EP3325113A1 - Vorrichtung zur steuerung der physikalischen widerstandskraft eines patienten und anordnung für körperliche rehabilitation mit solch einer vorrichtung - Google Patents

Vorrichtung zur steuerung der physikalischen widerstandskraft eines patienten und anordnung für körperliche rehabilitation mit solch einer vorrichtung

Info

Publication number
EP3325113A1
EP3325113A1 EP16750404.2A EP16750404A EP3325113A1 EP 3325113 A1 EP3325113 A1 EP 3325113A1 EP 16750404 A EP16750404 A EP 16750404A EP 3325113 A1 EP3325113 A1 EP 3325113A1
Authority
EP
European Patent Office
Prior art keywords
patient
axis
rotation
intensity
sensor
Prior art date
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.)
Granted
Application number
EP16750404.2A
Other languages
English (en)
French (fr)
Other versions
EP3325113B1 (de
Inventor
Gianfranco Tudico
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Louisin Research And Development Ltd
Original Assignee
Louisin Research And Development Ltd
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by Louisin Research And Development Ltd filed Critical Louisin Research And Development Ltd
Publication of EP3325113A1 publication Critical patent/EP3325113A1/de
Application granted granted Critical
Publication of EP3325113B1 publication Critical patent/EP3325113B1/de
Active legal-status Critical Current
Anticipated expiration legal-status Critical

Links

Classifications

    • AHUMAN NECESSITIES
    • A63SPORTS; GAMES; AMUSEMENTS
    • A63BAPPARATUS FOR PHYSICAL TRAINING, GYMNASTICS, SWIMMING, CLIMBING, OR FENCING; BALL GAMES; TRAINING EQUIPMENT
    • A63B24/00Electric or electronic controls for exercising apparatus of preceding groups; Controlling or monitoring of exercises, sportive games, training or athletic performances
    • A63B24/0087Electric or electronic controls for exercising apparatus of groups A63B21/00 - A63B23/00, e.g. controlling load
    • AHUMAN NECESSITIES
    • A63SPORTS; GAMES; AMUSEMENTS
    • A63BAPPARATUS FOR PHYSICAL TRAINING, GYMNASTICS, SWIMMING, CLIMBING, OR FENCING; BALL GAMES; TRAINING EQUIPMENT
    • A63B21/00Exercising apparatus for developing or strengthening the muscles or joints of the body by working against a counterforce, with or without measuring devices
    • A63B21/02Exercising apparatus for developing or strengthening the muscles or joints of the body by working against a counterforce, with or without measuring devices using resilient force-resisters
    • A63B21/04Exercising apparatus for developing or strengthening the muscles or joints of the body by working against a counterforce, with or without measuring devices using resilient force-resisters attached to static foundation, e.g. a user
    • A63B21/0407Anchored at two end points, e.g. installed within an apparatus
    • A63B21/0435One or both ends being anchored to a rotating element
    • AHUMAN NECESSITIES
    • A63SPORTS; GAMES; AMUSEMENTS
    • A63BAPPARATUS FOR PHYSICAL TRAINING, GYMNASTICS, SWIMMING, CLIMBING, OR FENCING; BALL GAMES; TRAINING EQUIPMENT
    • A63B21/00Exercising apparatus for developing or strengthening the muscles or joints of the body by working against a counterforce, with or without measuring devices
    • A63B21/02Exercising apparatus for developing or strengthening the muscles or joints of the body by working against a counterforce, with or without measuring devices using resilient force-resisters
    • A63B21/04Exercising apparatus for developing or strengthening the muscles or joints of the body by working against a counterforce, with or without measuring devices using resilient force-resisters attached to static foundation, e.g. a user
    • A63B21/0442Anchored at one end only, the other end being manipulated by the user
    • AHUMAN NECESSITIES
    • A63SPORTS; GAMES; AMUSEMENTS
    • A63BAPPARATUS FOR PHYSICAL TRAINING, GYMNASTICS, SWIMMING, CLIMBING, OR FENCING; BALL GAMES; TRAINING EQUIPMENT
    • A63B21/00Exercising apparatus for developing or strengthening the muscles or joints of the body by working against a counterforce, with or without measuring devices
    • A63B21/02Exercising apparatus for developing or strengthening the muscles or joints of the body by working against a counterforce, with or without measuring devices using resilient force-resisters
    • A63B21/055Exercising apparatus for developing or strengthening the muscles or joints of the body by working against a counterforce, with or without measuring devices using resilient force-resisters extension element type
    • A63B21/0552Elastic ropes or bands
    • AHUMAN NECESSITIES
    • A63SPORTS; GAMES; AMUSEMENTS
    • A63BAPPARATUS FOR PHYSICAL TRAINING, GYMNASTICS, SWIMMING, CLIMBING, OR FENCING; BALL GAMES; TRAINING EQUIPMENT
    • A63B24/00Electric or electronic controls for exercising apparatus of preceding groups; Controlling or monitoring of exercises, sportive games, training or athletic performances
    • A63B24/0003Analysing the course of a movement or motion sequences during an exercise or trainings sequence, e.g. swing for golf or tennis
    • AHUMAN NECESSITIES
    • A63SPORTS; GAMES; AMUSEMENTS
    • A63BAPPARATUS FOR PHYSICAL TRAINING, GYMNASTICS, SWIMMING, CLIMBING, OR FENCING; BALL GAMES; TRAINING EQUIPMENT
    • A63B24/00Electric or electronic controls for exercising apparatus of preceding groups; Controlling or monitoring of exercises, sportive games, training or athletic performances
    • A63B24/0003Analysing the course of a movement or motion sequences during an exercise or trainings sequence, e.g. swing for golf or tennis
    • A63B24/0006Computerised comparison for qualitative assessment of motion sequences or the course of a movement
    • AHUMAN NECESSITIES
    • A63SPORTS; GAMES; AMUSEMENTS
    • A63BAPPARATUS FOR PHYSICAL TRAINING, GYMNASTICS, SWIMMING, CLIMBING, OR FENCING; BALL GAMES; TRAINING EQUIPMENT
    • A63B24/00Electric or electronic controls for exercising apparatus of preceding groups; Controlling or monitoring of exercises, sportive games, training or athletic performances
    • A63B24/0062Monitoring athletic performances, e.g. for determining the work of a user on an exercise apparatus, the completed jogging or cycling distance
    • AHUMAN NECESSITIES
    • A63SPORTS; GAMES; AMUSEMENTS
    • A63BAPPARATUS FOR PHYSICAL TRAINING, GYMNASTICS, SWIMMING, CLIMBING, OR FENCING; BALL GAMES; TRAINING EQUIPMENT
    • A63B71/00Games or sports accessories not covered in groups A63B1/00 - A63B69/00
    • A63B71/06Indicating or scoring devices for games or players, or for other sports activities
    • A63B71/0619Displays, user interfaces and indicating devices, specially adapted for sport equipment, e.g. display mounted on treadmills
    • AHUMAN NECESSITIES
    • A63SPORTS; GAMES; AMUSEMENTS
    • A63BAPPARATUS FOR PHYSICAL TRAINING, GYMNASTICS, SWIMMING, CLIMBING, OR FENCING; BALL GAMES; TRAINING EQUIPMENT
    • A63B24/00Electric or electronic controls for exercising apparatus of preceding groups; Controlling or monitoring of exercises, sportive games, training or athletic performances
    • A63B24/0003Analysing the course of a movement or motion sequences during an exercise or trainings sequence, e.g. swing for golf or tennis
    • A63B24/0006Computerised comparison for qualitative assessment of motion sequences or the course of a movement
    • A63B2024/0012Comparing movements or motion sequences with a registered reference
    • AHUMAN NECESSITIES
    • A63SPORTS; GAMES; AMUSEMENTS
    • A63BAPPARATUS FOR PHYSICAL TRAINING, GYMNASTICS, SWIMMING, CLIMBING, OR FENCING; BALL GAMES; TRAINING EQUIPMENT
    • A63B24/00Electric or electronic controls for exercising apparatus of preceding groups; Controlling or monitoring of exercises, sportive games, training or athletic performances
    • A63B24/0062Monitoring athletic performances, e.g. for determining the work of a user on an exercise apparatus, the completed jogging or cycling distance
    • A63B2024/0068Comparison to target or threshold, previous performance or not real time comparison to other individuals
    • AHUMAN NECESSITIES
    • A63SPORTS; GAMES; AMUSEMENTS
    • A63BAPPARATUS FOR PHYSICAL TRAINING, GYMNASTICS, SWIMMING, CLIMBING, OR FENCING; BALL GAMES; TRAINING EQUIPMENT
    • A63B24/00Electric or electronic controls for exercising apparatus of preceding groups; Controlling or monitoring of exercises, sportive games, training or athletic performances
    • A63B24/0075Means for generating exercise programs or schemes, e.g. computerized virtual trainer, e.g. using expert databases
    • A63B2024/0078Exercise efforts programmed as a function of time
    • AHUMAN NECESSITIES
    • A63SPORTS; GAMES; AMUSEMENTS
    • A63BAPPARATUS FOR PHYSICAL TRAINING, GYMNASTICS, SWIMMING, CLIMBING, OR FENCING; BALL GAMES; TRAINING EQUIPMENT
    • A63B2220/00Measuring of physical parameters relating to sporting activity
    • A63B2220/10Positions
    • A63B2220/16Angular positions
    • AHUMAN NECESSITIES
    • A63SPORTS; GAMES; AMUSEMENTS
    • A63BAPPARATUS FOR PHYSICAL TRAINING, GYMNASTICS, SWIMMING, CLIMBING, OR FENCING; BALL GAMES; TRAINING EQUIPMENT
    • A63B2220/00Measuring of physical parameters relating to sporting activity
    • A63B2220/50Force related parameters
    • A63B2220/51Force
    • AHUMAN NECESSITIES
    • A63SPORTS; GAMES; AMUSEMENTS
    • A63BAPPARATUS FOR PHYSICAL TRAINING, GYMNASTICS, SWIMMING, CLIMBING, OR FENCING; BALL GAMES; TRAINING EQUIPMENT
    • A63B2220/00Measuring of physical parameters relating to sporting activity
    • A63B2220/50Force related parameters
    • A63B2220/58Measurement of force related parameters by electric or magnetic means

Definitions

  • Device for controlling the physical resistance forces produced by a patient as well as a physical rehabilitation unit comprising such a device
  • the present invention relates to a device for controlling the physical resistance forces produced by a patient.
  • the invention also relates to a set of physical rehabilitation of a patient, comprising such a control device.
  • small elastic accessories are commonly used, such as bands commonly called Sandows (registered trademark) or spring cages. These accessories allow to work a patient, sitting or standing, in progressive resistance: to do this, the patient puts the accessory in tension and then maintains this tension without loosening for a given duration, all under the supervision of a therapist which controls that the posture of the patient is correct and that the intensity and direction of the resistance efforts produced by the patient are those expected for the exercise requested.
  • This technique allows both to remuster and perform proprioceptive work.
  • it requires only a small financial investment and equipment insofar as the aforementioned elastic accessories are inexpensive and take up almost no space.
  • the exercises performed by the patient must be visually controlled by the therapist, so that the patient can not use these accessories independently .
  • Isokinetic machines are also known which are generally used for the rehabilitation of athletes.
  • the associated isokinetic method consists in making the patient work in resistance against constant velocity movements, the resistance exerted by the isokinetic machine being self-adapted to the effort developed by the patient. This method makes it possible to obtain, thanks to the self-adapted resistance that the machine regulates, a maximum muscular contraction, at a constant speed, on the total amplitude of a movement.
  • isokinetic machines are cumbersome and very expensive, often only allowing to work the lower limbs of the patient because the latter is usually sitting on an instrumented seat of the machine.
  • the object of the present invention is to provide effective means of physical rehabilitation of a patient, which, while allowing their implementation by the patient in an autonomous manner, are easy and safe to use.
  • the subject of the invention is a device for controlling the physical resistance forces produced by a patient, as defined in claim 1.
  • the invention also relates to a set of physical rehabilitation of a patient, as defined in claim 10.
  • the control device is simple to install and use, in order to help a therapist to perform rehabilitation of the lower limbs as well as the upper limbs of the patient, with a patient's work, regardless of whether he is sitting or standing, in progressive resistance which is controlled and, advantageously, compared to a prefixed instruction.
  • the concept of "physical effort control" also covers the measurement and / or evaluation of these efforts.
  • the patient can perform a work in motion, which is both small and large amplitude and that in all directions of space, while, simultaneously, the efforts produced by the patient are applied to a freely rotating member of the control device: by means of this freely rotatable member which, by definition, opposes to the forces produced by the patient no additional resistance than that resulting from the frame, are measured, on the one hand, the traction component of the forces applied to this body by the patient, thanks to a force sensor, and, secondly, the angular positioning of these forces around the axis of rotation of this body, thanks to a sensor of angle.
  • the measurements of the force sensor and the angle sensor are advantageously processed to check that the forces developed by the patient correspond to pre-programmed intensity and positioning instructions of the therapist, in particular by real-time feedback to the patient. patient, typically via a control display, so that the device and the assembly according to the invention can be used by the patient autonomously and safely. Thanks to the invention, the therapist widens his therapeutic range and diversifies the exercises proposed to the patients while keeping for these exercises the same freedom in the space.
  • the device and the assembly according to the invention adapt to all situations and allow to work all the muscle groups and all the joints of patients.
  • FIG. 1 is an elevational view of a rehabilitation system according to the invention
  • FIG. 2 is a diagrammatic section along line II-II of FIG. 1, showing on a larger scale a control device according to the invention belonging to the assembly of FIG. 1;
  • FIG. 3 is a diagrammatic section along line III-III of FIG. 2;
  • FIG. 4 is a schematic section along line IV-IV of Figure 1, illustrating different configurations of use of the rehabilitation package.
  • FIG. 1 to 4 a set 1 physical rehabilitation of a patient.
  • the rehabilitation unit 1 comprises a staircase 2, which is fixed to a wall or the like, and elastic bands to be tensioned by the patient, these bands being commonly called Sandows.
  • Each of these elastic bands is provided, at one of its opposite longitudinal ends, to cooperate with the control device 10, as will be detailed later, while at its other end, each elastic band is designed to be held by the patient and / or attached to this patient, for example held by hand or attached to the wrist or the ankle of the patient.
  • the arrangements of connection between the elastic bands and the body of the patient are known as such, they will not be described here further, these arrangements not being limiting of the invention.
  • the elastic bands of the rehabilitation unit 1 there is a pair of elastic bands 3 which are represented in solid lines in FIGS. 1 and 4: these strips 3, which can be described respectively as left and right, are intended to be respectively connected to the two halves of the body of the patient, for example to his left arm and his right arm. Also among the elastic bands of the rehabilitation unit 1, there is a pair of long strips 4, these two long strips 4 being able, for the same reasons as those developed above for the short strips 3, to be respectively qualified as left-hand and right.
  • the patient is likely to put in tension either the short left band 3 or the long left band 4. It is the same for the straight strips, respectively short 3 and long 4, being noted that the patient is of course likely to simultaneously tension one of the left elastic bands, namely the short 3 or the long 4, and one of the straight elastic bands, namely the short 3 4.
  • the elastic band (s) effectively used in the rehabilitation assembly 1 depend on the muscle groups and the joints of the patient that are to be made to work, as well as the posture of the patient during the treatment. exercise, being noticed that the patient can stand indifferently sitting or standing up.
  • the rehabilitation unit 1 also comprises pulleys 5 which are respectively arranged in the upper right dial, the lower right dial, the lower left dial and the upper left dial of the espalier. 2, being restrained to the latter by any appropriate means, such as straps.
  • Each of these pulleys 5 makes it possible to return one of the long elastic bands 4 during the tensioning of the latter, that is, to bend the direction in which this long strip extends: as shown schematically on 1 and 4, the pulleys 5 pass the long strips 4 of a substantially vertical orientation for their part extending between the control device 10 and the pulleys, at an inclined orientation with respect to the vertical for the part of these strips 4 extending between the pulleys 5 and the patient.
  • the device 10 comprises a frame 12 which, in use, is attached to the espalier 2, in particular to an intermediate horizontal bar of this espalier.
  • the embodiment of the attachment between the frame 12 and the espalier 2 is not limiting, any mechanical fixing system, possibly adjustable, being appropriate, being noted that, advantageously, a removable system is preferred for, if need, release the device 10 vis-à-vis the espalier 2, typically for storage purposes of this device or when it is desired to use the espalier 2 of independently.
  • the frame 12 is designed to be fixed not exclusively to a espalier, but, more generally, to any immovable structural element, for example directly to a wall.
  • the frame 12 includes a tubular body 14, centered on a geometric axis X-X and with a circular base.
  • the X-X axis preferably extends horizontally, it being understood that this axis X-X is fixed relative to the frame 12.
  • the body 14 movably carries a tubular member 16 coaxial with the axis X-X.
  • the two members 16 are arranged, in the direction of the axis XX, on either side of the frame 12.
  • Each of the members 16 is mounted for free rotation around the outside.
  • XX axis on the corresponding end of the body 14 of the frame 12, through a bearing 18.
  • each bearing 18 integrates a stop system 20, known per se, which limits the rotational stroke around the axis XX of the corresponding member 16 towards the body 14 by approximately one turn, being reminded that over this entire stroke, the rotation relative between the member 16 and the body 14 is free, that is to say non-slaved kinematically.
  • each member 16 is provided with a fastener 22 making it possible to attach one of the elastic bands 3 and 4 to it indifferently.
  • the fastener 22 comprises an eyelet inside which is threaded the band 3 or 4 and fixed to the corresponding member 16.
  • the fastener 22 is secured to the rest of the member 16 so as to be at least linked in rotation to this member 16 about the axis XX: it is understood that, in use, when the elastic band 3 or 4, attached to the member 16 by the corresponding fastener 22, is tensioned by the patient , the efforts F produced by this patient, in particular these efforts of resistance to maintain the elastic band in tension, are applied to the member 16 and thus impose on the latter its angular positioning around the axis XX.
  • the device 10 further comprises, for each member 16, a force sensor 24 which, in the embodiment considered here, is advantageously integrated inside the tubular wall of the member 16.
  • the force sensor 24 includes one or more strain gauges, which are interposed between the corresponding fastener 22 and the rest of the member 16. Regardless of its embodiment, the force sensor 24 is sensitive to mechanical stresses applied to the member 16 in a direction radial to the axis XX, so that, within the device 10, each force sensor 24 makes it possible to measure, in a direction radial to the axis XX, the component of traction of the forces F applied by the patient to the corresponding organ 16.
  • each angle sensor 26 is a magnetoresistive sensor, including, on the one hand, a fixed portion 26A, which is fixedly connected to the 12, in this case via a bracket 28 for supporting the fixed portion 26A of the angle sensor 26, fixedly integrated inside the tubular body 14, and, secondly, a part mobile 26B, which is rotatably connected to the member 16 about the axis XX, being advantageously integrated inside the tubular wall of this member 16.
  • the measurements respectively provided by the force sensor 24 and by the angle sensor 26 make it possible to control the physical resistance forces F produced by the patient in order to put and maintain in tension the elastic band 3 or 4 used, without this body 16 opposes its own resistance: the measurement provided by the force sensor 24 allows to know the intensity of the forces F, more precisely the intensity of the tensile component of these efforts F, to which is sensitive the force sensor 24, and the measurement provided by the angle sensor 26 allows to know the spatial orientation, about the axis XX, of the elastic band used 3 or 4, more precisely the angular position of the member 16 around the axis XX imposed by the portion of this band, attached to the fastener 22.
  • this unit 30 includes, on the one hand, electronic means 32 for processing the aforementioned signals, including, for example, a microprocessor and a computer memory, and, secondly, a screen 34 for displaying the output of the processing means 32.
  • the processing means 32 and the display screen 34 operate in real time that the patient has, by observing the screen 34, an immediate feedback, the processing time and display near, on the resistance F forces that it produces, as well as on the angular position where the exercise was performed.
  • the processing means 32 are designed to follow over the duration of a physical exercise the measurements respectively provided by the force sensor 24 and the angle sensor 26 associated with each member 16.
  • the means processing 32 are then provided to determine the variation, as a function of time, of both the intensity of the tensile component of the forces F applied to the member 16 and the angular position of this member around the axis XX: the variation of this intensity and the variation of this angular position are advantageously displayed on the screen 34 as the physical exercise unfolds, for example in the form of curves or other graphic forms.
  • This feedback can also be accompanied by sound effects.
  • the processing means 32 are advantageously designed to both memorize an instruction, typically pre-recorded by a therapist, and to compare this instruction with at least one characteristic of the variation of the intensity of the instruction.
  • the result of this comparison is either made available in real time to the patient via the display screen 34 , either memorized for subsequent analysis by the therapist, these two alternatives can of course be cumulated.
  • this provision allows the therapist to set physical rehabilitation instructions to the patient before the beginning of a rehabilitation exercise, so that during this exercise, the patient can be controlled, in real time by himself and / or delayed by the therapist, as for the respect of these instructions of reeducation.
  • the characteristic or characteristics of the variation of the intensity of the tensile component of the forces F, which are compared by the processing means 32 to pre-recorded instructions, are advantageously chosen from: - the maximum value of this intensity,
  • the characteristic or characteristics of the variation of the angular position of each member 16, which are compared by the processing means 32 to pre-recorded instructions, are advantageously chosen from:
  • the therapist sets the instructions stored by the device 10 so that:
  • the member 16 attached to the band 3 is to be oriented angularly so that the strip extends horizontally away from it at the most that between the two orientations drawn in dashed lines in Figure 4, and
  • the band 3 is to be tensioned ten times, each time from a substantially zero voltage to a voltage of intensity equivalent to 10 kg + 1 kg, the band 3 being maintained, each time, at rest and under full voltage for ten seconds, while passing each time between rest and full voltage in less than two seconds.
  • the device 10 and the rehabilitation package 1 allow to perform a variety of physical exercises, in this case amplitude gain exercises, evaluation of the maximum strength of a limb at the beginning and end of rehabilitation, specific muscle strengthening, both analytical and global , both in load and in discharge, and in the muscular chain, until the proprioceptive work and the reproduction of sports gestures, against resistance opposed by the bands 3 and 4.

Landscapes

  • Health & Medical Sciences (AREA)
  • General Health & Medical Sciences (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biophysics (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Human Computer Interaction (AREA)
  • Rehabilitation Tools (AREA)
EP16750404.2A 2015-07-23 2016-07-22 Vorrichtung zur steuerung der physikalischen widerstandskraft eines patienten und anordnung für körperliche rehabilitation mit solch einer vorrichtung Active EP3325113B1 (de)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
FR1556987A FR3039075A1 (fr) 2015-07-23 2015-07-23 Dispositif de controle des efforts physiques de resistance produits par un patient, ainsi qu'ensemble de reeducation physique comprenant un tel dispositif
PCT/EP2016/067517 WO2017013243A1 (fr) 2015-07-23 2016-07-22 Dispositif de contrôle des efforts physiques de résistance produits par un patient, ainsi qu'ensemble de rééducation physique comprenant un tel dispositif

Publications (2)

Publication Number Publication Date
EP3325113A1 true EP3325113A1 (de) 2018-05-30
EP3325113B1 EP3325113B1 (de) 2019-04-24

Family

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Family Applications (1)

Application Number Title Priority Date Filing Date
EP16750404.2A Active EP3325113B1 (de) 2015-07-23 2016-07-22 Vorrichtung zur steuerung der physikalischen widerstandskraft eines patienten und anordnung für körperliche rehabilitation mit solch einer vorrichtung

Country Status (6)

Country Link
US (1) US10874904B2 (de)
EP (1) EP3325113B1 (de)
ES (1) ES2727750T3 (de)
FR (1) FR3039075A1 (de)
PT (1) PT3325113T (de)
WO (1) WO2017013243A1 (de)

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Also Published As

Publication number Publication date
FR3039075A1 (fr) 2017-01-27
US20180207486A1 (en) 2018-07-26
US10874904B2 (en) 2020-12-29
EP3325113B1 (de) 2019-04-24
WO2017013243A1 (fr) 2017-01-26
PT3325113T (pt) 2019-06-28
ES2727750T3 (es) 2019-10-18

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