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
  • A61H1/0218—Drawing-out devices
  • A61H1/0229—Drawing-out devices by reducing gravity forces normally applied to the body, e.g. by lifting or hanging the body or part of it
• • 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
  • A61H1/0255—Both knee and hip of a patient, e.g. in supine or sitting position, the feet being moved together in a plane substantially parallel to the body-symmetrical plane
• • 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
  • A61H1/0255—Both knee and hip of a patient, e.g. in supine or sitting position, the feet being moved together in a plane substantially parallel to the body-symmetrical plane
  • A61H1/0262—Walking movement; Appliances for aiding disabled persons to walk
• • 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
  • A61H2201/16—Physical interface with patient
  • A61H2201/1602—Physical interface with patient kind of interface, e.g. head rest, knee support or lumbar support
  • A61H2201/164—Feet or leg, e.g. pedal
  • A61H2201/1642—Holding means therefor
• • 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
  • A61H2203/00—Additional characteristics concerning the patient
  • A61H2203/04—Position of the patient
  • A61H2203/0406—Standing on the feet
• • 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
  • A61H2203/00—Additional characteristics concerning the patient
  • A61H2203/04—Position of the patient
  • A61H2203/0443—Position of the patient substantially horizontal
  • A61H2203/0456—Supine

Definitions

• the invention relates to a device and a method for starting locomotion training in patients with mobility problems in an early phase of rehabilitation, according to patent claims 1 and 8, respectively.
• EXPLICIT COAL US Pat. No. 4,986,261 (1991) describes an apparatus that also causes hip extension. However, the knee joints are not moved as in physiological walking.
• the aim is to make it possible to continuously bring the patient's body closer to the vertical position during training.
• the aim of the device according to the invention is to create a so-called 'active standing table' (tilting table) which enables the movement of the legs of paraplegic patients in a physiological manner similar to walking, without the need to straighten it up.
• this object is achieved with an active standing table according to the wording of claim 1 and an associated method for operating the active standing table according to the wording of claim 8
• FIG. 1 side view of an active standing table with a patient in a vertical position.
• Fig. 2 overall view of a first embodiment of an active
• Fig. 7 overall view of a second embodiment of an active
• a base frame serves as the basis. It consists of a chassis 1 with castors 2 and 3 and a height-adjustable frame 6 (eg "tilting table") Super “, Gymna, Belgium)
• the frame 6 can be adjusted in height manually or with a drive (not shown).
• a joint 7 is attached to the frame 6, with which a leg part 8, consisting of two bars and two cross struts (see Fig. 2) is articulated to the frame 6.
• the leg part 8 is in turn connected via a joint 9 to a head part 10 (frame similar to leg part 8), on which there is a lying surface 11 consisting of a wooden board with a foam cover, so that during therapy with the active standing table the angle of the standing table can be continuously increased from the horizontal to the vertical, the leg section 8 can be driven by a drive 4 and m rotate the joint 7 and so an inclination angle ⁇ 1 can be set in order to be able to carry out a treatment at various inclination angles in a known manner.
• the inclination angle ⁇ 1 is 90 °, which corresponds to a vertical position of the patient.
• the adjustability of the inclination angle ⁇ 1 can Patients with unstable blood circulation are treated while lying down and then continuously brought into the vertical position appropriately for their status during the therapy by slightly increasing the angle of inclination ⁇ 1
• a mechanism 21 for adjusting the hoof extension it is possible to fix an inclination between the leg part 8 and the head part 10, as a result of which a hoof extension angle ⁇ 2 is defined.
• a hoof extension of the legs can be achieved during the therapy if the standing table is in a horizontal position ß2 is always 180 °, because the head part 10 rests on the frame 6. If the angle ß1 is increased, then ß2 also decreases until the mechanism 21 comes to a stop and the head part is also pulled upwards.
• the angle is ß2 172 ° which results in a hoof extension angle of 8 ° for the patient, preferred values are 12 °
• the leg part 8 there is a knee mechanism 13 with two knee drives 24 and a foot mechanism 14. These two mechanisms can be moved parallel to the leg part on two rails 15, which are fastened on each side of the leg part 8, and thus allow the standing table to be adjusted the anatomy of different patients
• the lying surface 1 1 is tilted into the horizontal position and brought to the same height as the hospital bed on which the patient to be treated lies by adjusting the height of the base frame. Then the patient is transferred to the lying surface 1 1. so that his upper body comes to rest on the lying surface and his hip joints on the lower edge of the lying surface.
• fixation strap 16 The patient is then tightened with a fixation strap 16 around his waist, which is attached to eyes 22 with fixing straps 17 on the upper side of the lying surface, with fixing straps 18 the lower side of the bed is attached to eyelets 23.
• This fixation prevents the upper body from moving up and down during therapy.It is designed in such a way that the trunk movements are minimized in order to prevent injuries to the spine, which may still be unstable.
• the fixation belt 16 corresponds to one Belt like he used for weight relief during treadmill training of paraplegics is used as standard (eg treadmill "Walker ', Fa Hamster's Parachute Service, Austria)
• the knee mechanism 13 If the patient is fixed on the lying surface, the knee mechanism 13 is moved on the rails 15 in such a way that the knee drives 24 close under the back of the patient's knees Come to lie there
• the knee mechanism is fixed with locking screws 25
• the foot mechanism 14 is also moved so that an extension (extension) of the patient's legs press footplates 19a
• the foot mechanism 14 is in the correct position Position fixed with locking screws 26
• knee cuffs 20 are attached to the patient's knees (see FIG. 6). These are attached to the knee drives 24, which pull the patient's knees down or push them up during the therapy each causes a stretching or a bending of the legs. In the figure, the patient's right leg is shown bent, the left leg in a stretched state. It should be mentioned that at the beginning of the therapy, the two knee drives 24 are retracted so that the patient can easily open be transferred to the standing table Only at the beginning of the treatment is a knee drive extended and one leg bent
• the knee drives 24 are moved alternately up and down, so that the patient's legs move with a movement sequence similar to that which occurs during normal walking.
• the sensory input (afferents) from the legs for the spinal locomotion centers in the spinal cord similar information as in physiological walking, which stimulates the locomotive centers to activate
• FIG. 2 shows the overall view of a first exemplary embodiment of an active standing table in a horizontal position.
• the base frame can again be seen, consisting of a chassis 1 with rollers 2a, 2b, 3a and 3b and the height-adjustable frame 6.
• the leg part 8 is a frame via the joint 7 consisting of two bars 8A and 8A 'and two cross struts 8B and 8B', connected to the frame 6.
• the leg part 8 is in turn connected via the joint 9 to the head part 10, on which the lying surface 11 is located.
• the joint 9 is located at the joint 9 the mechanism 21 for adjusting the hoof extension
• leg part 8 there are the knee mechanism 13 with the two knee drives 24a and 24b and a foot mechanism 14 which can be moved parallel to the leg part 8 on the rails 15a and 15b.
• the locking screws 25 and 26 are located on the leg part 13 and on the foot part 14 which are used for fixation on the rails 15a and 15b
• Eyelets 22a, 22b, 23a and 23b are attached to the lying surface 11 for fixing the patient
• FIG. 3 shows the mechanism for adjusting the hoof extension angle in a side view.
• a pointer 33 shows on a scale 32 which hoof extension angle is set for the patient with the limiting screw.
• the hoof extension angle corresponds to 180 ° - ß2
• FIG. 4A shows the knee mechanism 13 to FIG. 2 in a perspective view.
• a cross member 40 On each side of a cross member 40 there are the square tubes 41 a and 41 b (not shown). These serve as guides for the knee mechanism 13 on the rails on the leg part.
• the cross member 40 has two rectangular ones Recesses 40 'in which the two knee drives 24a and 24b are located. These two drives are identical in construction, which is why only one drive is numbered in the figure.
• bearings 42, 43a and 43b (not shown), in which suspension shafts 44b and 45b can rotate freely. These suspension shafts are each fastened to a base plate 46b.
• the knee drives can be rotated by this mounting, so that they flex when the patient knees about the axis of rotation of the hip joint or extension are moved in the base plate 46b, a motor 47b is fixed, as well as two guide tubes 48 b or 49b (not shown) recessed There is also a guide 50b in the base plate 46b in which a threaded rod 51 can be freely rotated.
• the structure of the drive by means of the threaded rod is described in detail in FIG. 4B.
• the guide tubes 48b and 49b can each have a guide rod 52b and 53b can be moved up and down If the linear drive is now moved up or down, a plate 54b and an attached knee pad 55b are moved up and down with the knees of the patient with a movement of the Knee pads brought into flexion when moving downwards from the knee cuffs (see FIG. 6) pulled into an extension.
• the two guide rods 52b and 53b, which are guided in the guide tubes 48b and 49b, ensure lateral stability of the knee drive, so that the leg the patient does not incline to the side
• the guide tubes 48b and 49b as well as the
• Threaded rod 51b are mounted at the upper end in the plate 54b and at the lower end in a plate 62b
• a protective cover 56a made of rubber protects the patient from injuries to the
• FIG. 4B shows the knee mechanism 13 of FIG. 2 in a side view.
• the principle of the drive is explained in more detail with reference to this figure.
• the suspension shaft 44 can be seen, which is a rotation of the knee drive around the axis indicated by the round arrow.
• the guide rod 52 can be moved through the guide tube 48, and the threaded rod 51 can be moved through the guide 50.
• the motor 47 which is fixedly mounted in the base plate 46, drives with a gearwheel 57 via a V-belt 58 a gear 59 mounted on the guide 50 in the gear 59 there is a thread. If the gear is now driven by the motor 47, the threaded rod 51 in the base plate 46 is moved up or down, as with the straight arrow indicated
• a limit switch 60 and 60 'at the top and bottom serve to announce to a control unit which controls the movement of the front end that the end positions have been reached. If the drive has reached the lowest point, the plate prints with the Knee cuff on a contact button 61 and the limit switch 60 signals the control unit that the motor should run in the opposite direction. Then the drive moves up until the lower plate presses on a contact button 61 'and the limit switch 60' of the control unit provides another signal for switching granted
• Fig. 5 shows the foot mechanism 14 to Fig. 2 in a perspective view.
• a square tube 69a and 69b are each firmly connected to it. These serve as a guide for the foot mechanism on the rails attached to the leg part Therapy at the correct place with the fixing screws 26a and 26b are screwed at the upper end of the T-piece 63 on each side there is a footplate 19a and 19b which can be rotated around a bearing at the fastening point on the T-piece
• the foot plates are identical in construction, all parts appear symmetrically on both sides.
• the patient's feet can each be inserted into an elastic loop 65a and 65b on the foot plates. They are then protected from slipping out by the heel holders 66a and 66b
• the foot plates 19a and 19b are each connected to a spring 67a or 67b (not shown). This is tensioned on a bolt 68a or 68b (not shown) when the footplate is pressed downwards by the patient (caution). This generates a compressive force The sole of the patient's foot in the extended phase of the movement cycle, which simulates a weight force similar to that produced when walking. The strength of this weight force can be adjusted by moving the bolt 68a in the various holes 68a '. If the angle of inclination of the standing table becomes larger, then usually the weight increases, which acts on the legs. This effect can be compensated and controlled by pulling the patient with the fixation straps and the fixation belt more or less upwards
• FIG. 6 shows a knee cuff to FIG. 2 in a perspective view.
• a plate 70 is fixedly attached to the upper end of the threaded rod 49 and the guide rods 54 and 55.
• a bracket 71 is fastened to this, to which two clip mechanisms 72 and 72 'engage Allow knee pad 53 to be attached
• This knee pad 53 is a plastic-covered foam.
• the clip mechanism holds the knee pad sufficiently strong to cause the knee to stretch when the knee drive is pulled down.
• the connection is lost if the patient's knee is incorrectly manipulated for some reason can not be stretched.
• the clip mechanism are the knee pads in load forces, or pulling forces from 150 to 200 N, preferably 180 N, free on knees ⁇ pad 53 is a knee cuff consisting of two Velcro straps 73 and 73 attached, which allows it to attach the patient's knee to the knee pad by attaching the bands to the Velcro strip 74.
• the two bands are attached to the knee so that the patient's kneecap is between the bands so that no pressure is exerted on them when the leg is extended becomes 7 shows the overall view of a second exemplary embodiment of an active standing table in a horizontal position.
• the basic structure is identical to the first exemplary embodiment.
• the patient's legs are not driven by linear drives but by a cable 80 from an eccentric drive 81, which is shown in more detail in FIG. 8.
• a knee part 82 and a foot part 83 can be moved on the rails 15a and 15b and thus adapted to the patient's leg length
• FIG. 8A shows the knee mechanism for FIG. 7 in perspective. It consists of the eccentric drive 81, ropes 80a and 80b (nylon ropes), and the knee part 82.
• a gear 91 is attached to a motor 90.
• This drives an eccentric disk 92, in which a pin 94 is inserted If the eccentric disc 92 now rotates, the pin 94 moves on a circular path.
• This circular movement causes a slide 95, in which the pin 94 is guided, to move back and forth, the slide in turn being guided in guide rails 96 and 97
• the movement of the carriage 95 causes a tensile force on one of the ropes 80a and 80b, respectively.
• the ropes are guided over rollers 98a, 98b, 99a, 99b, 100a and 100b (not shown) and then each pull over a hook 101a or 101b on the knee cuffs the patient's knees into an extension
• Plastic-covered foam pads 102a and 102b protect the back of the patient's knees from injury in the extension and push the knees back in the direction of flexion when the ropes 80a and 80b are relieved.
• the pads are located on a plate 108 which has guide tubes 109a and 109b on each side with locking screws 1 10a and 1 10b
• a tensioning device 103a or 103b is attached to each of the ropes 80a and 80b, with which the ropes can be adjusted in length. This allows the pull on the hooks 101a and 101b to be adjusted so that the patient's knees are moved by the movement of the Eccentric disc 92 can be stretched into an extension
• Velcro straps can be used as knee cuffs, with which the patient's knees can be attached to the hooks 101 a and 101 b, similar to that described in FIG. 6 Fig. 8B shows the eccentric drive to Fig. 7 in supervision.
• the motor 90 with the gear 91 can be seen, on which the eccentric disk 92 is located.
• Various holes 93 are provided in this so that the pin 94 can be inserted into the eccentric disk 92 on different radii Stroke length of the knee movement can be adjusted to different sizes by the different positions of the pin 94 in the holes 93.
• Rollers 104 to 107 are attached to the slide 95, which support the plate in the guide rails 96 and 97.
• control unit In contrast to the first exemplary embodiment, a much simpler control unit is required here, since the motor can simply rotate and the extension or flexion of the leg results automatically.
• the control unit only controls the speed of the motor 90 and thus determines the frequency of the movement on the patient's leg In the first exemplary embodiment, the control unit must always switch the drives from an upward movement to a downward movement and vice versa when the end positions are reached
• Fig. 9 shows the foot mechanism 83 to Fig. 7 in a perspective view.
• a square tube 121 a and 121 b is firmly connected to it. These serve as a guide for the foot mechanism on the rails attached to the leg part Therapy to be screwed in the correct place with the fixing screws 122a and 122b.
• a bracket 123 is attached to the plate 120, at the upper end of which a second bracket 124 is attached.
• On both sides of the bracket 124 there is a footplate 125a and 125b, respectively, which are located can be rotated around a bearing at the attachment point on the carrier 124.
• a lever 126a and 126b are attached to each of the foot plates, which are connected to one another via a steel cable 127.
• This steel cable 127 runs over a roller 128 and serves as a reciprocation mechanism if a foot plate follows printed below, the other moves up under footplates 125a and 125b there is a spring 129a or 129b, which is tensioned on a plate 130a or 130b. If one of the foot plates is pressed down from the patient's leg (extension), the other leg is automatically bent by the reciprocation mechanism straight leg a weight on the patient's sole (afferenter Input)
• the patient's leg can be fixed with a cuff 1 31 a or 1 31 b, which are connected to the foot plate 125a or 125b via a connecting part 132a or 132b. This stabilizes the side so that it does not tip to the side when bent.
• a heel holder 133a or 133b protects the patient's foot from sliding off the footplate 125a or 125b
• the active standing table With the active standing table according to the invention, it is possible to control the movement sequence of all joint planes (hips, knees, feet) of the patient's lower extremities in a physiological pattern (kinematics and kinetics) that is as similar as possible to walking.
• the most important movement sizes for successful localization therapy are the hip joint extension and the weight load of the sole of the foot during the extension phase of the leg. Both parameters can be individually adjusted to the needs of the patient with the active standing table described here
• the active standing table can be adapted to the individual size differences of the patients

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• Health & Medical Sciences (AREA)
• Animal Behavior & Ethology (AREA)
• Pain & Pain Management (AREA)
• Physical Education & Sports Medicine (AREA)
• Rehabilitation Therapy (AREA)
• Life Sciences & Earth Sciences (AREA)
• Epidemiology (AREA)
• General Health & Medical Sciences (AREA)
• Public Health (AREA)
• Veterinary Medicine (AREA)
• Orthopedic Medicine & Surgery (AREA)
• Orthopedics, Nursing, And Contraception (AREA)
• Rehabilitation Tools (AREA)
• Massaging Devices (AREA)

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• 2000
  • 2000-04-07 AT AT00914001T patent/ATE262878T1/de not_active IP Right Cessation
  • 2000-04-07 EP EP00914001A patent/EP1169003B1/fr not_active Expired - Lifetime
  • 2000-04-07 WO PCT/CH2000/000203 patent/WO2000061059A1/fr active IP Right Grant
  • 2000-04-07 DE DE50005903T patent/DE50005903D1/de not_active Expired - Lifetime
  • 2000-04-07 US US09/958,034 patent/US6685658B1/en not_active Expired - Lifetime
  • 2000-04-07 CA CA002369226A patent/CA2369226C/fr not_active Expired - Lifetime

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