EP0022002A1 - Apparatus for kinetic therapy, especially for reeducation treatment - Google Patents

Apparatus for kinetic therapy, especially for reeducation treatment Download PDF

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Publication number
EP0022002A1
EP0022002A1 EP80400910A EP80400910A EP0022002A1 EP 0022002 A1 EP0022002 A1 EP 0022002A1 EP 80400910 A EP80400910 A EP 80400910A EP 80400910 A EP80400910 A EP 80400910A EP 0022002 A1 EP0022002 A1 EP 0022002A1
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European Patent Office
Prior art keywords
movement
limb
segment
physiotherapy
branches
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EP80400910A
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German (de)
French (fr)
Inventor
Alain Barnet
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Individual
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Individual
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    • A—HUMAN NECESSITIES
    • A63—SPORTS; GAMES; AMUSEMENTS
    • A63B—APPARATUS FOR PHYSICAL TRAINING, GYMNASTICS, SWIMMING, CLIMBING, OR FENCING; BALL GAMES; TRAINING EQUIPMENT
    • A63B23/00—Exercising apparatus specially adapted for particular parts of the body
    • A63B23/035—Exercising apparatus specially adapted for particular parts of the body for limbs, i.e. upper or lower limbs, e.g. simultaneously
    • A63B23/0355—A single apparatus used for either upper or lower limbs, i.e. with a set of support elements driven either by the upper or the lower limb or limbs
    • A—HUMAN NECESSITIES
    • A63—SPORTS; GAMES; AMUSEMENTS
    • A63B—APPARATUS FOR PHYSICAL TRAINING, GYMNASTICS, SWIMMING, CLIMBING, OR FENCING; BALL GAMES; TRAINING EQUIPMENT
    • A63B24/00—Electric or electronic controls for exercising apparatus of preceding groups; Controlling or monitoring of exercises, sportive games, training or athletic performances
    • A—HUMAN NECESSITIES
    • A63—SPORTS; GAMES; AMUSEMENTS
    • A63B—APPARATUS FOR PHYSICAL TRAINING, GYMNASTICS, SWIMMING, CLIMBING, OR FENCING; BALL GAMES; TRAINING EQUIPMENT
    • A63B2220/00—Measuring of physical parameters relating to sporting activity
    • A63B2220/17—Counting, e.g. counting periodical movements, revolutions or cycles, or including further data processing to determine distances or speed

Definitions

  • the present invention relates to a physiotherapy apparatus, in particular for the rehabilitation treatments of a limb or segment of a limb and making it possible to control the kinematic and dynamic characteristics of the movements executed by the patient as well as those of static or dynamic muscular contractions. 'relating to it in order to intervene on said characteristics according to the results obtained.
  • the invention provides a physiotherapy device intended to control and modify at least one of the kinematic, dynamic or static characteristics of a repetitive, in particular reciprocating movement, of a limb or segment of limb executed by a patient between adjustable positions, one of rest and the other set downstream of the first in the direction of movement, which is characterized in that it comprises, mounted on an adjustable support, a plate on which is articulated by one of its ends, around an axis, a control arm adapted to be driven by said member or segment of member during its movement and to cooperate with a plurality of means capable of delivering image signals from said characteristics of the movement, to record said signals and, in response to certain preselected of said signals, to modify at least one of said characteristics.
  • the invention effectively allows, firstly, the control of the characteristics of an angular movement carried out by a patient during the rehabilitation of a limb or segment of limb and, moreover , thanks to the signals generated, visualization by light, digital and / or sound display intended for this patient.
  • the device still has a number of other characteristics, which emerge in particular from claims which all aim at the dual purpose of controlling the work and motivating the patient.
  • the physiotherapy device according to the invention is assumed to be used for the rehabilitation of the legs (knee). It goes without saying that the device is easily adaptable to other rehabilitation problems and includes for this purpose mechanical and electrical adjustment means which involve devices known in themselves and which will therefore not be described in detail here. .
  • the apparatus can essentially be broken down into a cabinet for controlling, processing and recording signals as well as for viewing and signaling 3, a support linkage 4, a plate 5, a control crew 6.
  • This control unit 6 articulated as a whole around an axis 7, itself consists of an arm 8 which is extended by a rod 9, orientable relative to the arm 8, carrying a stirrup 10 with two flexible branches 11 and 12, mounted adjustable on a cross member 13.
  • the aim being to control the alternating movement of raising and lowering of a leg, the crew 6 is adjusted so that the patient's calf 14 cooperates with the crosspiece 13 in the "up" direction (arrow M), the return contact (arrow R) being provided by a very gentle action return spring 15.
  • the possibility is offered to control the angular characteristics (stroke, speed, frequency, etc. ) of the movement while the "linearity" of the movement (trajectory maintained in a median plane between the branches 11, 12) is monitored by means associated with the stirrup 10.
  • control cabinet 3 Thanks to the processing in the control cabinet 3 of the signals the emission of which is caused at different stages of the movement, the latter can be followed and corrected, the patient being able to be visually or acoustically informed of the result of his efforts.
  • FIG 3 highlights certain details of the plate 5 whose essential function is the control of the angular characteristics of the movement.
  • This plate is, as a whole, mounted orientable at the end of the rod 16 of the support linkage 4. It has a semi-circular plate 17 mounted in a stirrup 18 in which the axis 7 is journalled (around which the arm 8) also oscillates, a movable sector 19 and a stepping-type motor-reduction unit 22 associated with said sector 19.
  • the plate 17 and the sector 19 are provided with graduations 21 enabling the amplitude of the patient movement.
  • the stepping motor group 22 acting by means of a mechanism 23 (of the worm and toothed wheel type for example) on the sector 19 which is adapted to pivot around the axis 7.
  • the sector 19 is equipped with a plurality of contacts capable of being activated when the arm 8 passes, and - of which only the contacts 24 and 25 are shown, in particular defining the so-called intermediate and set positions .
  • the movement of the latter causes the arm 8 to successively activate a rest contact (normally closed not shown), then contact 24 which may correspond at a minimum required stroke or is intended to control the speed of movement at a given angle and, finally, the contact 25 which defines the set value to be reached in a time and possibly after a predetermined number of return trips.
  • a rest contact normally closed not shown
  • contact 24 which may correspond at a minimum required stroke or is intended to control the speed of movement at a given angle
  • the contact 25 which defines the set value to be reached in a time and possibly after a predetermined number of return trips.
  • the signal emitted when contact 24 is passed is used by the devices in the cabinet 3 for various control purposes, but that emitted by activating contact 25 is specially designed to cause, after validation by the control cabinet, the advancement of an angular "step" prefixed, in one direction or the other, of the contact carrier sector 19.
  • the activation of the contact 25 set point automatically causes stimulation to a progressively pushed effort within predetermined limits.
  • the displacement can be done, ideally, along a vertical plane parallel to the arm 8 and median with respect to the branches 11, 12 of the stirrup 10.
  • the mounts 26, 27, sliding on the cross member 13, branches 11, 12 are provided with microswitches activated when one of these two branches is slightly deformed, in bending, by the impact of the leg deviating from its median trajectory.
  • the corresponding signals are processed in the control cabinet 3 and are reflected by the corresponding displays and, in particular, by the temporary inhibition of the control of the stepping motor 22; it is this process which was alluded to above as validation of the activation of the set point contact 25.
  • stirrup 10 is mounted orientable at the end of the rod 9 which is itself orientable relative to the arm 8 which, in turn, can pivot with the plate 5. All the possibilities of directional adjustment (arrows F, G, H) are thus offered to define the characteristics of the movement and its median plane.
  • branches 11, 12 comprise means (electrodes, heating resistors, etc.) that are pre-activated and capable of acting correctly on the trajectory of the limb or segment of member at its predetermined approach to one of the two branches.
  • FIG. 4 gives an overview of certain additional devices which, in the case of a movement according to FIG. 2 for example, can affect the characteristics of the movement.
  • the patient's heel being taken between two half-shells 28 held by elastic clamps 29, these shells carry a support bracket 30 on which are mounted a directional stimulator 31, an additional weight 32 and a hooking frame 33 with a movable roller 34 of a counterweight (not shown).
  • the purpose of the directional stimulator 31 is to impart to the limb or segment of the limb in motion a directional impulse calling, on the part of the patient, for a muscular reaction (torsion, flexion or combination of the two) determined to oppose said impulse.
  • the stimulator 31 comprises a tube, preferably transparent, 35 closed at its ends by screwed end pieces 36. On these end pieces 36 are attached electromagnets 37 whose spring plungers terminate externally by a flange 38 and internally by a contact d excitation of the electromagnet 37. Inside the tube is placed a heavy ball 39.
  • any inclination of the tube 35 results in an impact of the ball on one of the flanges 38, and possible activation of one of the electromagnets 37 with, if necessary, returning the ball to the other end of the tube.
  • the tube 35 is normally mounted pivoting and sliding on the bracket 30 to work the targeted muscles under well defined conditions, forcing the patient to react to avoid going out of the median plane which is imposed on him between the branches of the stirrup 10 .
  • the attachment frame 33 also mounted pivoting and sliding, aims for a similar purpose. Thanks to the roller 34 movable on a rail 40 between adjustable stops 41, a counterweight coupled to the sling 42 can stress different muscles (internal or external rotator, for example).
  • the devices 31 and 33 can be arranged at any other location of the bracket 30 and in particular interchanged between them.
  • control cabinet 3 comprises a plurality of means, all known in themselves, for "counting" all the signals emitted during the movement and for triggering, in response to some of these signals, the activation of various signaling and / or display means, in particular directional optical signaling means.
  • the physiotherapy device according to the invention lends itself to very numerous variant embodiments as a function of the movement subjected to control and of the limb or segment of limb, object of rehabilitation, variants which all form an integral part of this application.

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  • Health & Medical Sciences (AREA)
  • General Health & Medical Sciences (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Rehabilitation Tools (AREA)

Abstract

The apparatus comprises, mounted on an orientable support (16), a plate (5) with a control arm (6) driven by the movement of a member or segment of a member and adapted to interact with a plurality of means delivering image signals of the characteristics of the movement which are used in a central cabinet (3) for the purposes of visualisation and intervention in respect of the characteristics of the movement. Application: reeducation treatment. <IMAGE>

Description

La présente invention a pour objet un appareil de kinésithérapie, notamment pour les traitements de rééducation d'un membre ou segment de membre et permettant de contrôler les caractéristiques cinématiques et dynamiques des mouvements exécutés par le patient ainsi que celles des contractions musculaires statiques ou dynamiques s'y rattachant en vue d'intervenir sur lesdites caractéristiques en fonction des résultats obtenus.The present invention relates to a physiotherapy apparatus, in particular for the rehabilitation treatments of a limb or segment of a limb and making it possible to control the kinematic and dynamic characteristics of the movements executed by the patient as well as those of static or dynamic muscular contractions. 'relating to it in order to intervene on said characteristics according to the results obtained.

Le problème de la rééducation après accident d'un membre ou segment de membre ou, d'une manière beaucoup plus générale, le problème de la contraction musculaire dynamique génératrice de mouvement conduit à envisager un certain nombre de paramètres parmi lesquels :

  • -la force opposée au mouvement ou exercée dans le sens de ce dernier,
  • - l'amplitude du mouvement,
  • - la fréquence du mouvement,
  • - le temps de travail.
The problem of rehabilitation after accident of a limb or segment of limb or, in a much more general way, the problem of dynamic muscular contraction generating movement leads to consider a certain number of parameters among which:
  • -the force opposed to the movement or exerted in the direction of the latter,
  • - range of motion,
  • - the frequency of movement,
  • - work time.

On n'étudiera pas ici l'intérêt intrinsèque, séparé ou combiné sur le plan médical ou physiologique de ces paramètres qui sont bien connus de l'homme de l'art, mais tout praticien est convaincu de l'intérêt qu'il y aurait, en vue d'une optimisation des processus, à pouvoir les contrôler étroitement en temps réel ou a posteriori par voie d'enregistrements ou de signalisations, mais encore de l'intérêt que présenterait, sur le plan d'une motivation psychologique, la possibilité pour le patient de suivre ses efforts, d'en apprécier les résultats, de se corriger lui-même et de tendre, par esprit de compétitivité, à une certaine perfection.We will not study here the intrinsic, separate or combined medical or physiological interest of these parameters which are well known to those skilled in the art, but any practitioner is convinced of the interest that there would be , in order to optimize processes, to be able to control them closely in time real or a posteriori by means of recordings or signals, but also of the interest that would present, in terms of psychological motivation, the possibility for the patient to follow his efforts, to appreciate the results, to correct himself and strive, for the sake of competitiveness, for a certain perfection.

C'est là précisément le problème que vise à résoudre l'invention en se posant comme impératif supplémentaire, celui d'un appareil relativement simple et ne mettant en jeu que les dispositifs éprouvés ou des modules aisément assemblables.This is precisely the problem that the invention aims to solve by posing as an additional imperative, that of a relatively simple device and involving only proven devices or easily assembled modules.

Pour la solution du problème ainsi posé, l'invention propose un appareil de kinésithérapie destiné à contrôler et à modifier au moins l'une des caractéristiques cinématiques, dynamiques ou statiques d'un mouvement répétitif, notamment alternatif, d'un membre ou segment de membre exécuté par un patient entre des positions réglables, l'une de repos et l'autre consigne en aval de la première dans le sens du mouvement, qui est caractérisé en ce qu'il comporte, montée sur un support orientable, une platine sur laquelle est articulé par l'une de ses extrémités, autour d'un axe, un bras de contrôle adapté à être entraîné par ledit membre ou segment de membre durant son mouvement et à coopérer avec une pluralité de moyens susceptibles de délivrer des signaux image desdites caractéristiques du mouvement, d'enregistrer lesdits signaux et, en réponse à certains présélectionnés desdits signaux, de modifier au moins l'une desdites caractéristiques.For the solution of the problem thus posed, the invention provides a physiotherapy device intended to control and modify at least one of the kinematic, dynamic or static characteristics of a repetitive, in particular reciprocating movement, of a limb or segment of limb executed by a patient between adjustable positions, one of rest and the other set downstream of the first in the direction of movement, which is characterized in that it comprises, mounted on an adjustable support, a plate on which is articulated by one of its ends, around an axis, a control arm adapted to be driven by said member or segment of member during its movement and to cooperate with a plurality of means capable of delivering image signals from said characteristics of the movement, to record said signals and, in response to certain preselected of said signals, to modify at least one of said characteristics.

Selon une première de ces caractéristiques, il est prévu en outre au moins une position intermédiaire entre lesdites positions de repos et consigne et des contacts électriques respectivement disposés au niveau desdites positions de repos, intermédiaire et consigne, sur un secteur à graduations étalonnées, monté à rotation contrôlée sur ladite platine et autour dudit axe, contacts susceptibles d'être activés lors de leur franchissement par ledit bras de contrôle et d'émettre des signaux image de son départ de la position de repos et de son retour à celle-ci ainsi que du franchissement des positions intermédiaire et consigne.According to a first of these characteristics, there is further provided at least one intermediate position between said rest and set positions and electrical contacts respectively arranged at the level said rest positions, intermediate and setpoint, on a sector with calibrated graduations, mounted with controlled rotation on said plate and around said axis, contacts capable of being activated when they are crossed by said control arm and of transmitting image signals from its departure from the rest position and its return to it as well as from the crossing of the intermediate and setpoint positions.

On appréciera, à ce stade, que l'invention permet effectivement, dans un premier temps, le contrôle des caractéristiques d'un mouvement angulaire effectué par un patient dans le cours de la rééducation d'un membre ou segment de membre et, de plus, grâce aux signaux provoqués, une visualisation par affichage lumineux, numérique et/ou sonore destinée à ce patient.It will be appreciated, at this stage, that the invention effectively allows, firstly, the control of the characteristics of an angular movement carried out by a patient during the rehabilitation of a limb or segment of limb and, moreover , thanks to the signals generated, visualization by light, digital and / or sound display intended for this patient.

Avantageusement, il est prévu l'activation, au franchissement de ladite position consigne, d'un moyen adapté à décaler angulairement vers l'aval ou vers l'amont d'une valeur prédéterminée ledit secteur gradué et au moins l'un de ses contacts associés ; ledit moyen est constitué par un moteur du type pas-à-pas agissant par l'intermédiaire d'un mécanisme connu en soi sur ledit secteur gradué.Advantageously, provision is made for activating, on crossing said set position, a means adapted to offset angularly downstream or upstream by a predetermined value said graduated sector and at least one of its contacts. partners; said means is constituted by a motor of the stepping type acting by means of a mechanism known per se on said graduated sector.

On retrouve ici l'avantage d'une stimulation en quelque sorte sportive du patient l'incitant, dans un cadre bien défini, à améliorer ses résultats.Here we find the advantage of a kind of sport stimulation of the patient, encouraging him, in a well-defined framework, to improve his results.

L'appareil présente encore nombre d'autres caractéristiques, ressortant notamment des revendications qui tendent toutes au double but du contrôle du travail et de la motivation du patient.The device still has a number of other characteristics, which emerge in particular from claims which all aim at the dual purpose of controlling the work and motivating the patient.

Ces caractéristiques ainsi que les avantages s'y rattachant se retrouvent également dans la description qui va suivre d'un mode de réalisation de l'invention, en référence aux dessins annexés dans lesquels :

  • la figure 1 est une vue d'ensemble de l'appareil de kinésithérapie selon l'invention permettant d'en définir les éléments essentiels ;
  • la figure 2 est une vue plus détaillée de la platine de contrôle des caractéristiques angulaires du mouvement ;
  • la figure 3 est une vue d'un accessoire permettant la fixation de dispositifs auxiliaires et équipé de tels dispositifs ;
  • la figure 4 est une vue en perspective d'éléments mobiles attelés au pied du patient ;
  • la figure 5 est une vue plus détaillée et en coupe partielle de l'un des dispositifs auxiliaires de la figure 4.
These characteristics as well as the associated advantages are also found in the following description of an embodiment of the invention, with reference to the accompanying drawings in which:
  • Figure 1 is an overview of the physiotherapy device according to the invention for defining the essential elements;
  • Figure 2 is a more detailed view of the control plate of the angular characteristics of the movement;
  • Figure 3 is a view of an accessory for attaching auxiliary devices and equipped with such devices;
  • Figure 4 is a perspective view of movable elements coupled to the patient's foot;
  • FIG. 5 is a more detailed view in partial section of one of the auxiliary devices in FIG. 4.

Dans la description qui va suivre ainsi que dans les figures auxquelles on se réfère, l'appareil de kinésithérapie selon l'invention est supposé mis en oeuvre pour la rééducation des jambes (genou). Il va de soi que l'appareil est aisément adaptable à d'autres problèmes de rééducation et comporte à cet effet des moyens de réglage mécaniques et électriques qui font intervenir des dispositifs connus en eux-mêmes et qui ne seront donc pas décrits en détail ici.In the following description and in the figures to which reference is made, the physiotherapy device according to the invention is assumed to be used for the rehabilitation of the legs (knee). It goes without saying that the device is easily adaptable to other rehabilitation problems and includes for this purpose mechanical and electrical adjustment means which involve devices known in themselves and which will therefore not be described in detail here. .

On précisera ici que la notion de mouvement évoquée ci-après définit aussi bien le déplacement d'un membre ou segment de membre qu'une simple contraction musculaire sans déplacement apparent.It will be specified here that the notion of movement mentioned below defines both the movement of a limb or segment of a limb as well as a simple muscular contraction without apparent displacement.

En se référant tout d'abord à la figure 1, on trouvera désignée dans son ensemble par 1 une table de soins sur laquelle est rapporté l'appareil de kinésithérapie selon l'invention désigné par 2 dans son ensemble.Referring first to Figure 1, we will find designated as a whole by 1 a treatment table on which is reported the physiotherapy apparatus according to the invention designated by 2 as a whole.

L'appareil peut se décomposer essentiellement en une armoire de commande, de traitement et d'enregistrement des signaux ainsi que de visualisation et de signalisation 3, une tringlerie de support 4, une platine 5, un équipage de contrôle 6.The apparatus can essentially be broken down into a cabinet for controlling, processing and recording signals as well as for viewing and signaling 3, a support linkage 4, a plate 5, a control crew 6.

Cet équipage de contrôle 6, articulé dans son ensemble autour d'un axe 7, est lui-même constitué d'un bras 8 que prolonge une tige 9, orientable par rapport au bras 8, portant un étrier 10 à deux branches flexibles 11 et 12, montées réglables sur une traverse 13.This control unit 6, articulated as a whole around an axis 7, itself consists of an arm 8 which is extended by a rod 9, orientable relative to the arm 8, carrying a stirrup 10 with two flexible branches 11 and 12, mounted adjustable on a cross member 13.

Encore que l'on reviendra plus loin à certains détails du fonctionnement de l'appareil de kinésithérapie selon l'invention, il paraît utile, dès ce stade, d'expliquer succinctement, en référence à la figure 2, le principe de son action.Although we will return later to certain details of the operation of the physiotherapy device according to the invention, it seems useful, from this stage, to explain succinctly, with reference to FIG. 2, the principle of its action.

Le but visé étant de contrôler le mouvement alternatif d'élévation et d'abaissement d'une jambe, l'équipage 6 est réglé de manière à ce que le mollet 14 du patient coopère avec la traverse 13 dans le sens "montée" (flèche M), le contact au retour (flèche R) étant assuré par un ressort de rappel d'action très douce 15. Au niveau de la platine 5, la possibilité est offerte de contrôler les caractéristiques angulaires (course, vitesse, fréquence, etc.) du mouvement tandis que la "linéarité" du mouvement (trajectoire maintenue dans un plan médian entre les branches 11, 12) est surveillée par des moyens associés à l'étrier 10.The aim being to control the alternating movement of raising and lowering of a leg, the crew 6 is adjusted so that the patient's calf 14 cooperates with the crosspiece 13 in the "up" direction (arrow M), the return contact (arrow R) being provided by a very gentle action return spring 15. At the level of the plate 5, the possibility is offered to control the angular characteristics (stroke, speed, frequency, etc. ) of the movement while the "linearity" of the movement (trajectory maintained in a median plane between the branches 11, 12) is monitored by means associated with the stirrup 10.

Grâce au traitement dans l'armoire de commande 3 des signaux dont l'émission est provoquée à différents stades du mouvement, ce dernier peut être suivi et corrigé, le patient étant en mesure d'être averti visuellement ou acoustiquement du résultat de ses efforts.Thanks to the processing in the control cabinet 3 of the signals the emission of which is caused at different stages of the movement, the latter can be followed and corrected, the patient being able to be visually or acoustically informed of the result of his efforts.

La figure 3 fait ressortir certains détails de la platine 5 dont la fonction essentielle est le contrôle des caractéristiques angulaires du mouvement. Cette platine est, dans son ensemble, montée orientable à l'extrémité de la tige 16 de la tringlerie de support 4. Elle présente une plaque en demi-cercle 17 montée dans un étrier 18 dans lequel est tourillonné l'axe 7 (autour duquel oscille par ailleurs le bras 8), un secteur mobile 19 et un ensemble moteur-réducteur du type pas-à-pas 22 associé audit secteur 19. La plaque 17 et le secteur 19 sont munis de graduations 21 permettant de définir l'amplitude du mouvement du patient. A la partie inférieure de la platine 5 est agencé le groupe moteur pas-à-pas 22 agissant par l'intermédiaire d'un mécanisme 23 (du type à vis sans fin et roues dentées par exemple) sur le secteur 19 qui est adapté à pivoter autour de l'axe 7. Le secteur 19 est équipé d'une pluralité de contacts susceptibles d'être activés au passage du bras 8, et - dont ne sont représentés que les contacts 24 et 25 définissant notamment les positions dites intermédiaire et consigne. Partant d'une position de repos dans laquelle la jambe du patient reposerait sur la table 1, le mouvement de celle-ci amène le bras 8 à activer successivement un contact de repos (normalement fermé non représenté), puis le contact 24 qui peut correspondre à une course minimale exigée ou est destiné à contrôler la vitesse du mouvement à un angle donné et, enfin, le contact 25 qui définit la valeur consigne à atteindre dans un temps et éventuellement après un nombre d'aller-retour d'échauffement prédéterminé.Figure 3 highlights certain details of the plate 5 whose essential function is the control of the angular characteristics of the movement. This plate is, as a whole, mounted orientable at the end of the rod 16 of the support linkage 4. It has a semi-circular plate 17 mounted in a stirrup 18 in which the axis 7 is journalled (around which the arm 8) also oscillates, a movable sector 19 and a stepping-type motor-reduction unit 22 associated with said sector 19. The plate 17 and the sector 19 are provided with graduations 21 enabling the amplitude of the patient movement. At the lower part of the plate 5 is arranged the stepping motor group 22 acting by means of a mechanism 23 (of the worm and toothed wheel type for example) on the sector 19 which is adapted to pivot around the axis 7. The sector 19 is equipped with a plurality of contacts capable of being activated when the arm 8 passes, and - of which only the contacts 24 and 25 are shown, in particular defining the so-called intermediate and set positions . Starting from a rest position in which the patient's leg would rest on the table 1, the movement of the latter causes the arm 8 to successively activate a rest contact (normally closed not shown), then contact 24 which may correspond at a minimum required stroke or is intended to control the speed of movement at a given angle and, finally, the contact 25 which defines the set value to be reached in a time and possibly after a predetermined number of return trips.

Le signal émis au passage du contact 24 est exploité par les dispositifs de l'armoire 3 à diverses fins de contrôle, mais celui émis par l'activation du contact 25 est spécialement destiné à provoquer, après validation par l'armoire de commande, l'avancement d'un "pas" angulaire préfixé, dans un sens ou dans l'autre, du secteur porte-contacts 19. Autrement dit, sous réserve de validation, l'activation du contact 25 de point consigne entraîne automatiquement une stimulation à un effort progressivement poussé dans les limites prédéterminées.The signal emitted when contact 24 is passed is used by the devices in the cabinet 3 for various control purposes, but that emitted by activating contact 25 is specially designed to cause, after validation by the control cabinet, the advancement of an angular "step" prefixed, in one direction or the other, of the contact carrier sector 19. In other words, subject to validation, the activation of the contact 25 set point automatically causes stimulation to a progressively pushed effort within predetermined limits.

Dans le cas d'un mouvement de la jambe suivant la figure 2, on conçoit que le déplacement peut se faire, idéalement, suivant un plan vertical parallèle au bras 8 et médian par rapport aux branches 11, 12 de l'étrier 10. Pour le contrôle de cette caractéristique de "linéarité", les montures 26, 27, coulissant sur la traverse 13, des branches 11, 12 sont munies de micro-rupteurs activés lorsque l'une de ces deux branches est légèrement déformée, en flexion, par l'impact de la jambe déviant de sa trajectoire médiane. Les signaux correspondants sont traités dans l'armoire de commande 3 et se traduisent par les visualisations correspondantes et, notamment, par l'inhibition provisoire de la commande du moteur pas-à-pas 22 ; c'est ce processus auquel il avait été fait allusion plus haut au titre de la validation de l'activation du contact de point consigne 25.In the case of a movement of the leg according to FIG. 2, it is understood that the displacement can be done, ideally, along a vertical plane parallel to the arm 8 and median with respect to the branches 11, 12 of the stirrup 10. For control of this characteristic of "linearity", the mounts 26, 27, sliding on the cross member 13, branches 11, 12 are provided with microswitches activated when one of these two branches is slightly deformed, in bending, by the impact of the leg deviating from its median trajectory. The corresponding signals are processed in the control cabinet 3 and are reflected by the corresponding displays and, in particular, by the temporary inhibition of the control of the stepping motor 22; it is this process which was alluded to above as validation of the activation of the set point contact 25.

On notera que l'étrier 10 est monté orientable à l'extrémité de la tige 9 elle-même orientable par rapport au bras 8 lequel, à son tour, peut pivoter avec la platine 5. Toutes les possibilités de réglage directionnel (flèches F, G, H) sont ainsi offertes pour définir les caractéristiques du mouvement et son plan médian.It will be noted that the stirrup 10 is mounted orientable at the end of the rod 9 which is itself orientable relative to the arm 8 which, in turn, can pivot with the plate 5. All the possibilities of directional adjustment (arrows F, G, H) are thus offered to define the characteristics of the movement and its median plane.

On peut aussi prévoir que les branches 11, 12 comportent des moyens (électrodes, résistances chauffantes, etc.) préactivés et susceptibles d'intervenir correctivement sur la trajectoire du membre ou segment de membre à son approche prédéterminée de l'une des deux branches.It is also possible to provide that the branches 11, 12 comprise means (electrodes, heating resistors, etc.) that are pre-activated and capable of acting correctly on the trajectory of the limb or segment of member at its predetermined approach to one of the two branches.

La figure 4 donne un aperçu de certains dispositifs additionnels susceptibles, dans le cas d'un mouvement selon la figure 2 par exemple, d'intervenir sur les caractéristiques du mouvement. Le talon du patient étant pris entre deux demi-coquilles 28 maintenues par des serrages élastiques 29, ces coquilles portent une équerre-support 30 sur laquelle sont montés un stimulateur directionnel 31, un poids additionnel 32 et un cadre d'accrochage 33 à galet mobile 34 d'un contrepoids (non représenté).FIG. 4 gives an overview of certain additional devices which, in the case of a movement according to FIG. 2 for example, can affect the characteristics of the movement. The patient's heel being taken between two half-shells 28 held by elastic clamps 29, these shells carry a support bracket 30 on which are mounted a directional stimulator 31, an additional weight 32 and a hooking frame 33 with a movable roller 34 of a counterweight (not shown).

Le stimulateur directionnel 31 a pour objet d'imprimer au membre ou segment de membre en mouvement une impulsion directionnelle appelant, de la part du patient, une réaction musculaire (torsion, flexion ou combinaison des deux) déterminée pour s'opposer à ladite impulsion. Le stimulateur 31 comporte un tube, préférentiellement transparent, 35 obturé à ses extrémités par des embouts vissés 36. Sur ces embouts 36 sont rapportés des électro-aimants 37 dont les plongeurs à ressort se terminent extérieurement par une collerette 38 et intérieurement par un contact d'excitation de l'électro-aimant 37. A l'intérieur du tube est placée une bille pesante 39. Toute inclinaison du tube 35 (par torsion du pied ou inclinaison de la jambe durant son mouvement) se traduit par un impact de la bille sur l'une des collerettes 38, et activation éventuelle de l'un des électro-aimants 37 avec, le cas échéant, renvoi de la bille vers l'autre extrémité du tube. En réglant les positions des embouts (par vissage), la force des ressorts des plongeurs, le poids de la bille, on peut-prédéterminer les conditions de déclenchement du mouvement de la bille (course simple ou va-et- vient) et son amortissement. Le tube 35 est normalement monté pivotant et coulissant sur l'équerre 30 pour faire travailler les muscles visés dans des conditions bien définies, obligeant le patient à réagir pour éviter de sortir du plan médian qui lui est imposé entre les branches de l'étrier 10.The purpose of the directional stimulator 31 is to impart to the limb or segment of the limb in motion a directional impulse calling, on the part of the patient, for a muscular reaction (torsion, flexion or combination of the two) determined to oppose said impulse. The stimulator 31 comprises a tube, preferably transparent, 35 closed at its ends by screwed end pieces 36. On these end pieces 36 are attached electromagnets 37 whose spring plungers terminate externally by a flange 38 and internally by a contact d excitation of the electromagnet 37. Inside the tube is placed a heavy ball 39. Any inclination of the tube 35 (by twisting the foot or inclination of the leg during its movement) results in an impact of the ball on one of the flanges 38, and possible activation of one of the electromagnets 37 with, if necessary, returning the ball to the other end of the tube. By adjusting the positions of the tips (by screwing), the force of the plungers springs, the weight of the ball, we can predetermine the conditions for triggering the movement of the ball (single stroke or back and forth comes) and its amortization. The tube 35 is normally mounted pivoting and sliding on the bracket 30 to work the targeted muscles under well defined conditions, forcing the patient to react to avoid going out of the median plane which is imposed on him between the branches of the stirrup 10 .

Le cadre d'accrochage 33, monté également pivotant et coulissant, vise un but de même nature. Grâce au galet 34 mobile sur un rail 40 entre des butées réglables 41, un contre-poids attelé à l'élingue 42 peut solliciter des muscles différents (rotateur interne ou externe, par exemple).The attachment frame 33, also mounted pivoting and sliding, aims for a similar purpose. Thanks to the roller 34 movable on a rail 40 between adjustable stops 41, a counterweight coupled to the sling 42 can stress different muscles (internal or external rotator, for example).

Bien entendu, les dispositifs 31 et 33 peuvent être disposés à tout autre emplacement de l'équerre 30 et notamment intervertis entre eux.Of course, the devices 31 and 33 can be arranged at any other location of the bracket 30 and in particular interchanged between them.

On rappellera pour finir que l'armoire de commande 3 comporte une pluralité de moyens, tous connus en eux-mêmes, pour "comptabiliser" tous les signaux émis au cours du mouvement et à déclencher, en réponse à certains de ces signaux, l'activation de moyens de signalisation et/ou de visualisation variés, notamment de moyens de signalisation optique directionnels.Finally, it will be recalled that the control cabinet 3 comprises a plurality of means, all known in themselves, for "counting" all the signals emitted during the movement and for triggering, in response to some of these signals, the activation of various signaling and / or display means, in particular directional optical signaling means.

Il va de soi que l'appareil de kinésithérapie selon l'invention se prête à de très nombreuses variantes de réalisation en fonction du mouvement soumis à contrôle et du membre ou segment de membre, objet de la rééducation, variantes qui toutes font partie intégrante de la présente demande.It goes without saying that the physiotherapy device according to the invention lends itself to very numerous variant embodiments as a function of the movement subjected to control and of the limb or segment of limb, object of rehabilitation, variants which all form an integral part of this application.

Claims (13)

1. Appareil de kinésithérapie destiné à contrôler et à modifier au moins l'une des caractéristiques cinématiques, dynamiques ou statiques d'un mouvement répétitif, notamment alternatif, d'un membre ou segment de membre, exécuté par un patient entre des positions réglables, l'une de repos et l'autre consigne en aval de la première dans le sens du mouvement, caractérisé en ce qu'il comporte, montée sur un support orientable, une platine sur laquelle est articulé par l'une de ses extrémités, autour d'un axe, un bras de contrôle adapté à être entraîné par ledit membre ou segment de membre durant son mouvement et à coopérer avec une pluralité de moyens susceptibles de délivrer des signaux image desdites caractéristiques du mouvement, d'enregistrer lesdits signaux et, en réponse à certains présélectionnés desdits signaux, de modifier au moins l'une desdites caractéristiques.1. A physiotherapy device intended to control and modify at least one of the kinematic, dynamic or static characteristics of a repetitive, in particular reciprocating movement, of a limb or segment of a limb, executed by a patient between adjustable positions, one of rest and the other set downstream of the first in the direction of movement, characterized in that it comprises, mounted on an orientable support, a plate on which is articulated by one of its ends, around an axis, a control arm adapted to be driven by said limb or segment of limb during its movement and to cooperate with a plurality of means capable of delivering image signals of said characteristics of the movement, of recording said signals and, in response to certain preselected of said signals, to modify at least one of said characteristics. 2. Appareil de kinésithérapie selon la revendication 1, caractérisé en ce qu'il est prévu en outre au moins une position intermédiaire entre lesdites positions de repos et consigne et des contacts électriques respectivement disposés au niveau desdites positions de repos, intermédiaire et consigne, sur un secteur à graduations étalonnées, monté à rotation contrôlée sur ladite platine et autour dudit axe, contacts susceptibles d'être activés lors de leur franchissement par ledit bras de contrôle et d'émettre des signaux image de son départ de la position de repos et de son retour à celle-ci ainsi que du franchissement des positions intermédiaire et consigne.2. physiotherapy device according to claim 1, characterized in that there is further provided at least one intermediate position between said rest and set positions and electrical contacts respectively disposed at said rest positions, intermediate and set, on a sector with calibrated graduations, mounted with controlled rotation on said plate and around said axis, contacts capable of being activated when they are crossed by said control arm and of emitting image signals of its departure from the rest position and from its return to it as well as the crossing of the intermediate and setpoint positions. 3. Appareil de kinésithérapie selon la revendication 2, caractérisé par l'activation, au franchissement de ladite position consigne, d'un moyen adapté à décaler angulairement vers l'aval ou vers l'amont d'une valeur prédéterminée ledit secteur gradué et au moins l'un de ses contacts associés.3. physiotherapy device according to claim 2, characterized by the activation, on crossing of said set position, of a means adapted to offset angularly downstream or upstream by a predetermined value said graduated sector and at least one of its associated contacts. 4. Appareil de kinésithérapie selon la revendication 3, caractérisé en ce que ledit moyen est constitué d'un moteur du type pas-à-pas agissant par l'in- . termédiaire d'un mécanisme connu en soi sur ledit secteur gradué.4. Physiotherapy apparatus according to claim 3, characterized in that said means consists of a motor of the step-by-step type acting by in. through a mechanism known per se on said graduated sector. 5. Appareil de kinésithérapie selon une quelconque des revendications 1 à 4, caractérisé en ce que ledit bras de contrôle comporte un moyen adapté, d'une part, à contrôler les déviations transversales du mouvement dudit membre ou segment de membre par rappport à un plan de déplacement angulaire médian prédéterminé et, d'autre part, à émettre un signal lorsque ladite déviation atteint, dans un sens ou dans l'autre, par inclinaison ou torsion dudit membre ou segment de membre, une valeur préréglée.5. physiotherapy device according to any one of claims 1 to 4, characterized in that said control arm comprises means adapted, on the one hand, to control the transverse deviations of the movement of said member or segment of member by reference to a plane predetermined median angular displacement and, on the other hand, to emit a signal when said deviation reaches, in one direction or the other, by tilting or twisting of said member or segment of member, a preset value. 6. Appareil de kinésithérapie selon la réven- dication 5, caractérisé en ce que ledit moyen est constitué d'un étrier à deux branches flexibles d'écartement réglable, articulé par son sommet à l'extrémité libre dudit bras de contrôle qu'il accompagne dans sa course et positionné de manière à ce que les deux branches soient situées symétriquement de part et d'autre du plan de déplacement médian préfixé dudit bras, et en ce que lesdites branches sont munies de contacts électriques qui sont activés par l'impact dudit membre ou segment de membre lorsque son mouvement dévie de ladite valeur préréglée dudit plan médian.6. Physiotherapy apparatus according to claim 5, characterized in that said means consists of a stirrup with two flexible branches of adjustable spacing, articulated by its apex at the free end of said control arm which it accompanies in its course and positioned so that the two branches are located symmetrically on either side of the prefixed median displacement plane of said arm, and in that said branches are provided with electrical contacts which are activated by the impact of said limb or limb segment when its movement deviates from said preset value of said median plane. 7. Appareil de kinésithérapie selon la revendication 6, caractérisé en ce que l'émission du signal correspondant à l'impact sur l'un des contacts des branches dudit étrier inhibe l'activation immédiate du moyen adapté à décaler ledit secteur gradué.7. physiotherapy device according to claim 6, characterized in that the emission of the signal corresponding to the impact on one of the contacts of the branches of said stirrup inhibits immediate activation date of the means adapted to offset said graduated sector. 8. Appareil de kinésithérapie selon une quelconque des revendications 1 à 7, caractérisé en ce que ledit membre ou segment de membre est pris entre deux demi-coquilles rigides façonnées, formant enveloppe amovible, et en ce qu'il est prévu sur ladite enveloppe un moyen adapté à lui communiquer des impulsions directionnelles.8. physiotherapy device according to any one of claims 1 to 7, characterized in that said member or member segment is caught between two shaped rigid half-shells, forming a removable envelope, and in that there is provided on said envelope a means adapted to communicate directional impulses to it. 9. Appareil de kinésithérapie selon la revendication 8, caractérisé en ce que ledit moyen est constitué d'une bille de poids approprié mobile dans un tube d'axe sensiblement horizontal, monté axialement coulissant et orientable autour d'un axe vertical par rapport audit plan médian du déplacement angulaire, entre deux butées réglables définissant la course de ladite bille et dont chacune est munie d'un contact qui, en réponse à son activation par la bille, imprime à cette dernière, par le jeu d'un électro-aimant, une impulsion de renvoi d'intensité réglable.9. physiotherapy apparatus according to claim 8, characterized in that said means consists of a ball of suitable weight movable in a tube of substantially horizontal axis, mounted axially sliding and orientable about a vertical axis relative to said plane median of the angular displacement, between two adjustable stops defining the stroke of said ball and each of which is provided with a contact which, in response to its activation by the ball, prints on the latter, by the play of an electromagnet, an adjustable intensity return pulse. 10. Appareil de kinésithérapie selon la revendication 8 ou 9, caractérisé en ce que ladite enveloppe comporte en outre un dispositif d'attelage, monté coulissant et pivotant, de l'une des extrémités d'une élingue dont l'autre est solidaire d'un contrepoids, dispositif constitué d'un rail sensiblement horizontal sur lequel se déplace entre des butées réglables une roulette à laquelle est atteléeladite élingue.10. physiotherapy device according to claim 8 or 9, characterized in that said envelope further comprises a coupling device, mounted sliding and pivoting, from one end of a sling the other of which is integral with a counterweight, device consisting of a substantially horizontal rail on which moves between adjustable stops a roller to which is attached the said sling. 11. Appareil de kinésithérapie selon une quelconque des revendications 1 à 10, caractérisé en ce que ledit bras comporte un dispositif d'accouplement, d'un type connu en soi, auquel est incorporé un limiteur d'effort qui intervient pour permettre le glissement dudit accouplement dans le cas où la sollicitation appliquée au bras excède une valeur préfixée.11. physiotherapy apparatus according to any one of claims 1 to 10, characterized in that said arm comprises a coupling device, of a type known per se, which is incorporated a force limiter which intervenes to allow the sliding of said coupling in the event that the stress applied to the arm exceeds a preset value. 12. Appareil de kinésithérapie, selon une quelconque des revendications 1 à 11, caractérisé en ce qu'il est prévu une centrale de commande et de traitement adaptée à l'enregistrement chronologique et au comptage des différents signaux émis au cours du mouvement répétitif dudit membre ou segment de membre, à activer, en réponse à certains desdits signaux ou à leur fréquence, des moyens de signalisation optiques, notamment directionnels, et acoustiques, ainsi qu'à contrôler certaines interactions prédéfinies desdits signaux.12. Physiotherapy device, according to a any one of claims 1 to 11, characterized in that there is provided a control and processing unit suitable for chronological recording and counting of the various signals emitted during the repetitive movement of said member or member segment, to be activated, in response to some of said signals or to their frequency, optical, in particular directional, and acoustic signaling means, as well as to control certain predefined interactions of said signals. 13. Appareil de kinésithérapie selon la revendication 6, caractérisé en ce que lesdites branches sont munies de moyens.susceptibles d'agir, en vue d'un effet directionnel, sur ledit membre ou segment de membre à son approche prédéterminée de l'une des deux dites branches.13. physiotherapy device according to claim 6, characterized in that said branches are provided with means.susceptible to act, for a directional effect, on said limb or segment of limb at its predetermined approach to one of the two said branches.
EP80400910A 1979-06-20 1980-06-19 Apparatus for kinetic therapy, especially for reeducation treatment Withdrawn EP0022002A1 (en)

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FR7915762 1979-06-20
FR7915762A FR2459040A1 (en) 1979-06-20 1979-06-20 KINESITHERAPY APPARATUS, IN PARTICULAR FOR REHABILITATION TREATMENTS

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US4603687A (en) * 1983-08-08 1986-08-05 Greenwood Eugene C Continuous passive motion orthopedic device
FR2590151A1 (en) * 1985-11-21 1987-05-22 Centre Nat Rech Scient Electronic ambulatory apparatus for locomotary recording and/or reeduction
FR2604364A1 (en) * 1986-09-30 1988-04-01 David Int Ltd APPARATUS FOR REEDUCATION, ESPECIALLY FOR MUSCLES AND ARTICULATIONS OF THE ENDS
US4784121A (en) * 1988-01-26 1988-11-15 Brooks Lester N Knee exercising device
FR2630333A1 (en) * 1988-04-22 1989-10-27 Bodin Dominique Device for measuring physical suppleness, particularly the suppleness of an individual's joints and muscles
US5336138A (en) * 1993-01-07 1994-08-09 Arjawat P Singh Head, neck, and shoulder exercise machine
EP0979641A2 (en) * 1998-05-19 2000-02-16 Ferno (UK) Limited Monitoring patient handling equipment

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FR2590151A1 (en) * 1985-11-21 1987-05-22 Centre Nat Rech Scient Electronic ambulatory apparatus for locomotary recording and/or reeduction
FR2604364A1 (en) * 1986-09-30 1988-04-01 David Int Ltd APPARATUS FOR REEDUCATION, ESPECIALLY FOR MUSCLES AND ARTICULATIONS OF THE ENDS
US4784121A (en) * 1988-01-26 1988-11-15 Brooks Lester N Knee exercising device
FR2630333A1 (en) * 1988-04-22 1989-10-27 Bodin Dominique Device for measuring physical suppleness, particularly the suppleness of an individual's joints and muscles
US5336138A (en) * 1993-01-07 1994-08-09 Arjawat P Singh Head, neck, and shoulder exercise machine
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FR2459040A1 (en) 1981-01-09

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