EP0691837B1 - Movement system for the upper talocalcanean joint - Google Patents

Movement system for the upper talocalcanean joint Download PDF

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Publication number
EP0691837B1
EP0691837B1 EP94911143A EP94911143A EP0691837B1 EP 0691837 B1 EP0691837 B1 EP 0691837B1 EP 94911143 A EP94911143 A EP 94911143A EP 94911143 A EP94911143 A EP 94911143A EP 0691837 B1 EP0691837 B1 EP 0691837B1
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EP
European Patent Office
Prior art keywords
force
pedal
torque
characteristic line
compression
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Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Lifetime
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EP94911143A
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German (de)
French (fr)
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EP0691837A1 (en
Inventor
Jochen Staubesand
Josef Anton Grotenhuis
Bernd Holz
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Medireha GmbH
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Medireha GmbH
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Publication of EP0691837A1 publication Critical patent/EP0691837A1/en
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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H1/00—Apparatus for passive exercising; Vibrating apparatus; Chiropractic devices, e.g. body impacting devices, external devices for briefly extending or aligning unbroken bones
    • A61H1/02—Stretching or bending or torsioning apparatus for exercising
    • A61H1/0237—Stretching or bending or torsioning apparatus for exercising for the lower limbs
    • A61H1/0266—Foot
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/01—Constructive details
    • A61H2201/0173—Means for preventing injuries
    • A61H2201/018—By limiting the applied torque or force
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/12—Driving means
    • A61H2201/1207—Driving means with electric or magnetic drive
    • A61H2201/1215—Rotary drive
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/12—Driving means
    • A61H2201/1238—Driving means with hydraulic or pneumatic drive
    • A61H2201/1246—Driving means with hydraulic or pneumatic drive by piston-cylinder systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/16—Physical interface with patient
    • A61H2201/1657—Movement of interface, i.e. force application means
    • A61H2201/1676—Pivoting

Definitions

  • the invention relates to a device for moving the upper ankle, according to the preamble of claim 1.
  • Devices of the type mentioned are used for passive and active joint mobilization. Most of these are devices that were designed without taking into account the special features of the upper ankle.
  • the situation in the upper ankle is a very special one.
  • the tibia and fibula extend to the clearly visible and palpable ankles (malleolus lateralis et medialis).
  • the role (trochlea) of the anklebone (talus) moves in this Malleolen fork. It is therefore a hinge joint, which allows both extension (dorsiflexion) and flexion (plantar flexion) of the foot against the lower leg and vice versa about an axis running across the inner and outer ankle and referred to as the upper ankle joint (articulatio talocruralis) becomes.
  • the upper ankle is of particular importance. In its vicinity there are dense skin vein nets and numerous blood vessels in the fat body between the Achilles tendon and Malleolenkabel, which - like a sponge - are filled distally or squeezed with every movement in the talocrural articulation.
  • foot pedals foot supports
  • an electric or pneumatic drive the rotating or the linear movement of the drive being converted into a back and forth swiveling of the foot pedal
  • the angular velocity can be regulated and the swivel range can be adjusted.
  • all known devices do not meet the practical requirements of the clinic. They are either too cumbersome, too heavy, too loud, too unwieldy or too prone to failure. Therefore, they are not accepted by patients, nursing staff or procurement offices. Therefore, they have not been able to assert themselves on the market.
  • the maximum torque that can occur in the device when the pedals are at a standstill as a result of the end of a possible extension or flexion from the reversing movement must be significantly below the pain limit and must not increase when the two foot pedals or one of them is at a standstill.
  • the selected maximum torque should represent a break point in the almost straight-line characteristic curve in the force / displacement diagram, in the sense that after this break point is exceeded, the characteristic curve continues essentially flat.
  • a foot movement device according to the preamble of claim 1 is known, in which the drive shaft of the motor is connected to the pedal shaft by means of a resiliently contractible connecting rod.
  • This fulfills the requirement that when a foot pedal is forced to stand still as a result of reaching an end position in the range of motion of the upper ankle, the motor shaft can continue to run.
  • the second much more important requirement that when a foot pedal is at a standstill the maximum torque when the motor shaft continues to run must not be met.
  • the coil springs disclosed are conventional type, so that even after reaching an end position in the range of motion of an upper ankle, the characteristic curve of these helical springs continues to rise in a straight line and thus the force acting on the ankle further increases.
  • the device Since patients waking up from anesthesia are often very restless, the device should be easy to attach to any bed.
  • the foot pedals can also be adjusted to the left and to the right in the attachment pivot point.
  • the right foot with the specified maximum torque remains as pressure on the sole of the foot, and the left foot with the same maximum torque loaded as a train on the instep.
  • the motor shaft that continues rotates the pedals by reversing the crank movement.
  • the individual end position of the plantar flexion e.g. 28 °
  • a tensile or compressive load on the instep and sole is guaranteed with the specified maximum torque. According to the invention, this maximum value can never be exceeded.
  • the device should be convertible in a few simple steps for a single leg, either for the left or the right. This applies e.g. for accident injuries with leg surgery and for some orthopedic surgery on one leg.
  • the foot pedal that is not in use must not swivel, and therefore it is best not to be present.
  • the invention has for its object to provide a device for moving the upper ankle, which overcomes the disadvantages described and in particular the swivel range of the two foot pedals automatically the possible, possibly limited by disease or age and often also left and right different, range of motion Adapts patient feet.
  • the advantage of the device according to the invention is, above all, that when a foot pedal is forced to stand still due to reaching an end position in the range of motion of a foot, the torque on the stationary foot pedal shaft reaches a predetermined maximum value and remains almost constant while the motor shaft continues to run, so that the foot In its possible end position, both in the plantar flexion and in the dorsiflexion, the predetermined, almost constant torque remains applied, irrespective of the angle at which a foot pedal comes to a standstill in the swivel range.
  • the device for moving the upper ankle shown in FIGS. 1 to 4 comprises within a housing 7 two foot pedal shafts 1a, 1b lying horizontally in a bearing 6a, 6b, coaxially extending left and right, on each of which radially a left and right foot pedal 2a, 2b are mounted in a rotationally fixed manner.
  • each foot pedal 2a, 2b can be axially displaced on an angled rail 23a, 23b in a slot 24a, 24b, so that the foot pedals 2a, 2b can be adjusted further apart axially in patients with obese thighs.
  • each pedal 2a, 2b can also be pivoted to the left or right at the pivot point of attachment, as indicated by arrow 25, by approximately 10 ° to adapt the device to patients with X or O legs.
  • the foot pedals 2a, 2b are fixed by means of an eccentric tensioning lever 29.
  • the above-mentioned, angled rails 23a, 23b - in the form of angle plates - are each provided on the housing side with an adapter 27a, 27b with integrated index bolts 26.
  • the shafts 1a, 1b mounted within the housing 7 are also provided with an adapter plate 21a, 21b at the housing outlet and can be connected to one another by means of a knurled screw 28 with the adapters 27a, 27b of the angle rails 23a, 23b in three positions defined by the above-mentioned index bolts. so that two further zero positions can be set in addition to the main zero position (hatched positions in FIG. 4).
  • the motor shaft 4 is driven by means of a geared motor 3 controlled by the power pack 34 via the clutch 31 and the bevel gear 32.
  • a push rod 51a or 51b designed as a hollow rod is fastened via a mandrel 35a or 35b.
  • the push rod 51a or 51b engages at its other end - again eccentrically - on the mandrel 22a or 22b of an adapter plate 21a, 21b which is non-rotatably connected to the foot pedal shaft 1a or 1b.
  • the push rod 51b is in the top dead center position, which corresponds to the plantar flexion of approximately 40 °.
  • the push rod 51a is in the bottom dead center position, which corresponds to the dorsiflexion of approximately 20 °.
  • two disk spring assemblies 52, 58 with opposing spring travel are arranged in the push rod 51a, which are preloaded in the characteristic curve shortly before the break point.
  • the plate spring assembly 58 is arranged in the chamber 57 for the compression stage and the plate spring assembly 52 is arranged in the chamber 53 for the rebound stage.
  • the plate spring assembly 58 is connected to the pressure anchor 56, the plate spring assembly 52 with the tie rod 54.
  • Tie rods 54 and 56 both have a bearing eye 55 at their free end, into which the mandrels 22a and 35a can engage.
  • Fig. 6 the structure and operation of the push rod 51a is described in more detail.
  • the push rod is in the rest position for forces within the range of 0-220 Newtons. This value corresponds to a disengagement torque of approx. 5 Nm.
  • the plate spring assembly 52 is mounted on the sleeve 62 with an end plate 65.
  • the tie rod 54 is slidably disposed within the sleeve 62 and abuts the ring 64 with its disk 61.
  • the plate spring assembly 58 is mounted on the hollow pressure anchor 56 with washer 63 and also abuts the ring 64.
  • FIG. 6 shows how, in the case of expansion with a tensile force of 220 N or greater, the plate spring assembly 52 through the tie rod 54 slidably arranged in the sleeve 62, by means of its firmly connected disk 61, which abuts the sleeve 62, is compressed. Since the tie rod 54 is slidably mounted within the hollow tie rod 56, no forces are exerted on the plate spring assembly 58. The expansion of the push rod 51a is 8 mm in the dimensions provided.
  • the lower picture in FIG. 6 shows how, in the case of compression with a compressive force of 220 N or greater, the plate spring assembly 58 is firmly connected to the tie rod 56 Disk 63 is compressed while the plate spring assembly 52 remains unloaded. The compression of the push rod 51a is also 8 mm given the dimensions provided.
  • the characteristic curve of the plate springs used in the plate spring assemblies 52, 58 according to the invention is shown diagrammatically in FIG. 7.
  • the disc spring stroke s is given on the abscissa in millimeters, the force F is given in Newtons on the ordinate.
  • the unshaded area represents the preload area, the hatched area the working area of the disc spring.
  • the thickly drawn characteristic curve of the disc spring is preloaded just before its break point.
  • the essentially constant maximum torque when the foot pedal shaft 1a; 1b is forced to stand still lies on the essentially flat characteristic curve after the break point.
  • cup springs are used for torque limitation
  • other means 8, 9, 10 can also be used for this purpose.
  • the means 8 for torque limitation consists of two hydraulic cylinders 83 connected to one another in the axial direction, with opposite stroke movement of the pistons 85 and lateral hydraulic cylinders 83, each with an accumulator 84.
  • the two pistons 85 are in an end position and the piston rods 86 are each connected to the adapter plates 21a, 21b of the foot pedal shafts 6a, 6b and the eccentric discs 33a, 33b of the motor shaft 4 via the mandrels 22a, 22a and 35a, 35b.
  • the two surfaces A 1 and A 2 of the pistons 85 are of the same size.
  • the gas pressure of the accumulators 84 corresponds to the selectable maximum value for the torque to be transmitted.
  • the torque-limiting means 9 consists of two pneumatic cylinders 93 connected to one another in the axial direction and equipped with counter-stroke movement of the pistons 95 and gas-filled displacement 97.
  • the two pistons 95 are in an end position and the piston rods 96 are connected via the mandrels 22a, 22b and 35a, 35b to the adapter plates 21a, 21b of the foot pedal shafts 1a, 1b and the eccentric discs 33a, 33b of the motor shaft 4.
  • the two surfaces A 1 and A 2 of the pistons 95 are of the same size.
  • the gas pressure in the displacement 97 corresponds to the selectable maximum value for the torque to be transmitted.
  • the torque-limiting means can also consist of suitable electronics.
  • two motors instead of a single motor, since the range of motion of the two feet should be controlled independently of one another.
  • two direct drives are provided in the ankle axis itself.
  • Electric motors with position or position detection, in particular stepper motors or servomotors, are suitable as motors.
  • the two motors must be able to communicate with each other (synchronization) in order not to get out of step, ie a real 2-axis card is required, which regulates or controls the two motors.
  • the basic mode of operation for electronic torque limitation can be divided into the following steps:
  • the two motors move to their respective limit switches for reference.
  • This step can be carried out when using an absolute position measuring system (e.g. potentiometer or resolver) omitted.
  • an absolute position measuring system e.g. potentiometer or resolver
  • relative displacement measuring systems e.g. encoders
  • the electronics control the amplifiers of the two motors with slow speed and low torque.
  • the individual limit values for the patient's range of motion are recorded via the increase in power (current and / or voltage) or the following error of the two motors and stored in the electronics.
  • the two motors run at full power within the measured angular range in reverse operation, whereby synchronization can be achieved either via different angular velocities on the left and right side of the foot or through different pause lengths in the reverse positions (programming).
  • FIG. 10 A further embodiment of the invention is described in FIG. 10, in which the means for torque limitation comprise a hydraulic cylinder 10 with a continuous piston rod 103 and a rectifier circuit 104 on the side, consisting of four check valves 105 and a controllable pressure relief valve 106.
  • the continuous piston rod 103 on one side and the housing 107 on the other side are provided with a swivel eye 108 for connection to the Adapter plates 21a, 21b by means of the mandrels 22a and 35a, the set spring pressure of the pressure relief valve 106 corresponding to the selectable maximum value for the transmitted torque.

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Abstract

The device is intended for the movement of the upper talocalcanean joint. It comprises two pedal shafts (1a, 1b) fitted horizontally in a bearing (6a, 6b) and extending coaxially to left and right on which a left and right pedal (2a, 2b) are radially secured integrally in rotation and driven by a gear motor (3) in such a way that the rotary movement of the motor shaft (4) is converted into an alternating contrarotatory oscillating movement of the left and right pedals (2a, 2b) between to terminal positions within a restricted angular region. In addition there are means (5; 8; 9; 10) which limit the torque transmitted from the motor shaft (4) to the pedal shaft (1a; 1b) on the forced stoppage of a pedal (2a, 2b) resulting from the reaching of an end position in the range of movement of a talocalcanean joint to a selectable maximum value, the force/travel diagram of the means (5; 8; 9; 10) preferably having a torque limitation characteristic which is substantially flat when the selected salient point is exceeded.

Description

Die Erfindung bezieht sich auf eine Vorrichtung zur Bewegung des oberen Sprunggelenkes, gemäss der Gattung des Patentanspruchs 1.The invention relates to a device for moving the upper ankle, according to the preamble of claim 1.

Geräte der genannten Art werden zur passiven und aktiven Gelenkmobilisation eingesetzt. Zumeist handelt es sich dabei um Geräte, welche ohne Berücksichtigung der Besonderheiten des oberen Sprunggelenkes konstruiert wurden.Devices of the type mentioned are used for passive and active joint mobilization. Most of these are devices that were designed without taking into account the special features of the upper ankle.

Die Situation im oberen Sprunggelenk ist aber eine sehr spezielle. An ihren distalen Enden laden Schien- und Wadenbein aus zu den gut sicht- und tastbaren Knöcheln (malleolus lateralis et medialis). In dieser Malleolengabel bewegt sich die Rolle (trochlea) des Sprungbeins (talus). Es handelt sich somit um ein Scharniergelenk, welches sowohl eine Streckung (Dorsalextension) als auch eine Beugung (Plantarflexion) des Fusses gegen den Unterschenkel und umgekehrt um eine quer durch den inneren und äusseren Knöchel verlaufende Achse erlaubt und als oberes Sprunggelenk (articulatio talocruralis) bezeichnet wird.
Durch den engen Kontakt der Malleolengabel mit der Sprungbeinrolle sind andere Bewegungsarten nicht möglich, abgesehen von gewissen Wackelbewegungen, die bei zunehmender Plantarflexion grösser werden, da in dieser Stellung der hintere, schmalere Abschnitt der Sprungbeinrolle in der Malleolengabel liegt.
Aus der Grundstellung, in welcher der Fuss zum Unterschenkel in einem rechten Winkel steht, ist eine Bewegungsamplitude von insgesamt 70° - 80° möglich, wobei zu berücksichtigen ist, dass der Bewegungsausschlag erheblichen individuellen, z.B. trainingsbedingten Schwankungen unterliegt, und mit zunehmendem Alter sowie bei gelenkversteifenden Prozessen deutlich kleiner wird. Umschlossen wird das obere Sprunggelenk von einer Kapsel, die nach vorn und hinten relativ dünn und schlaff ist, während sie an beiden Seiten durch kräftige Bänder verstärkt wird.
Bewegungen im oberen Sprunggelenk, die beim Gehen, Laufen, Springen u.s.w. erfolgen, wirken zusätzlich auf den venösen Rückstrom ein.
Allgemein ist bekannt, dass die Rückkehr des Blutes aus den Beinvenen zum Herzen durch sogenannte "Muskel- und Gelenkpumpen" gefördert wird. Infolge der aufrechten Körperhaltung des Menschen und der damit verbundenen hydrostatischen Druckbelastung erhalten die Venen der unteren Extremitäten eine Sonderstellung. Die vom Herzen über die Arterien vermittelte Energie reicht zunächst, jedoch nicht auf Dauer aus, um die Strömung im venösen Gefässgebiet der Beine zu gewährleisten. Zu treibenden Kräften des venösen Rückstroms werden vor allem die Kontraktionen der Muskulatur des Beines. Sie führen zur Kompression der Venen, deren Klappenventile dafür sorgen, dass das Blut nicht peripherwärts, sondern nur zentralwärts - also zum Herzen hin - fliessen kann.The situation in the upper ankle is a very special one. At their distal ends, the tibia and fibula extend to the clearly visible and palpable ankles (malleolus lateralis et medialis). The role (trochlea) of the anklebone (talus) moves in this Malleolen fork. It is therefore a hinge joint, which allows both extension (dorsiflexion) and flexion (plantar flexion) of the foot against the lower leg and vice versa about an axis running across the inner and outer ankle and referred to as the upper ankle joint (articulatio talocruralis) becomes.
Due to the close contact of the Malleolen fork with the ankle bone roller, other types of movement are not possible, apart from certain wobbling movements that occur with increasing Plantar flexion becomes larger, because in this position the rear, narrower section of the ankle bone lies in the malleolar fork.
From the basic position, in which the foot is at a right angle to the lower leg, a movement amplitude of a total of 70 ° - 80 ° is possible, taking into account that the movement rash is subject to considerable individual, e.g. training-related fluctuations, and with increasing age and at joint stiffening processes becomes significantly smaller. The upper ankle is enclosed in a capsule that is relatively thin and limp at the front and back, while it is reinforced on both sides by strong ligaments.
Movements in the upper ankle, which occur when walking, running, jumping, etc., additionally affect the venous return flow.
It is generally known that the return of blood from the leg veins to the heart is promoted by so-called "muscle and joint pumps". As a result of human upright posture and the associated hydrostatic pressure load, the veins of the lower extremities are given a special position. The energy transmitted from the heart via the arteries is sufficient initially, but not permanently, to ensure the flow in the venous vascular region of the legs. The main contraction of the leg muscles is the driving force behind the venous return flow. They lead to the compression of the veins, the flap valves of which ensure that the blood cannot flow peripherally, but only centrally - i.e. towards the heart.

Aber auch die Bewegung in den Gelenken, von den Zehen- über die Fuss-, die Knie- bis zu den Hüftgelenken, führt zu Dilatationen und Kompressionen der Venen. Dadurch wird die Wirkung der Muskelpumpe entscheidend unterstützt. Besonders zu beachten ist, dass aktive wie passive Bewegungen in den Gelenken blutströmungsfördernd wirken. Dadurch besteht die Möglichkeit, auch bei durch Narkose, Bewusstlosigkeit, Lähmung oder Fixierung durch Gips- und andere Verbände muskelinaktiven Patienten die Gelenkpumpen mit Hilfe "von aussen" kommender Kräfte wirksam werden zu lassen.But also the movement in the joints, from the toes to the feet, the knees to the hip joints, leads to dilatation and compression of the veins. This significantly supports the effect of the muscle pump. It is particularly important to note that active and passive movements in the joints promote blood flow. This makes it possible to make the articulated pumps effective even with anesthesia, loss of consciousness, paralysis or fixation by gypsum and other bandages with muscle-inactive patients with the help of "outside" forces.

Eine herausragende Bedeutung kommt hierbei dem oberen Sprunggelenk zu. In seiner Umgebung finden sich dichte Hautvenennetze und zusätzlich zahlreiche Blutgefässe im Fettkörper zwischen Achillessehne und Malleolengabel, die - geradezu wie ein Schwamm - mit jeder Bewegung in der Articulatio talocruralis von distal her gefüllt bzw. herzwärts ausgepresst werden.The upper ankle is of particular importance. In its vicinity there are dense skin vein nets and numerous blood vessels in the fat body between the Achilles tendon and Malleolenkabel, which - like a sponge - are filled distally or squeezed with every movement in the talocrural articulation.

Da Blutstillstand in den Venen (= Stase) unstrittig einer der wesentlichen thrombosefördernden Faktoren darstellt, ist jede Massnahme, die der Stase entgegenwirkt, von vorbeugender Bedeutung, weil sie das Thrombose-Embolie-Risiko senkt.Since hemostasis in the veins (= stasis) is undoubtedly one of the main factors that promote thrombosis, any measure that counteracts stasis is of preventive importance because it reduces the risk of thrombosis-embolism.

Eine physikalische Thromboseprophylaxe allein oder zur Unterstützung medikamentöser Therapien ist also ganz allgemein bei bettlägerigen Patienten angezeigt. Bekannt ist auch, dass Bewegungen in den oberen Sprunggelenken Folgezustände der chronischen venösen Insuffizienz (z.B. "offene Beine") und gelenkversteifende Prozesse günstig beeinflussen können. Die durch diese Bewegungen bewirkte Beschleunigung des venösen Rückstroms im oberflächlichen und tiefen Venensystem der unteren Extremitäten geht mit einer Steigerung des arteriellen Inflows einher. Dies wirkt sich auch bei arteriellen Durchblutungsstörungen im Bereich der Beine positiv aus. Erste Versuche weisen auch darauf hin, dass solche Bewegungen die Ergebnisse von Lymphographien durch Kompression der Lymphgefässe in der Umgebung des Sprunggelenkes verbessern können.Physical thrombosis prophylaxis alone or to support drug therapies is therefore generally indicated in bedridden patients. It is also known that movements in the upper hocks result from the chronic venous insufficiency (eg "open legs") and joint-stiffening processes can favorably influence. The acceleration of the venous return flow in the superficial and deep venous system of the lower extremities caused by these movements is accompanied by an increase in arterial inflow. This also has a positive effect on arterial circulatory disorders in the area of the legs. Initial experiments also indicate that such movements can improve the results of lymphographies by compressing the lymphatic vessels in the vicinity of the ankle.

Da durch Pflegepersonal oder Krankengymnasten ausgeführte passive Bewegungen im oberen Sprunggelenk meist nur begrenzt möglich sind, besteht Bedarf an einem mechanischen Gerät, das diese Funktionen weitgehend übernehmen kann.Since passive movements in the upper ankle are usually only possible to a limited extent by nursing staff or physiotherapists, there is a need for a mechanical device that can largely perform these functions.

Derartige mechanische mit Fusspedalen (= Fussauflagen) versehene Geräte mit elektrischem oder pneumatischem Antrieb, wobei die rotierende bzw. die lineare Bewegung des Antriebes in eine hin- und hergehende Schwenkung des Fusspedals umgesetzt wird, sind bekannt. Ebenso ist bekannt, dass die Drehwinkelgeschwindigkeit regelbar und der Schwenkbereich verstellbar ist.
Alle bekannten Geräte werden zudem den praktischen Anforderungen der Klinik nicht gerecht. Sie sind entweder zu umständlich, zu schwer, zu laut, zu unhandlich oder zu störanfällig. Deshalb werden sie von Patienten, Pflegepersonal bzw. Beschaffungsstellen nicht angenommen. Sie haben sich deshalb auf dem Markt nicht durchsetzen können.Such mechanical devices provided with foot pedals (= foot supports) with an electric or pneumatic drive, the rotating or the linear movement of the drive being converted into a back and forth swiveling of the foot pedal, are known. It is also known that the angular velocity can be regulated and the swivel range can be adjusted.
In addition, all known devices do not meet the practical requirements of the clinic. They are either too cumbersome, too heavy, too loud, too unwieldy or too prone to failure. Therefore, they are not accepted by patients, nursing staff or procurement offices. Therefore, they have not been able to assert themselves on the market.

Ein weiterer Nachteil der bekannten Geräte besteht darin, dass der Schwenkbereich der Pedale oder Fussauflagen von Patient zu Patient auf die Beweglichkeit des Fusses eingestellt werden muss, denn es gibt grosse individuelle Variationen des Bewegungsumfanges im oberen Sprunggelenk.
Klinische Messungen haben Unterschiede ergeben von 0 bis 35 Grad bei der Dorsalextension und von 27 bis 65 Grad bei der Plantarflexion in Abhängigkeit vom Alter, vom Geschlecht und vom Einfluss von Venenkrankheiten und Versteifungen.
Auch Seitendifferenzen kommen häufig vor, d.h. dass Extension und Flexion linksseitig und rechtsseitig verschieden sind.Another disadvantage of the known devices is that the swiveling range of the pedals or footrests has to be adjusted from patient to patient to the mobility of the foot, because there are large individual variations in the range of motion in the upper ankle.
Clinical measurements have shown differences from 0 to 35 degrees in dorsiflexion and from 27 to 65 degrees in plantar flexion depending on age, gender and the influence of venous diseases and stiffening.
Side differences also occur frequently, ie extension and flexion are different on the left and right side.

Beim Einstellen des Schwenkbereiches auf den Bewegungsausschlag des Fusses können Fehler gemacht werden, oder während des Betriebes durch ein unbeabsichtigtes Verstellen Änderungen auftreten, die zu Verletzungen oder Überbeanspruchung führen.When adjusting the swivel range to the movement of the foot, errors can be made, or changes can occur during operation due to unintentional adjustment, which can lead to injuries or excessive stress.

Sowohl aus Gründen der Sicherheit als auch der praktischen Handhabung stellt sich die Forderung nach einem Gerät, das so konstruiert ist, dass der Schwenkbereich des Fusspedals sich automatisch auf das Höchstmass an Beweglichkeit eines Fusses einstellt, so dass auch für einen alters- oder krankheitsbedingt eingeschränkten Bewegungsumfang im oberen Sprunggelenk keine Einstellung durch das Pflegepersonal erforderlich ist. Diese automatische Einstellung soll für beide Füsse getrennt erfolgen können, sodass eine selbsttätige Anpassung auch dann erfolgt, wenn der Bewegungsumfang im oberen Sprunggelenk des rechten und linken Fusses ungleich ist.For reasons of safety as well as practical handling, there is a demand for a device that is designed in such a way that the swivel range of the foot pedal automatically adjusts to the maximum degree of mobility of a foot, so that the range of motion is restricted due to age or illness no adjustment by the nursing staff is required in the upper ankle. This automatic setting should be done separately for both feet so that an automatic adjustment takes place even if the range of motion in the upper ankle joint of the right and left foot is unequal.

Weitere Forderungen in Bezug auf Sicherheit und praktische Handhabung sind folgende:Further requirements regarding safety and practical handling are the following:

Das Höchstdrehmoment, das im Gerät beim Stillstand der Pedale infolge des Erreichens des Endes einer möglichen Extension oder Flexion von der Umkehrbewegung auftreten kann, muss deutlich unterhalb der Schmerzgrenze liegen und darf beim Stillstand der beiden Fusspedale oder eines davon nicht ansteigen. Mit anderen Worten: Das gewählte Höchstdrehmoment soll in der nahezu geradlinigen Kennlinie im Kraft/Weg-Diagramm einen Knickpunkt darstellen, in dem Sinne, dass nach Überschreiten dieses Knickpunktes die Kennlinie im wesentlichen flach weiterläuft.The maximum torque that can occur in the device when the pedals are at a standstill as a result of the end of a possible extension or flexion from the reversing movement must be significantly below the pain limit and must not increase when the two foot pedals or one of them is at a standstill. In other words: The selected maximum torque should represent a break point in the almost straight-line characteristic curve in the force / displacement diagram, in the sense that after this break point is exceeded, the characteristic curve continues essentially flat.

Aus der US-A-3 695 255 ist ein Fussbewegungsgerät gemäss dem Oberbegriff des Anspruchs 1 bekannt, bei welchem die Antriebswelle des Motors mit der Pedalwelle mittels eines federnd zusammenziehbaren Verbindungsgestänges verbunden ist. Dadurch wird die Forderung erfüllt, dass beim erzwungenen Stillstand eines Fusspedals infolge Erreichens einer Endlage im Bewegungsumfang des oberen Sprunggelenkes die Motorwelle weiterlaufen kann. Die zweite wesentlich wichtigere Forderung, dass beim Stillstand eines Fusspedals das Höchstdrehmoment beim Weiterlaufen der Motorwelle nicht mehr ansteigen darf, wird jedoch nicht erfüllt. Die offenbarten Schraubenfedern sind konventioneller Art, so dass auch nach Erreichen einer Endlage im Bewegungsumfang eines oberen Sprunggelenkes die Kennlinie dieser Schraubenfedern geradlinig weiter ansteigt und somit die Krafteinwirkung auf das Sprunggelenk weiter ansteigt.From US-A-3 695 255 a foot movement device according to the preamble of claim 1 is known, in which the drive shaft of the motor is connected to the pedal shaft by means of a resiliently contractible connecting rod. This fulfills the requirement that when a foot pedal is forced to stand still as a result of reaching an end position in the range of motion of the upper ankle, the motor shaft can continue to run. However, the second much more important requirement that when a foot pedal is at a standstill the maximum torque when the motor shaft continues to run must not be met. The coil springs disclosed are conventional type, so that even after reaching an end position in the range of motion of an upper ankle, the characteristic curve of these helical springs continues to rise in a straight line and thus the force acting on the ankle further increases.

Da aus der Narkose aufwachende Patienten häufig sehr unruhig sind, sollte das Gerät in einfacher Weise an jedem Bett befestigt werden können.Since patients waking up from anesthesia are often very restless, the device should be easy to attach to any bed.

Bei Patienten mit dicken Oberschenkeln ist es notwendig, dass die Fusspedale axial verstellbar sind, sodass die Füsse weiter auseinander kommen.In patients with thick thighs, it is necessary that the foot pedals are axially adjustable so that the feet come apart.

Für Patienten mit X- oder O-Beinen ist es wünschenswert, dass die Fusspedale ausserdem im Befestigungsdrehpunkt nach links und nach rechts verstellbar sind.For patients with X- or O-legs, it is desirable that the foot pedals can also be adjusted to the left and to the right in the attachment pivot point.

Aus der Grundstellung, in welcher der Fuss zum Unterschenkel in einem rechten Winkel steht, ist bei dem erfindungsgemässen Gerät ein Heben (Dorsalextension) von 20° und ein Senken (Plantarflexion) von 40°, d.h. ein Schwenkbereich von insgesamt 60° vorgesehen. Wenn nun bei einem Patienten der rechte Fuss (ausgehend von besagter Grundstellung) eine Dorsalextension von 6° und der linke Fuss eine Plantarflexion von 32° zulässt, dann bleibt das rechte Fusspedal bei "6° Heben" stehen und das linke Pedal schwenkt bis "32° Senken" weiter. Im Stillstand bleibt der rechte Fuss mit dem vorgegebenen Höchstdrehmoment als Druck auf der Fusssohle, und der linke Fuss mit demselben Höchstdrehmoment als Zug auf dem Rist belastet. Die weiterlaufende Motorwelle nimmt durch Umkehr der Kurbelbewegung beide Pedale wieder in die Schwenkbewegung auf. Beim Erreichen der individuellen Endlage der Plantarflexion (z.B. 28°) bleibt alsdann des rechte Pedal stehen, während das linke Pedal beim Erreichen der individuellen Endlage der Dorsalextension (z.B. 10°) steht. In beiden Fällen ist eine Zug-, bzw. Druck-Belastung auf Rist und Sohle mit dem vorgegebenen Höchstdrehmoment gewährleistet. Dieser Höchstwert kann erfindungsgemäss niemals überschritten werden.From the basic position, in which the foot is at a right angle to the lower leg, a lifting (dorsiflexion) of 20 ° and a lowering (plantar flexion) of 40 °, ie a swivel range of 60 ° in total, is provided in the device according to the invention. If the patient's right foot (starting from said basic position) allows a dorsiflexion of 6 ° and the left foot allows a plantar flexion of 32 °, then the right foot pedal stops at "6 ° lifting" and the left pedal swivels until "32 ° Lower "further. At a standstill, the right foot with the specified maximum torque remains as pressure on the sole of the foot, and the left foot with the same maximum torque loaded as a train on the instep. The motor shaft that continues rotates the pedals by reversing the crank movement. When the individual end position of the plantar flexion is reached (e.g. 28 °), the right pedal stops, while the left pedal stops when the individual end position of the dorsiflexion (e.g. 10 °) is reached. In both cases, a tensile or compressive load on the instep and sole is guaranteed with the specified maximum torque. According to the invention, this maximum value can never be exceeded.

Im weiteren soll das Gerät mit wenigen Handgriffen in einfacher Weise umrüstbar sein für ein einzelnes Bein, wahlweise für das linke oder das rechte. Dies gilt z.B. für Unfallverletzte mit Beinoperationen und für manche orthopädischen Operationen an einem Bein. In diesem Falle darf das nicht benutzte Fusspedal nicht mitschwenken, und daher am besten nicht vorhanden sein.Furthermore, the device should be convertible in a few simple steps for a single leg, either for the left or the right. This applies e.g. for accident injuries with leg surgery and for some orthopedic surgery on one leg. In this case, the foot pedal that is not in use must not swivel, and therefore it is best not to be present.

Der Erfindung liegt die Aufgabe zugrunde, eine Vorrichtung zur Bewegung des oberen Sprunggelenkes zu schaffen, welche die beschriebenen Nachteile überwindet und insbesondere den Schwenkbereich der beiden Fusspedale automatisch dem jeweils möglichen, durch Krankheit oder Alter eventuell eingeschränkten und oftmals auch links und rechts unterschiedlichen, Bewegungsumfang der Patientenfüsse anpasst.The invention has for its object to provide a device for moving the upper ankle, which overcomes the disadvantages described and in particular the swivel range of the two foot pedals automatically the possible, possibly limited by disease or age and often also left and right different, range of motion Adapts patient feet.

Die Erfindung löst die gestellte Aufgabe mit einer Vorrichtung, welche die Merkmale des Anspruchs 1 aufweist. Weitere vorteilhafte Ausgestaltungen der Erfindung sind in den abhängigen Ansprüchen gekennzeichnet.The invention achieves the stated object with a device which has the features of claim 1. Further advantageous embodiments of the invention are characterized in the dependent claims.

Der Vorteil der erfindungsgemässen Vorrichtung liegt vorallem darin, dass beim erzwungenen Stillstand eines Fusspedals, infolge des Erreichens einer Endlage im Bewegungsumfang eines Fusses, das Drehmoment an der stillstehenden Fusspedalwelle einen vorgegebenen Höchstwert erreicht und nahezu konstant beibehält, während die Motorwelle weiterläuft, so dass der Fuss in seiner möglichen Endlage, sowohl in der Plantarflexion als auch in der Dorsalextension, mit dem vorgegebenen, nahezu konstanten Drehmoment beaufschlagt bleibt, unabhängig davon bei welchem Gradwinkel im Schwenkbereich ein Fusspedal zum Stillstand kommt.The advantage of the device according to the invention is, above all, that when a foot pedal is forced to stand still due to reaching an end position in the range of motion of a foot, the torque on the stationary foot pedal shaft reaches a predetermined maximum value and remains almost constant while the motor shaft continues to run, so that the foot In its possible end position, both in the plantar flexion and in the dorsiflexion, the predetermined, almost constant torque remains applied, irrespective of the angle at which a foot pedal comes to a standstill in the swivel range.

Ein Ausführungsbeispiel der Erfindung, welches zugleich das Funktionsprinzip erläutert, ist in der Zeichnung dargestellt und wird im folgenden näher beschrieben.

  • Fig. 1 zeigt einen Längsschnitt durch die erfindungsgemässe Vorrichtung;
  • Fig. 2 zeigt einen Querschnitt durch die erfindungsgemässe Vorrichtung;
  • Fig. 3 zeigt eine Ansicht von vorne der erfindungsgemässen Vorrichtung;
  • Fig. 4 zeigt eine Seitenansicht der erfindungsgemässen Vorrichtung;
  • Fig. 5 zeigte eine als Hohlstange ausgebildete Schubstange der Vorrichtung nach Fig. 1;
  • Fig. 6 zeigt eine schematische Darstellung der Wirkungsweise der Hohlstange nach Fig. 5;
  • Fig. 7 zeigt ein Diagramm mit der Kennlinie der in der Schubstange nach Fig. 5 enthaltenen Tellerfedern;
  • Fig. 8 zeigt eine schematische Teildarstellung einer Variante der Schubstange für die erfindungsgemässe Vorrichtung;
  • Fig. 9 zeigt eine schematische Teildarstellung einer zweiten Variante der Schubstange für die erfindungsgemässe Vorrichtung; und
  • Fig. 10 zeigt eine schematische Teildarstellung einer dritten Variante der Schubstange für die erfindungsgemässe Vorrichtung.
An embodiment of the invention, which also explains the principle of operation, is shown in the drawing and is described in more detail below.
  • 1 shows a longitudinal section through the device according to the invention;
  • 2 shows a cross section through the device according to the invention;
  • 3 shows a front view of the device according to the invention;
  • 4 shows a side view of the device according to the invention;
  • FIG. 5 shows a push rod designed as a hollow rod of the device according to FIG. 1;
  • FIG. 6 shows a schematic illustration of the mode of operation of the hollow rod according to FIG. 5;
  • FIG. 7 shows a diagram with the characteristic curve of the disc springs contained in the push rod according to FIG. 5;
  • 8 shows a schematic partial illustration of a variant of the push rod for the device according to the invention;
  • 9 shows a schematic partial illustration of a second variant of the push rod for the device according to the invention; and
  • 10 shows a schematic partial illustration of a third variant of the push rod for the device according to the invention.

Die in den Fig. 1 bis 4 dargestellte Vorrichtung zur Bewegung des oberen Sprunggelenkes umfasst innerhalb eines Gehäuses 7 zwei horizontal in einer Lagerung 6a,6b liegende, links und rechts koaxial sich erstreckende Fusspedalwellen 1a,1b, auf denen radial je ein linkes und rechtes Fusspedal 2a,2b drehfest montiert sind.The device for moving the upper ankle shown in FIGS. 1 to 4 comprises within a housing 7 two foot pedal shafts 1a, 1b lying horizontally in a bearing 6a, 6b, coaxially extending left and right, on each of which radially a left and right foot pedal 2a, 2b are mounted in a rotationally fixed manner.

Jedes Fusspedal 2a,2b ist - wie in Fig. 3 dargestellt - auf einer abgewinkelten Schiene 23a,23b in einem Schlitz 24a,24b axial verschiebbar, so dass die Fusspedalen 2a,2b bei Patienten mit adipösen Oberschenkeln axial weiter auseinander eingestellt werden können. An beliebiger Stelle im besagten Schlitz 24a,24b ist jedes Pedal 2a,2b ausserdem im Befestigungsdrehpunkt nach links oder rechts - wie durch den Pfeil 25 angedeutet - um etwa 10° schwenkbar zur Anpassung des Gerätes an Patienten mit X- oder O-Beinen. Die Fusspedalen 2a,2b werden mittels eines Exzenterspannhebels 29 fixiert.As shown in FIG. 3, each foot pedal 2a, 2b can be axially displaced on an angled rail 23a, 23b in a slot 24a, 24b, so that the foot pedals 2a, 2b can be adjusted further apart axially in patients with obese thighs. At any point in said slot 24a, 24b, each pedal 2a, 2b can also be pivoted to the left or right at the pivot point of attachment, as indicated by arrow 25, by approximately 10 ° to adapt the device to patients with X or O legs. The foot pedals 2a, 2b are fixed by means of an eccentric tensioning lever 29.

Die obengenannten, abgewinkelten Schienen 23a,23b - in Form von Winkelblechen - sind an der Gehäuseseite mit je einem Adapter 27a,27b mit integrierten Indexbolzen 26 versehen. Die innerhalb des Gehäuses 7 gelagerten Wellen 1a,1b sind am Gehäuseaustritt ebenfalls mit einer Adapterplatte 21a,21b versehen und können mittels einer Rändelschraube 28 mit den Adaptern 27a,27b der Winkelschienen 23a,23b in drei durch die obengenannten Indexbolzen definierten Stellungen miteinander verbunden werden, so dass noch zwei weitere Nullagen neben der Hauptnullage einstellbar sind (schraffierte Stellungen in Fig. 4).The above-mentioned, angled rails 23a, 23b - in the form of angle plates - are each provided on the housing side with an adapter 27a, 27b with integrated index bolts 26. The shafts 1a, 1b mounted within the housing 7 are also provided with an adapter plate 21a, 21b at the housing outlet and can be connected to one another by means of a knurled screw 28 with the adapters 27a, 27b of the angle rails 23a, 23b in three positions defined by the above-mentioned index bolts. so that two further zero positions can be set in addition to the main zero position (hatched positions in FIG. 4).

Mittels eines über das Netzteil 34 gesteuerten Getriebemotors 3 wird über die Kupplung 31 und das Kegelradgetriebe 32 die Motorwelle 4 angetrieben. An der drehfest mit der Motorwelle 4 verbundenen Exzenterscheibe 33a, bzw. 33b ist über einen Dorn 35a, bzw. 35b eine als Hohlstange ausgebildete Schubstange 51a, bzw. 51b befestigt. Die Schubstange 51a, bzw. 51b greift an ihrem anderen Ende - wiederum exzentrisch - am Dorn 22a, bzw. 22b einer drehfest mit der Fusspedalwelle 1a, bzw. 1b verbundenen Adapterplatte 21a,21b an.The motor shaft 4 is driven by means of a geared motor 3 controlled by the power pack 34 via the clutch 31 and the bevel gear 32. On the eccentric disk 33a or 33b, which is connected to the motor shaft 4 in a manner fixed against relative rotation, a push rod 51a or 51b designed as a hollow rod is fastened via a mandrel 35a or 35b. The push rod 51a or 51b engages at its other end - again eccentrically - on the mandrel 22a or 22b of an adapter plate 21a, 21b which is non-rotatably connected to the foot pedal shaft 1a or 1b.

Auf diese Weise wird eine alternierende, gegenläufige Schwenkbewegung des linken und rechten Fusspedals 2a,2b zwischen zwei Endlagen innerhalb eines beschränkten Winkelbereiches umgesetzt. In Fig. 2 befindet sich links die Schubstange 51b in der oberen Totpunkt-Stellung, welche der Plantarflexion von ca. 40° entspricht. Rechts in der Figur befindet sich die Schubstange 51a in der unteren Totpunkt-Stellung, welche der Dorsalextension von ca. 20° entspricht.In this way, an alternating, counter-rotating pivoting movement of the left and right foot pedals 2a, 2b is implemented between two end positions within a limited angular range. 2, the push rod 51b is in the top dead center position, which corresponds to the plantar flexion of approximately 40 °. On the right in the figure, the push rod 51a is in the bottom dead center position, which corresponds to the dorsiflexion of approximately 20 °.

Wie in Fig. 5 gezeigt, sind in der Schubstange 51a zwei Tellerfederpakete 52,58 mit gegenläufigem Federweg angeordnet, welche kurz vor dem Knickpunkt in der Kennlinie vorgespannt sind. Das Tellerfederpaket 58 ist in der Kammer 57 für die Druckstufe angeordnet und das Tellerfederpaket 52 ist in der Kammer 53 für die Zugstufe angeordnet. Das Tellerfederpaket 58 ist mit dem Druckanker 56 verbunden, das Tellerfederpaket 52 mit dem Zuganker 54. Zug- und Druckanker 54 und 56 weisen an ihrem frei Ende beide ein Lagerauge 55 auf, in welches die Dorne 22a, bzw. 35a eingreifen können.As shown in FIG. 5, two disk spring assemblies 52, 58 with opposing spring travel are arranged in the push rod 51a, which are preloaded in the characteristic curve shortly before the break point. The plate spring assembly 58 is arranged in the chamber 57 for the compression stage and the plate spring assembly 52 is arranged in the chamber 53 for the rebound stage. The plate spring assembly 58 is connected to the pressure anchor 56, the plate spring assembly 52 with the tie rod 54. Tie rods 54 and 56 both have a bearing eye 55 at their free end, into which the mandrels 22a and 35a can engage.

In Fig. 6 ist der Aufbau und die Funktionsweise der Schubstange 51a näher beschrieben.
Im mittleren Bild der Fig. 6 befindet sich die Schubstange in Ruhelage für Kräfte innerhalb des Bereiches von 0 - 220 Newton.
Dieser Wert entspricht einem Ausrastdrehmoment von ca. 5 Nm. Das Tellerfederpaket 52 ist auf der Hülse 62 mit endständiger Scheibe 65 gelagert. Innerhalb der Hülse 62 ist der Zuganker 54 gleitbar angeordnet der mit seiner Scheibe 61 am Ring 64 anstösst. Das Tellerfederpaket 58 ist auf dem hohl ausgebildeten Druckanker 56 mit Scheibe 63 gelagert und stösst ebenfalls an den Ring 64.
Im oberen Bild der Fig. 6 ist dargestellt, wie bei einer Expansion mit einer Zugkraft von 220 N oder grösser das Tellerfederpaket 52 durch den in der Hülse 62 gleitbar angeordneten Zuganker 54, mittels dessen fest verbundener Scheibe 61, welche an der Hülse 62 anstösst, komprimiert wird.
Da der Zuganker 54 gleitbar innerhalb des hohl ausgebildeten Zugankers 56 gelagert ist, werden keine Kräfte auf das Tellerfederpaket 58 ausgeübt. Die Expansion der Schubstange 51a beträgt bei den vorgesehenen Abmessungen 8 mm.
Im unteren Bild der Fig. 6 ist dargestellt, wie bei einer Kompression mit einer Druckkraft von 220 N oder grösser das Tellerfederpaket 58 von der fest mit dem Zuganker 56 verbundenen Scheibe 63 komprimiert wird, währenddem das Tellerfederpaket 52 unbelastet bleibt. Die Kompression der Schubstange 51a beträgt bei den vorgesehenen Abmessungen ebenfalls 8 mm.In Fig. 6 the structure and operation of the push rod 51a is described in more detail.
In the middle picture of FIG. 6, the push rod is in the rest position for forces within the range of 0-220 Newtons.
This value corresponds to a disengagement torque of approx. 5 Nm. The plate spring assembly 52 is mounted on the sleeve 62 with an end plate 65. The tie rod 54 is slidably disposed within the sleeve 62 and abuts the ring 64 with its disk 61. The plate spring assembly 58 is mounted on the hollow pressure anchor 56 with washer 63 and also abuts the ring 64.
The upper picture in FIG. 6 shows how, in the case of expansion with a tensile force of 220 N or greater, the plate spring assembly 52 through the tie rod 54 slidably arranged in the sleeve 62, by means of its firmly connected disk 61, which abuts the sleeve 62, is compressed.
Since the tie rod 54 is slidably mounted within the hollow tie rod 56, no forces are exerted on the plate spring assembly 58. The expansion of the push rod 51a is 8 mm in the dimensions provided.
The lower picture in FIG. 6 shows how, in the case of compression with a compressive force of 220 N or greater, the plate spring assembly 58 is firmly connected to the tie rod 56 Disk 63 is compressed while the plate spring assembly 52 remains unloaded. The compression of the push rod 51a is also 8 mm given the dimensions provided.

Die Kennlinie der in den erfindungsgemässen Tellerfederpaketen 52,58 verwendeten Tellerfedern ist diagrammässig in Fig. 7 dargestellt. Auf der Abszisse ist der Tellerfederhub s in Millimetern angegeben, auf der Ordinate ist die Kraft F in Newton angegeben. Die unschraffierte Fläche stellt den Vorspannbereich, die schraffierte Fläche den Arbeitsbereich der Tellerfeder dar. Wie aus dem Diagramm ersichtlich, ist die dick ausgezogene Kennlinie der Tellerfeder kurz vor ihrem Knickpunkt vorgespannt. Das im wesentlichen konstante maximale Drehmoment beim erzwungenen Stillstand der Fusspedalwelle 1a;1b liegt auf der, im wesentlichen flachen Kennlinie nach dem Knickpunkt.The characteristic curve of the plate springs used in the plate spring assemblies 52, 58 according to the invention is shown diagrammatically in FIG. 7. The disc spring stroke s is given on the abscissa in millimeters, the force F is given in Newtons on the ordinate. The unshaded area represents the preload area, the hatched area the working area of the disc spring. As can be seen from the diagram, the thickly drawn characteristic curve of the disc spring is preloaded just before its break point. The essentially constant maximum torque when the foot pedal shaft 1a; 1b is forced to stand still lies on the essentially flat characteristic curve after the break point.

Statt der in den Figuren 1 - 7 erläuterten Ausführungsform, in welcher Tellerfedern zur Drehmomentbegrenzung verwendet werden, sind auch andere Mittel 8,9,10 zu diesem Zweck einsetzbar.Instead of the embodiment explained in FIGS. 1-7, in which cup springs are used for torque limitation, other means 8, 9, 10 can also be used for this purpose.

Beispielsweise sind auch andere mechanische Federn einsetzbar, die eine vergleichbare Kennlinie aufweisen, so z.B. spezielle gewickelte Spiralfedern mit stark degressiver Kennlinie., Gummifederelemente u.ä. Allerdings bedingen andere mechanische Federelemente einen wesentlich grösseren Bauraum als Tellerfederpakete beanspruchen. Dies deshalb, weil verschiedene Federn derart zu einem System zusammengestellt werden müssen, dass die Aufeinanderfolge der jeweils geradlinigen Kennlinien des Kraft/Weg-Diagramms der Einzelfedern Knickungen aufweist, welche zu einer Abflachung des Gesamtsystems führen.For example, other mechanical springs that have a comparable characteristic curve can also be used, for example special wound spiral springs with a strongly degressive characteristic curve, rubber spring elements and the like. However, other mechanical spring elements require a much larger space than plate spring sets. This is because different springs have to be put together in a system that the Sequence of the respective straight-line characteristics of the force / displacement diagram of the individual springs has kinks, which lead to a flattening of the overall system.

Besonders muss betont werden, dass mit Federn, welche eine im wesentlichen geradlinige Kennlinie aufweisen, das Beibehalten eines nahezu konstanten Drehmomentes über den gesamten Schwenkbereich beim erzwungenen Stillstand nicht erreichbar ist. Handelsübliche zylindrische Druckfedern mit einer gleichbleibenden Federrate c in N/mm sind für die vorliegende erfindungsgemässe Lösung somit nicht brauchbar.In particular, it must be emphasized that with springs which have an essentially straight-line characteristic curve, it is not possible to maintain an almost constant torque over the entire swivel range when forced to stand still. Commercially available cylindrical compression springs with a constant spring rate c in N / mm are therefore not usable for the solution according to the invention.

In Fig. 8 besteht das Mittel 8 zur Drehmomentbegrenzung aus zwei in axialer Richtung miteinander verbundenen, mit gegenläufiger Hubbewegung der Kolben 85 und seitliche mit je einem Akkumulator 84 versehenen Hydraulikzylindern 83. Die beiden Kolben 85 befinden sich dabei in einer Endlage und die Kolbenstangen 86 sind jeweils über die Dornen 22a,22a und 35a,35b mit den Adapterplatten 21a,21b der Fusspedalwellen 6a,6b bzw. den Exzenterscheiben 33a,33b der Motorwelle 4 verbunden. Die beiden Flächen A1 und A2 der Kolben 85 sind gleich gross ausgebildet. Der Gasdruck der Akkumulatoren 84 entspricht dabei dem wählbaren Höchstwert für das zu übertragende Drehmoment.In FIG. 8, the means 8 for torque limitation consists of two hydraulic cylinders 83 connected to one another in the axial direction, with opposite stroke movement of the pistons 85 and lateral hydraulic cylinders 83, each with an accumulator 84. The two pistons 85 are in an end position and the piston rods 86 are each connected to the adapter plates 21a, 21b of the foot pedal shafts 6a, 6b and the eccentric discs 33a, 33b of the motor shaft 4 via the mandrels 22a, 22a and 35a, 35b. The two surfaces A 1 and A 2 of the pistons 85 are of the same size. The gas pressure of the accumulators 84 corresponds to the selectable maximum value for the torque to be transmitted.

In Fig. 9 besteht das drehmomentbegrenzende Mittel 9 aus zwei in axialer Richtung miteinander verbundenen, mit gegenläufiger Hubbewegung der Kolben 95 und mit gasgefülltem Hubraum 97 ausgerüsteten Pneumatikzylindern 93. Die beiden Kolben 95 befinden sich dabei in einer Endlage und die Kolbenstangen 96 sind über die Dornen 22a,22b und 35a,35b mit den Adapterplatten 21a,21b der Fusspedalwellen 1a,1b bzw. den Exzenterscheiben 33a,33b der Motorwelle 4 verbunden. Die beiden Flächen A1 und A2 der Kolben 95 sind gleich gross ausgebildet. Der Gasdruck im Hubraum 97 entspricht dabei dem wählbaren Höchstwert für das zu übertragende Drehmoment.In FIG. 9, the torque-limiting means 9 consists of two pneumatic cylinders 93 connected to one another in the axial direction and equipped with counter-stroke movement of the pistons 95 and gas-filled displacement 97. The two pistons 95 are in an end position and the piston rods 96 are connected via the mandrels 22a, 22b and 35a, 35b to the adapter plates 21a, 21b of the foot pedal shafts 1a, 1b and the eccentric discs 33a, 33b of the motor shaft 4. The two surfaces A 1 and A 2 of the pistons 95 are of the same size. The gas pressure in the displacement 97 corresponds to the selectable maximum value for the torque to be transmitted.

Grundsätzlich kann das drehmomentbegrenzende Mittel auch aus einer geeigneten Elektronik bestehen. In einem solchen Fall sind zweckmässigerweise - statt eines einzigen Motors - zwei Motoren vorzusehen, da die beiden Füsse voneinander unabhängig in ihrem Bewegungsumfang angesteuert werden sollen. Vorzugsweise werden zwei Direktantriebe in der Sprunggelenkachse selbst vorgesehen. Als Motoren kommen Elektromotoren mit Positions-, bzw. Lageerkennung in Frage, insbesondere Schrittmotoren oder Servomotoren. Die beiden Motoren müssen miteinander kommunizieren können (Synchronisation), um nicht ausser Tritt zu kommen, d.h. es ist eine echte 2-Achskarte erforderlich, welche die zwei Motoren regelt, bzw. steuert.
Die grundsätzliche Arbeitsweise bei einer elektronischen Drehmomentbegrenzung kann in folgende Schritte unterteilt werden:In principle, the torque-limiting means can also consist of suitable electronics. In such a case, it is advisable to provide two motors instead of a single motor, since the range of motion of the two feet should be controlled independently of one another. Preferably two direct drives are provided in the ankle axis itself. Electric motors with position or position detection, in particular stepper motors or servomotors, are suitable as motors. The two motors must be able to communicate with each other (synchronization) in order not to get out of step, ie a real 2-axis card is required, which regulates or controls the two motors.
The basic mode of operation for electronic torque limitation can be divided into the following steps:

1. Referenzfahrt:1. Reference run:

Die beiden Motoren fahren auf ihre jeweiligen Endschalter zum referenzieren. Dieser Schritt kann bei Einsatz eines Absolutwegmesssystems (z.B. Potentiometer oder Resolver) entfallen. Bei Relativwegmesssystemen (z.B. Encoder) muss dieser Schritt nach dem Einschalten des Gerätes ohne Patient durchgeführt werden.The two motors move to their respective limit switches for reference. This step can be carried out when using an absolute position measuring system (e.g. potentiometer or resolver) omitted. In the case of relative displacement measuring systems (e.g. encoders), this step must be carried out without a patient after switching on the device.

2. Einmessen:2. Measure:

Die Elektronik (Mikroprozessor) steuert die Verstärker der beiden Motoren mit langsamer Drehzahl und kleinem Drehmoment an. Die für den Patienten individuellen Grenzwerte seines Bewegungsumfanges werden über den Leistungsanstieg (Strom und/oder Spannung) oder den Schleppfehler der beiden Motoren erfasst und in der Elektronik gespeichert.The electronics (microprocessor) control the amplifiers of the two motors with slow speed and low torque. The individual limit values for the patient's range of motion are recorded via the increase in power (current and / or voltage) or the following error of the two motors and stored in the electronics.

3. Behandlungsstart:3. Start of treatment:

Die beiden Motoren fahren mit ihrer vollen Leistung innerhalb des gemessenen Winkelbereiches im Reversierbetrieb, wobei die Synchronisation entweder über unterschiedliche Winkelgeschwindigkeiten der linken und rechten Fussseite oder durch unterschiedliche Pausenlänge in den Umkehrlagen erreicht werden kann (Programmierung).The two motors run at full power within the measured angular range in reverse operation, whereby synchronization can be achieved either via different angular velocities on the left and right side of the foot or through different pause lengths in the reverse positions (programming).

In Fig. 10 ist eine weitere Ausführungsform der Erfindung beschrieben, bei welcher die Mittel zur Drehmomentbegrenzung einen hydraulischen Zylinder 10 mit durchgehender Kolbenstange 103 und seitliche eine Gleichrichterschaltung 104, bestehend aus vier Rückschlagventilen 105 und einem regelbaren Überdruckventil 106 umfasst. Die durchgehende Kolbenstange 103 auf der einen Seite und das Gehäuse 107 auf der anderen Seite sind mit einem Schwenkauge 108 versehen zur Verbindung mit den Adapterplatten 21a,21b mittels der Dornen 22a und 35a, wobei der eingestellte Federdruck des Überdruckventils 106 dem wählbaren Höchstwert für das übertragende Drehmoment entspricht.A further embodiment of the invention is described in FIG. 10, in which the means for torque limitation comprise a hydraulic cylinder 10 with a continuous piston rod 103 and a rectifier circuit 104 on the side, consisting of four check valves 105 and a controllable pressure relief valve 106. The continuous piston rod 103 on one side and the housing 107 on the other side are provided with a swivel eye 108 for connection to the Adapter plates 21a, 21b by means of the mandrels 22a and 35a, the set spring pressure of the pressure relief valve 106 corresponding to the selectable maximum value for the transmitted torque.

Claims (11)

  1. Apparatus for the mobility of the talo-crural articulation, with two pedal shafts (1a, 1b) horizontally provided in a bearing (6a, 6b) and laterally extending to the left and to the right, with eccentric disks (33a, 33b) on each of which respective left and right pedals (2a, 2b) are fixedly mounted, said disks being drivable by means of an electric motor (3) having eccentric disks (33a, 33b) mounted on the ends of the two shafts and by means of connecting rods (51a, 51b) connected to said eccentric disks (33a, 33b) such that the rotational movement of the shaft (4) of said electric motor is converted into alternated and opposed tilting movements of said left and right pedals (2a, 2b) inside an angular range limited by two end positions, characterized in that said connecting rods (51a, 51b) are configured with resilient devices (8; 9; 10) the length of which is variable as a function of the force to be exerted, such that said connecting rods (51a, 51b) are rendered resilient in traction and in compression, said resilient devices (8; 9; 10) being prestressed by the same force in traction and in compression, the effect of which being that when a pedal (2a, 2b) is prescribed to stop because an end position is reached in the amount of movement of one talo-crural articulation, the torque transferred by said electric motor (4) on said pedal shafts (1a; 1b) and corresponding to said prestressing force cannot be exceeded because the force characteristic line in a force-elongation diagram extends along a straight line, and when said prestressing force is exceeded, said characteristic line has an inflection point and extends from there substantially flat.
  2. An apparatus as claimed in claim 1, characterized in that each said pedal (2a, 2b) is positioned on an angled rail (23a, 23b) such as to be able to glide axially within a slot (24a, 24b) and is further able to be inclined of an angle of approximately 10° to the left and to the right around the point of fixation thereof, at any position in said slot (24a, 24b), and on the casing side, said angled rail (23a, 23b) is provided with an adapter (27a, 27b) able to be fixed with an embossed nut (28) on an adapter (21a, 21b) provided on said shafts (1a, 1b), such that both adapters are able to be moved and attached to each other in three different positions, such that not only the neutral vertical position, but also two other neutral positions are able to be set.
  3. An apparatus as claimed in claim 1 or 2, characterized in that said resilient device provided in each connecting rod (51a, 51b) in order to limit said torque is comprised of two sets of disk springs (52, 58) having preferably disk springs with different elastic constants, wherein the number, diameter and thickness of material of the individual disk springs for each set are selected and prestressed such that said prestressing force reaches the desired inflection point in said force-elongation diagram (7), and when said force is exceeded as the result of a prescribed stop for one of said pedal shaft (1a, 1b) either in the direction of traction or the direction of compression, said force characteristic line extends substantially flat as a result of said disk springs proprieties.
  4. An apparatus as claimed in claim 1 or 2, characterized in that said resilient device (8) provided in each connecting rod (51a, 51b) in order to limit said torque is comprised of two hydraulic cylinders (83) connected to each other in the axial direction, provided with pistons (85) the strokes of which are mutually opposed and provided with a side accumulator (84), the gas pressure in said accumulator (84) corresponding to the elastic prestressing force, and when said force is exceeded as a result of a prescribed stop for one of said pedal shafts (1a, 1b), either in the direction of traction or in the direction of compression, said force characteristic line slopes upwards only negligeably under the dependance of the volume of said gas and because the surface areas (A1, A2) of said pistons (85) are equal.
  5. An apparatus as claimed in claim 1 or 2, characterized in that said resilient device (9) provided in each connecting rod (51a, 51b) in order to limit said torque est comprised of two pneumatic cylinders (93) attached to each other in the axial direction, provided with pistons (95) the strokes of which are opposed and of a displacement chamber (97) filled with gas, the pressure of said gas in said displacement chamber (97) corresponding to said elastic prestressing force, and when said force is exceeded as a result of a prescribed stop for one of said pedal shafts (1a, 1b), either in the direction of traction or in the direction of compression, said force characteristic line slopes upwards only negligeably under the dependance of the volume of said gas and because the surface areas (A1, A2) of said pistons (95) are equal.
  6. An apparatus as claimed in claim 1 or 2, characterized in that said resilient device (10) provided in each connecting rod (51a, 51b) in order to limit said torque is comprised of an hydraulic cylinder through which a piston rod (103) extends, and of a rectifying circuit (104) positioned laterally, comprising four one-way valves (105) and one controlable pressure valve (106), the settings of said pressure valve (106) corresponding to said elastic prestressing force, and when said force is exceeded as a result of a prescribed stop for one of said pedal shafts (1a, 1b), as a result of the opening of said pressure valve (106), either in the direction of traction or in the direction of compression, said force characteristic line extends exactly flat as a result of said rectifying circuit with said one-way valves (105).
  7. An apparatus as claimed in one of claims 1 to 6, characterized in that said electric motor (3) is a geared electric motor.
  8. An apparatus as claimed in claim 1 or 2, characterized in that said connecting rods (51a, 51b) provided with said resilient devices (8; 9; 10) in order to limit said torque comprise an electronic control for the electric motor (3), preferably with a microprocessor.
  9. An apparatus as claimed in claim 8, characterized in that said electric motor (3) is comprised of two individual electric motors.
  10. An apparatus as claimed in claim 1 or 2, characterized in that said resilient device provided in said connecting rods (51a, 51b) in order to limit said torque comprises a compression spring assembly coiled such that it has a strongly decreasing characteristic line in the force-elongation diagram.
  11. An apparatus as claimed in claim 1 or 2, characterized in that said resilient device provided in said connecting rods (51a, 51b) in order to limit said torque comprises a rubber or plastic spring assembly the shape of which is selected such that the assembly has a strongly decreasing characteristic line in the force-elongation diagram.
EP94911143A 1993-03-31 1994-03-10 Movement system for the upper talocalcanean joint Expired - Lifetime EP0691837B1 (en)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
CH993/93 1993-03-31
CH99393 1993-03-31
PCT/EP1994/000740 WO1994022411A1 (en) 1993-03-31 1994-03-10 Movement system for the upper talocalcanean joint

Publications (2)

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EP0691837A1 EP0691837A1 (en) 1996-01-17
EP0691837B1 true EP0691837B1 (en) 1997-05-14

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Application Number Title Priority Date Filing Date
EP94911143A Expired - Lifetime EP0691837B1 (en) 1993-03-31 1994-03-10 Movement system for the upper talocalcanean joint

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EP (1) EP0691837B1 (en)
AT (1) ATE152904T1 (en)
DE (1) DE59402761D1 (en)
WO (1) WO1994022411A1 (en)

Families Citing this family (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6599255B2 (en) * 2001-05-31 2003-07-29 Rehabilitation Institute Of Chicago Portable intelligent stretching device
DE102008036433A1 (en) * 2008-08-05 2010-02-11 Karl Mayr Therapy device for moving feet of person, comprises two pedals with foot bearing surface which is pushed in longitudinal direction and in transverse direction, where drive connecting device is connected with pedals
DE102010049483A1 (en) * 2009-10-28 2011-05-12 Universitätsklinikum Freiburg Method and device for training a person's ability to stand and walk
IT201900025075A1 (en) * 2019-12-20 2021-06-20 Delos S R L Oscillating plate balance device

Family Cites Families (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2815020A (en) * 1955-09-16 1957-12-03 Barkschat Eric Automatic exerciser for feet and legs
US3580244A (en) * 1969-03-20 1971-05-25 Mary E Graves Therapeutic device oscillating device
US3695255A (en) * 1970-05-14 1972-10-03 Edward J Rodgers Foot exercising device
US3917261A (en) * 1974-08-05 1975-11-04 Samuel N Small Foot exercising device
DE8632570U1 (en) * 1986-12-05 1987-02-19 Fa. A. Bösl, 5100 Aachen Gymnastic device for performing leg and/or foot gymnastics
CH682049A5 (en) * 1989-09-27 1993-07-15 Hydraulika Gmbh Device for post-operative ankle joint therapy - has two pedals each on shaft for accommodation of feet of patient, both shafts being connected via eccentric drive with motor shaft
US5211161A (en) * 1991-01-22 1993-05-18 Compagnie Generale De Materiel Orthopedique Three axis passive motion exerciser

Also Published As

Publication number Publication date
EP0691837A1 (en) 1996-01-17
WO1994022411A1 (en) 1994-10-13
ATE152904T1 (en) 1997-05-15
DE59402761D1 (en) 1997-06-19

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