), the third rehabilitation unit (32) is placed in the third region (3) to enable the user to take steps during the application of the step rehabilitation. Optionally, the stair is placed in the third rehabilitation unit (32). Depending on the rehabilitation application, among the sitting unit (31 ), the third rehabilitation unit (32), and the stair at least one of them is placed in the third region (3).

As shown in Figure 4, the robotic balance rehabilitation device (100) comprises at least one measuring and warning unit (20) provided to be placed in predetermined positions on the user. The said measuring and warning unit (20) has a belt-like structure in a ring shape that can be attached to the body in a possible embodiment of the invention. The measuring and warning unit (20) comprises at least one inertial measurement unit (IMU) for the evaluation of movement. The measuring and warning unit (20) comprises at least one vibration sensor for muscle stimulation. It is ensured that the said measuring and warning unit (20) is placed on the arms, body, leg, knee, and wrist of the user in a possible embodiment of the invention.

The robotic balance rehabilitation device further comprises at least one biological signal measurement unit (30) provided to be placed in predetermined positions on the user. The said biological signal measurement unit (30) comprises an EMG sensor for the electromyography of the extremity muscles in a possible embodiment of the invention. Since muscle activation values will be measured through the said EMG sensor, the performance and development of the patient in postural adjustments and reaction time can be evaluated. The measuring and warning unit (20) and the biological signal measurement unit (30) are installed in predetermined places on the user, especially during balance rehabilitation. The measuring and warning unit (20) and the biological signal measurement unit (30) helps the user to stand through vibration motors and enable the activation of the said muscles according to the measurement data taken from the body muscles. Thus, it is easier for the user to stand during the balance rehabilitation.

Referring to Figure 5, the robotic balance rehabilitation device (100) comprises a processor unit (40) for providing rehabilitation to the user. The said processor unit (40) provides the actuation of the haptic elements according to the data collected from the rehabilitation platform (10) and the user. There is a screen (50) associated with the processor unit (40) to enable the user to be guided and rehabilitated. The said screen (50) is provided digitally in a possible embodiment of the invention. It is ensured that at least one VR game is presented to the user through the screen (50). The screen (50) is placed on a support mechanism on the rehabilitation platform (10) in a possible embodiment of the invention. The said support mechanism allows the position of the screen (50) to be adjusted according to the height measurements of the user. The support mechanism also allows the lateral distance between the screen (50) and the user to be adjusted. The screen (50) is placed in the view of the user separately from the rehabilitation platform (10) in another possible embodiment of the invention.

Referring to Figure 5, there is a communication unit (60) to ensure that the data collected from the rehabilitation platform (10) and the user is transmitted to a remote user. The said communication unit (60) is provided to communicate wired and/or wirelessly in a possible embodiment of the invention. The communication unit (60) enables the collected data to be transmitted to a remote server. Data can be accessed through a user terminal (70) connected to the server. For example, through a physician, a specialist, etc., it can be ensured that the user’s difficulty level during rehabilitation can be adjusted by remote control. The processor unit (40) can enable the virtual image presented on the screen (50) to be changed according to the data received from the user terminal (70). Thus, it is possible to change the difficulty level of the user.

Referring to Figure 5, there is a memory unit (80) that allows the user’s data associated with the processor unit (40) to be recorded instantly. The said memory unit (80) allows the information to be stored for later use. For example, it can be ensured that people such as physicians, specialists, etc. follow the status of the user during the period from the first stages of rehabilitation to the last stages. The processor unit (40) may provide a visual graph to enable the user to be informed according to the information recorded in the memory unit (80) in a possible embodiment of the invention. The user can determine the stage of rehabilitation by examining this graph before starting rehabilitation.

An exemplary operating scenario of the invention is described as follows;

In a robotic balance rehabilitation device (100), firstly ankle rehabilitation is provided to a user. To apply ankle rehabilitation, first of all, the sitting unit (31) is placed in the third region (3). The sitting unit (31) is provided detachably in the rehabilitation platform (10) in the third region (3). By attaching the sitting unit (31 ) to the third region (3), the user is allowed to sit on the chair (311). The user can manually adjust the distance to the second rehabilitation unit (21 ) through the adjusting mechanism (312). The distance of the user according to the second rehabilitation unit (21) can also be adjusted automatically according to the predetermined reference values. In this case, the specialist ensures that a setting command is transmitted to the processor unit (40) through the user terminal (70). The processor unit (40) can enable the chair (311) to be moved to the predetermined position by actuating the haptic element provided to the adjusting mechanism (312) to make the necessary adjustment. By placing the user in the appropriate position, it is ensured that the pressure applied by the user to the chair (311 ) is measured through the sitting sensor (313) provided on the chair (311 ). The first measured status data is transmitted to the processor unit (40). The processor unit (40) compares the first status data with the predetermined data recorded in the memory unit (80). As a result of the comparison, it is determined that some points in the body of the user cannot apply sufficient pressure and/or apply too much pressure when sitting. To activate the muscles at the determined points, the processor unit (40) is used to actuate the sitting haptic element. By actuating the sitting haptic element (314), the measurement data is collected from the determined positions through the sitting sensor (313) again. Muscle stimulation is provided for all points in the user’s body by re-evaluating the collected data.

The user is allowed to sit on the chair (311) and place their feet on the second foot plate

(221 ) provided to the manipulator (22). Meanwhile, it is ensured that the second status data is collected from the bottom of the foot of the user through the second rehabilitation sensor

(222). The processor unit (40) ensures that a virtual foot image is presented to the user on the screen (50) according to the second status data. The user can view non-sensory points located under the foot by looking at the screen (50). The processor unit (40) also provides the actuation of the second rehabilitation haptic elements (223) provided to the second foot plates (221 ) to give the sensation to the non-sensory points located under the user’s foot. The second rehabilitation haptic elements (223) provide vibration to the determined points and provide muscle stimulation at the determined points. During ankle rehabilitation, VR games are provided to the user on the screen (50). The said VR games include the first process steps necessary for the user to provide foot rehabilitation. For example, it was determined that the user could not fully use the heel of their foot from the second status data obtained from the foot sensor. In this case, it is provided that the screen (50) shows a VR game that will guide the user to use the heel part of the foot. This will enable the user to use the heel and increase muscle activation at those points. In this way, it will be ensured that the sensation on the foot base will be increased.

After completing the ankle rehabilitation, the user is ensured to switch to the second stage of the robotic balance rehabilitation device (100). In balance rehabilitation, a stair (33) is placed in the third region (3) so that the user can climb the rehabilitation platform (10). The said stair (33) facilitates the user’s climbing to the high rehabilitation platform (10). Firstly, it is ensured that the user presses the second foot plate (221 ) on the manipulator (22) in the balance rehabilitation. The processor unit (40) enables the movement mechanism of the manipulator (22) to be moved and the angle between the two legs of the user to be adjusted. An application can be provided by the specialist to adjust the angle between the two feet of the user. The angle between the two foot of the user can be automatically adjusted through the user terminal (70). In this case, at least one haptic provider provided to the second rehabilitation unit (21 ) is actuated. The processor unit (40) controls the angle between the second foot plates (221 ) with haptic providers. The angle value between the feet of the user starts from 20^e and is reduced to 0^e depending on the progress of rehabilitation. The support surface taken from the sole of the foot will be reduced to 0^e, thus making balance rehabilitation more difficult.

The third status data is transmitted to the processor unit (40) through the foot sensors provided to the second foot plates (221). The processor unit (40) compares the third status data with the predetermined data recorded in the memory unit (80). As a result of the comparison, if the muscles are not active enough, the second rehabilitation haptic element (223) is actuated by the processor unit (40). In balance rehabilitation, it is also provided to measure the CoM of the user with at least one load cell located in at least one load region under the manipulator (22). The measurement data is transmitted to the processor unit (40). The processor unit (40) allows the CoM information from the load cells to be recorded in the memory unit (80). The load cells are positioned to be placed in each corner of an imaginary equilateral triangle in a possible embodiment of the invention. In addition, at least one measuring and warning unit (20) is placed in the user in predetermined positions in the balance rehabilitation. Using the inertial measurement unit (IMU) provided to the measuring and warning unit (20), it is ensured that the extent to which the user bend and the swinging movements of the arms are determined. Muscle stimulation is provided through the vibration motor provided to the measuring and warning unit (20). The measuring and warning unit (20) is placed on the user’s arms, legs, knee, wrist, etc.

The processor unit (40) enables the fourth status data including the bending and swinging status of the user from the measuring and warning unit (20). At least one biological signal measurement unit (30) is also placed in the user in the balance rehabilitation. The biological signal measurement unit (30) allows for measuring the user’s muscle activation. The processor unit (40) allows receiving the fifth status data including muscle measurement from the biological signal measurement unit (30). The processor unit (40) provides the actuation of the vibration motors according to the fourth status data and the fifth status data. The said vibration motors provide stimulation of the muscles that allow the user to stand during the balance rehabilitation. The user is also ensured to stand by holding on to the support unit (41 ) provided with the arm support (4) in the balance rehabilitation. In the meantime, it is ensured that a VR game that will help the user to stand is presented to the user through the screen (50). The user ensures that the tasks in the VR game are fulfilled. It is ensured that the force applied to the support unit (41) by the user is measured through the support sensors (411) provided to the support unit (41 ) while the user is standing. The processor unit (40) enables the comparison of the sixth status data received from the support sensors (411) according to the predetermined information. If the measured force is found to be below the predetermined values as a result of the comparison, the support haptic element (412) is actuated to stimulate the user. First of all, patients with high balance loss are asked to balance their CoM during PBT with the complete help of support unit (41 ). As the patient's postural control improves, an upper extremity support threshold value is determined for each individual and is constantly updated during rehabilitation. If the patient exceed threshold, support haptic element (412) is applied to reduce the support received and regain their balance. As patients progress in their balance capacity during the rehabilitation process, they will be asked to receive support only when necessary. Consequently, it is intended that they use their affected lower limb rather than relying mainly on their upper limb, as they are unable to apply excessive force for weight support. In an alternative embodiment of the invention, the measuring and warning unit (20) and the biological signal measurement unit (30) used in balance rehabilitation can also be used in foot rehabilitation and step rehabilitation. After completing the balance rehabilitation, the user is ensured to switch to step rehabilitation, namely the third step of the robotic balance rehabilitation device (100). For the step rehabilitation, the third rehabilitation unit (32) is placed in the third region (3) of the rehabilitation platform (10). It is ensured that a VR game is shown on the screen (50) that will guide the user to take steps. For example, the user should take steps on the rehabilitation platform (10) and escape from the obstacles to avoid hitting the obstacles provided in the game. During the user’s movement on the rehabilitation platform (10), data are obtained from the third rehabilitation sensor (323), the second rehabilitation sensor (222), and the first rehabilitation sensor (14). When the user is in the third region (3), it is enabled to move the third foot plates (322) in the second slot (321 ). In the meantime, the seventh status data is collected through the third rehabilitation sensor provided to the third foot plate (322). The collected seventh status data is transmitted to the processor unit (40). The processor unit (40) compares the collected seventh status data with the predetermined data in the memory unit (80). The required third rehabilitation haptic elements (324) are actuated when the data are found to be outside the predetermined data as a result of the comparison. Thus, it is ensured that the sensation is given to the points where there is not enough pressure during the movement of the foot and the user can take steps comfortably on their feet. The user (70) is enabled to move the second foot plates (221 ) while in the second region (2). In the meantime, the eighth status data is collected through the second rehabilitation sensor (222) provided to the second foot plate (221). The collected eighth status data is transmitted to the processor unit (40). The processor unit (40) compares the collected eighth status data with the predetermined data in the memory unit (80). As a result of the comparison, when the data is found to be outside the predetermined data, the necessary second rehabilitation haptic elements (223) are actuated. Thus, it is ensured that the sensation is given to the points where there is not enough pressure during the movement of the foot. When in the first region (1 ), the user is allowed to move the first foot plates (13) within the first slot (12). At the same time, the ninth status data is collected by the first rehabilitation sensor (14) provided to the first foot plate (13). The collected ninth status data is transmitted to the processor unit (40). The processor unit (40) compares the collected ninth status data with the predetermined data in the memory unit (80). As a result of the comparison, the first rehabilitation haptic elements (15) are actuated when the data are found to be outside the predetermined data. Thus, it is ensured that the sensation is given to the points where there is not enough pressure during the movement of the foot and the user can take steps comfortably on their feet.

The user continues to the second rehabilitation unit (21) starting from the third foot plates (322) provided to the third region (3). It is ensured that s/he completes the game by switching from the second rehabilitation unit (21 ) to the first rehabilitation unit (11). In the meantime, the difficulty level of the game shown on the screen (50) is changed by evaluating all the collected status data. The tasks in the VR environment are designed similar to the activities that patients have difficulty with, and their difficulty levels can be adjusted specifically to the patient. In this way, the patient can respond more consistently to subsequent imbalances in PBT. The reaction time may be shortened since the control strategies are mostly acquired through learning.

Each rehabilitation process applied to the user is recorded in the memory unit (80) by the processor unit (40). All data recorded in the memory unit (80) is transmitted to the user terminal (70) through the communication unit (60). People such as a specialist, a physician, etc. can access the data through the user terminal (70). For example, a physician can follow all the rehabilitation processes of a patient through an application provided to their smartphone. In addition, the selection of the game and difficulty level to be presented to the user can be made easily through the application.

The robotic balance rehabilitation device (100) provides the elimination of physical deficiencies. The robotic balance rehabilitation device (100) also provides remote monitoring of the rehabilitation phases of users by a specialist. The robotic balance rehabilitation device (100) automatically provides the user’s muscle activation according to the data collected through the rehabilitation platform (10) and the user. The robotic balance rehabilitation device (100) is not only used for people with deficiencies. The robotic balance rehabilitation device (100) is used to evaluate the muscle activity of athletes and to eliminate neurological disorders.

The robotic balance rehabilitation device (100) provides biological feedback about the patients’ instantaneous measured CoM, development, and status during rehabilitation. The robotic balance rehabilitation device (100) provides the evaluation of the active assistance information required to stimulate neuroplasticity from the data collected by the processor unit (40). Thus, it is ensured that the level of assistance is regulated to help patients when necessary. If the user performs a task flawlessly, it is ensured that the robotic assistance is withdrawn. However, if the user has difficulty completing the task or fails to do so, as much robot support as the patient needs to perform the task is provided. The processor unit (40) ensures that the assistance forces/torques or task difficulty are arranged according to the level of the deficiency of the patients or the performance of the training tasks. In addition, the pressure distribution of the feet shows the ability of the patients to balance their bodies during perturbations and provides information about postural adjustments level. Therefore, the robotic balance rehabilitation device (100) allows physicians/physiotherapists to evaluate the balance status of patients, and also the cognitive and physical responses (balance control responses) of patients to the physical perturbations applied on the rehabilitation platform (10) to compensate for the deteriorated balance. In other words, the robotic balance rehabilitation device (100) provides a quantitative evaluation of the patients’ robustness (postural control) against physical perturbations, while it helps to improve the patients’ neuromuscular systems through the VR environment and multiple sensory inputs. First of all, starting with the small angle changes, as the level progresses, the angular values of the system are increased up to the specified limit according to the maximum ankle anthropomorphist, and the control of the device is given to the patient by reducing gradually the mechanical support.

The scope of the protection of the invention is set forth in the annexed claims and certainly cannot be limited to exemplary explanations in this detailed description. It is evident that one skilled in the art can make similar embodiments in the light of the explanations above without departing from the main theme of the invention.

REFERENCE NUMBERS GIVEN IN THE FIGURE

100 Robotic balance rehabilitation device

10 Rehabilitation platform

1 First region

11 First rehabilitation unit

12 First slot

13 First foot plate

14 First rehabilitation sensor

15 First rehabilitation haptic element

2 Second region

21 Second rehabilitation unit

22 Manipulator

221 Second foot plate

222 Second rehabilitation sensor

223 Second rehabilitation haptic element

3 Third region

31 Sitting unit

311 Chair 312 Adjusting mechanism

313 Sitting sensor

314 Sitting haptic element

32 Third rehabilitation unit

321 Second slot

322 Third foot plate

323 Third rehabilitation sensor

324 Third rehabilitation haptic element

33 Stair Arm support Support unit

411 Support sensor

412 Support haptic element Measuring and warning unit Biological signal measurement unit Processor unit Screen Communication unit User terminal Memory unit

Claims

CLAIMS A robotic balance rehabilitation device (100) for eliminating physiological and/or anatomical deficiencies, comprising a rehabilitation platform (10); at least two arm supports (4) for providing support to a user standing on the said rehabilitation platform (10), characterized in that; it comprises a first rehabilitation unit (11 ) placed in a first region (1) of the rehabilitation platform (10) for enabling the said user to take steps on the rehabilitation platform (10); a second rehabilitation unit (21) placed in a second region (2) for enabling rehabilitation to be applied to at least one foot of the user; and at least two support units (41 ) provided to each arm support (4) for enabling the user to stand in balance on the rehabilitation platform (10). A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; the first rehabilitation unit (11) comprises at least one first foot plate (13) placed in at least one first slot (12) that provides at least one DoF in the two-dimensional plane. A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; said first foot plate (13) comprises a first movement provider to enable the step distance to be adjusted and moved for perturbation purposes (PBT). A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; the first foot plate (13) comprises at least one first rehabilitation sensor (14) for enabling the measurement of the foot pressure of the user and at least one first rehabilitation haptic element (15) for enabling the stimulation of the foot of the user. A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; the second rehabilitation unit (21) comprises a manipulator (22) with at least two DoF placed in the second region (2). A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; the said manipulator (22) comprises at least one second foot plate (221) for placing the feet of the user; at least one second rehabilitation sensor (222) for measuring the foot pressure of the user, that is provided to the said second foot plate (221 ); and at least one second rehabilitation haptic element (223) for providing stimulation of the foot of the user, that is provided to the second foot plate (221).

7. A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; the manipulator (22) comprises at least one load region to enable the measurement of the user’s CoM

8. A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; the said load region comprises at least one load sensor.

9. A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; the said support unit (41 ) comprises at least one support sensor (411 ) for measuring the force support required by the user and at least one support haptic element (412) for providing haptic feedback to the user.

10. A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; it comprises at least one measuring and warning unit (20) provided to be placed in predetermined positions on the user.

11. A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; it comprises at least one biological signal measurement unit (30) provided to be placed in predetermined positions on the user.

12. A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; the rehabilitation platform (10) comprises a sitting unit (31) provided to a third region (3) in an attachable way.

13. A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; the said sitting unit (31 ) comprises a chair (311 ) comprising at least one sitting sensor (313) for measuring the force applied by the user when the user is seated and at least one sitting haptic element (314) for providing haptic feedback of the user.

14. A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; it comprises an adjusting mechanism (312) provided to the said sitting unit (31) to adjust the distance of the chair (311 ) to the second rehabilitation unit (21 ).

15. A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; it comprises at least one third rehabilitation unit (32) provided to a third region (3) of the rehabilitation platform (10) in an attachable way.

16. A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; the said third rehabilitation unit (32) comprises at least one third foot plate (322) placed in at least one second slot (321) providing DoF in the two-dimensional plane.

17. A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; the said third foot plate (322) comprises at least one third rehabilitation sensor (323) to provide the measurement of the foot pressure of the user and at least one third rehabilitation haptic element (324) to provide haptic feedback under the sole of the foot of the user.

18. A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; the third foot plate comprises a second movement provider to enable the step distance to be adjusted and moved for perturbation purposes.

19. A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; it comprises a processor unit (40) to provide rehabilitation to the user.

20. A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; it comprises a screen (50) associated with the said processor unit (40) to provide the rehabilitation application by directing the user.

21. A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; it comprises a communication unit (60) associated with the processor unit (40).

22. A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; it comprises a memory unit (80) associated with the processor unit (40), that enables the storage of the data for later use.

23. A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; it comprises a user terminal (70) associated with the communication unit (60).

24. A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; the processor unit (40) is configured for:

- allowing a first status data to be received from the sitting sensor (313) by the user sitting on the sitting unit (31 );

- providing the actuation of the sitting haptic element (314) according to the first status data; - allowing a second status data to be received from the second rehabilitation sensor (222) by the user placing his/her feet on the manipulator (22);

- providing the actuation of the second rehabilitation haptic element (223) according to the second status data;

- allowing the first process steps enabling the user to be guided according to the first status data and the second status data to be transmitted to the user via the screen (50);

- allowing the first status data and the second status data to be instantly stored in the memory unit (80);

- allowing the first status data and the second status data recorded in the memory unit (80) to be instantly transmitted to the user terminal (70) via the communication unit (60). A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; the processor unit (40) is configured for:

- allowing a third status data to be received from the second rehabilitation sensor (222) by the user standing on the manipulator (22);

- providing the actuation of the second rehabilitation haptic element (223) according to the third status data;

- allowing a fourth status data to be received from the measuring and warning unit (20) placed in the user’s body;

- providing the actuation of at least one vibration motor provided to the measuring and warning unit (20) according to the fourth status data and the fifth status data;

- allowing a sixth status data to be received from the support sensor (411) by the user holding on to the support unit (41) on the arm supports (4);

- providing the actuation of the support haptic element (412) according to the sixth status data;

- allowing the second process steps enabling the user to be guided according to the third status data, the fourth status data, the fifth status data, and the sixth status data to be transmitted to the user via the screen (50);

- allowing the third status data, the fourth status data, the fifth status data, and the sixth status data to be stored in the memory unit (80);

- allowing the third status data, the fourth status data, the fifth status data, and the sixth status data recorded in the memory unit (80) to be instantly transmitted to the user terminal (70) via the communication unit (60). A robotic balance rehabilitation device (100) according to claim 1 , characterized in that; the processor unit (40) is configured for:

- allowing the third process steps enabling the user to be guided from the third rehabilitation unit (32) to the second rehabilitation unit (21), from the second rehabilitation unit (21 ) to the first rehabilitation unit (11) to be presented to the user via the screen (50);

- allowing a seventh status data to be received from the third rehabilitation sensor (323) while the user is in the third rehabilitation unit (32);

- providing the actuation of the third rehabilitation haptic element (324) according to the seventh status data;

- allowing an eighth status data to be received from the second rehabilitation sensor (222) while the user is in the second rehabilitation unit (21),

- providing the actuation of the second rehabilitation haptic element (223) according to the eighth status data;

- allowing ninth status data to be received from the first rehabilitation sensor (14) while the user is in the first rehabilitation unit (11);

- providing the actuation of the first rehabilitation haptic element (15) according to the ninth status data;

- allowing the seventh status data, the eighth status data, and the ninth status data to be stored in the memory unit (80);

- allowing the seventh status data, the eighth status data, and the ninth status data recorded in the memory unit to be instantly transmitted to the user terminal (70) via the communication unit (60).