JP3762996B2 - Muscle defense pseudo-presentation device - Google Patents

Muscle defense pseudo-presentation device Download PDF

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JP3762996B2
JP3762996B2 JP2003270605A JP2003270605A JP3762996B2 JP 3762996 B2 JP3762996 B2 JP 3762996B2 JP 2003270605 A JP2003270605 A JP 2003270605A JP 2003270605 A JP2003270605 A JP 2003270605A JP 3762996 B2 JP3762996 B2 JP 3762996B2
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elastic body
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優三 高橋
康之 鈴木
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Gifu University
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本発明は、筋性防御擬似提示装置に関するものであり、特に、診断の際に腹膜炎の患者の腹部を触れることによって腹筋が硬直化する筋性防護を医学部の学生などに擬似的、及び仮想的に提示することが可能な筋性防御擬似提示装置に関するものである。   The present invention relates to a muscular defense pseudo-presentation device, and in particular, to a muscular protection that abdominal muscles become stiff by touching the abdomen of a patient with peritonitis at the time of diagnosis to a medical student or the like. The present invention relates to a muscular defense pseudo-presentation device that can be presented to the user.

従来から、医師などの医療従事者を養成する医学部などの医学教育機関では、学習者（医学生）に対して、医学に係る専門的な知識の教授を行う講義の他に、実験及び実習などの教育が行われている。例えば、実際の診療現場において、患者に対して適切な対応をし、速やかに診断をすることを学ぶために、診断技術及び患者とのコミュニケーション能力の向上を目的とした実践的な実技指導が行われている。また、係る一例について説明すると、例えば、実際の患者を相手に学習者が診断を行うようにする教育なども行われている。   Traditionally, in medical educational institutions such as medical departments that train medical personnel such as doctors, in addition to lectures that teach learners (medical students) specialized medical knowledge, experiments and practical training Education is being conducted. For example, in practical practice, practical practical guidance is provided to improve diagnostic skills and the ability to communicate with patients in order to learn to respond appropriately to patients and make quick diagnoses. It has been broken. Further, an example of such a case will be described. For example, education for allowing a learner to make a diagnosis with an actual patient is also performed.

上記の従来技術は、当業者として当然として行われているものであり、出願人はこの従来技術が記載された文献等を本願出願時における現段階では特に知見するものではない。   The above-described prior art is naturally performed by those skilled in the art, and the applicant is not particularly aware of the literature describing the prior art at the present stage at the time of filing the present application.

しかしながら、上述の医学部などで行われる実践的な技能及び診断技術等の向上を図ることを目的とした医学教育は、次のような課題が生じることがあった。すなわち、上述の患者を相手にした授業では、一人の医学生が実習可能な時間は、非常に限られており、十分な教育が行われない場合もあった。また、実際に大学病院などの医療機関に診察に訪れた患者を相手にして実習することは、プライバシーなどの問題があり、また、特に緊急に処置を要する症状を訴える患者に対しては、学習者に指導を行っているような時間的余裕がないため、多くの医学生は、医師として実際の診療現場（医療機関）等に勤務するようになってから初めて上述の症状の診断を体験することがあった。そのため、予め症状を体験することができないことにより、初めての場合は戸惑いや不安を感じる医師が多かった。   However, medical education aimed at improving practical skills and diagnostic techniques performed in the above-mentioned medical departments and the like sometimes has the following problems. That is, in the class for the above-mentioned patients, the time during which one medical student can practice is very limited, and sufficient education may not be performed. In addition, it is important to practice with patients who have visited a medical institution such as a university hospital for problems such as privacy, especially for patients who complain of urgent symptoms. Because there is not enough time to give guidance to the elderly, many medical students experience the diagnosis of the above symptoms for the first time after starting to work at the actual medical treatment site (medical institution) etc. as a doctor There was a thing. Therefore, many doctors feel embarrassed and anxious in the first time because they cannot experience symptoms in advance.

ところで、胃潰瘍や急性虫垂炎などによって腹膜炎を起こしている可能性の高い患者の場合、激痛を訴え、苦しんでいる患者の腹部を医師が圧迫触診することにより、腹部近傍の腹筋が急激に硬直化する所謂「筋性防御」が起きることが知られている。これにより、医師は腹膜炎を的確に診断することができた。しかしながら、係る筋性防御が上述した医師によって確認されると、直ぐに腹膜炎と診断され、激痛を訴える患者に対して速やかにその後の適切な処置（例えば、開腹手術など）を執る必要があった。そのため、腹膜炎による筋性防御を実際に触診し、腹筋の硬直を触診指で感じることができる人物は、診断を行った医師に限定されることとなり、医学生などの学習者が係る筋性防御を実習中に体験する機会はほとんどなかった。そのため、実際に診療現場で初めて体験する医師は、乏しい経験や知識に基づいて診断をせざるをえなかった。さらに、初めて筋性防御を触診指によって体感した場合でも、自らの診断に不安を感じ、速やかな対処及び処置を講じることができないおそれもあった。   By the way, in the case of a patient who is likely to have peritonitis due to gastric ulcer or acute appendicitis, the abdominal muscles in the vicinity of the abdomen suddenly stiffen by complaining of severe pain and the doctor pressing and palpating the suffering patient's abdomen It is known that so-called “muscular defense” occurs. This allowed doctors to accurately diagnose peritonitis. However, when such a muscular defense is confirmed by the above-mentioned doctor, it is necessary to immediately perform appropriate subsequent treatment (for example, laparotomy) on a patient who is diagnosed with peritonitis and complains of severe pain. Therefore, the person who can actually feel the muscular defense due to peritonitis and feel the stiffness of the abdominal muscles with the palpation finger is limited to the doctor who made the diagnosis, and the muscular defense that learners such as medical students are concerned with There was almost no opportunity to experience during training. Therefore, doctors who actually experience for the first time in the clinic had to make a diagnosis based on their lack of experience and knowledge. Furthermore, even when muscular defense was first experienced with a palpation finger, there was a fear that the patient felt uneasy about his diagnosis and could not take prompt measures and measures.

その結果、腹膜炎によって筋性防御を疑似的に提示し、体験可能とする医学教育用の装置（筋性防御擬似提示装置）を必要と感じる医学教育関係者（例えば、医学部の教授など）が多く存在し、係る装置の開発を望む声が多かった。   As a result, many medical education personnel (for example, professors at the medical school) feel that they need a device for medical education (muscle defense pseudo-presentation device) that can present and experience muscular defense in a pseudo manner by peritonitis. There were many who wanted to develop such devices.

そこで、本発明は、上記実情に鑑み、医学生などの診断に係る経験及び技術に乏しい人物を主な対象とし、腹膜炎によって腹筋に起きる筋性防御を疑似的に提示することが可能な筋性防御擬似提示装置の提供を課題とするものである。   Therefore, in view of the above circumstances, the present invention is mainly intended for medical students and other persons with poor experience and skills, and is capable of presenting muscular defenses that occur in the abdominal muscles due to peritonitis in a pseudo manner. It is an object of the present invention to provide a defense pseudo presentation device.

上記の課題を解決するため、本発明にかかる筋性防御疑似提示装置は、「人体を模して形成され、前記人体の腹部に相当する箇所が人工皮膚によって被覆された人体モデルと、前記人体モデルの腹部の内部に形成された腹空間に前記人工皮膚と略当接した状態で配設され、前記人体の腹筋の収縮及び伸長動作を擬似的に提示する弾性変形可能な素材で形成された腹筋弾性体と、前記腹筋弾性体に所定の張力を加えた状態で支持する弾性体支持部と、前記人工皮膚の上方から体験者によって圧迫触診の手技が模擬的に行われたとき、腹膜炎の患者に確認される前記腹筋の筋性防御を、前記体験者の触診指に疑似的に提示する筋性防御提示部とを具備し、前記弾性体支持部は、前記人体モデルの腹部の上腹部及び下腹部に合わせて略円弧状に曲折して形成された円弧部を有し、該円弧部の内円弧側を互いに対向させた状態で前記人体モデルの腹空間に配された一対の棒状支持体を具備しており、前記腹筋弾性体は、前記一対の棒状支持体の間に架渡して支持されており、前記筋性防御提示部は、前記一対の棒状支持体の間に架渡して支持された腹筋弾性体に対し、前記円弧部の法線方向に調整しながら張力を加えることにより前記腹筋の筋性防御を提示する」ものから主に構成されている。 In order to solve the above problems, a muscular defense pseudo presenting device according to the present invention is described as follows: “A human body model imitating a human body and a portion corresponding to the abdomen of the human body covered with artificial skin; and the human body wherein the formed inside abdominal space belly portion of the model is provided with an artificial skin and a substantially abutting state was formed of an elastically deformable material which presents a contraction and expansion operation of the human body abdominal artificially An abdominal muscle elastic body, an elastic body support portion that supports the abdominal muscle elastic body in a state where a predetermined tension is applied , and a peritonitis when a pressure palpation technique is simulated by an experienced person from above the artificial skin. A muscular defense presentation unit that pseudo-presents the muscular defense of the abdominal muscles confirmed by the patient on the palpation finger of the experience person, and the elastic body support unit is provided on the abdomen of the human body model. Bend into a generally arc shape to fit the abdomen and lower abdomen A pair of rod-shaped supports disposed in the abdominal space of the human body model with the inner arc sides of the arc portions facing each other, and the abdominal muscle elastic body includes: The muscular defense presentation unit is supported across the pair of rod-shaped support members, and the arcuate portion of the muscle defense presentation unit is supported with respect to the abdominal elastic body supported between the pair of rod-shaped support members. of was adjusted to a normal direction to present a muscle guarding of the abdominal muscles by applying tension while "is mainly configured from the.

ここで、人体モデルは、人体を立体的に模型として形成されたものが利用され、各部がほぼ実寸大のサイズであることが、学習者の視覚的イメージを高めるために望ましい。そして、特に腹部に相当する箇所に、体験者が違和感を感じないようにするために実際の皮膚と色、質感、及び触感などを略同一とした人工皮膚が貼着されている。一方、腹筋弾性体とは、加えられた圧力に応じて自在に変形可能な素材で形成されたものであり、例えば、ゴムなどを板状にしたゴム板や、或いは布帛にゴム素材を織込んで形成した所謂「ゴム紐」などを挙げることができる。   Here, as the human body model, a human body model formed as a three-dimensional model is used, and it is desirable that each part is approximately the actual size to enhance the visual image of the learner. In particular, artificial skin having substantially the same color, texture, touch, and the like as the actual skin is affixed to a portion corresponding to the abdomen so as to prevent the experienced person from feeling uncomfortable. On the other hand, an abdominal muscle elastic body is formed of a material that can be freely deformed according to applied pressure. For example, a rubber plate made of rubber or the like, or a rubber material is woven into a fabric. The so-called “rubber string” formed by

また、腹膜炎とは、腹部の臓器及び腹壁の内側を包む腹膜に炎症が起きる病気であり、一般に細菌感染による急性細菌性腹膜炎を指すことが多い。さらに、腹膜炎のほとんどは外傷あるいは腹腔内臓器の炎症から二次的に発症するものである。   Peritonitis is a disease in which the peritoneum that wraps inside the abdominal organs and the abdominal wall is inflamed, and generally refers to acute bacterial peritonitis due to bacterial infection. Furthermore, most peritonitis is secondary to trauma or inflammation of organs in the abdominal cavity.

したがって、本発明の筋性防御擬似提示装置によれば、人体モデルの人工皮膚の下に、腹筋の筋動作を擬似的に提示可能な腹筋弾性体が弾性体支持部によって所定の張力で引っ張られた状態で支持されている。係る状態で、体験者（医学部の学生など）が腹膜炎の診断の際に行う圧迫触診を人工皮膚の上から実施することにより、人工皮膚下に設けられた腹筋の動きを擬似提示する腹筋弾性体が触診圧に応じて変形する。   Therefore, according to the muscular defense pseudo presenting device of the present invention, the abdominal muscle elastic body capable of presenting the abdominal muscle motion in a pseudo manner is pulled under the artificial skin of the human body model with a predetermined tension by the elastic body support portion. It is supported in the state. In such a state, an abdominal muscle elastic body that pseudo-presents the movement of the abdominal muscles provided under the artificial skin by performing pressure palpation performed by an experienced person (such as a medical student) on the artificial skin in the diagnosis of peritonitis Deforms according to the palpation pressure.

ここで、人間の人体は、腹膜炎を起こしている場合、圧迫触診により腹筋に筋性防御が生じ、急激に腹筋の硬直化が起こることが知られている。そこで、触診圧によって変形する腹筋弾性体の引張り状態を調整し、腹筋に生じる筋性防御を疑似的に再現し、触診を行った体験者の触診指に筋性防御提示部によって提示することが可能となる。 Here, it is known that when the human body has peritonitis, muscular defense occurs in the abdominal muscles by pressure palpation, and abdominal muscles stiffen suddenly. Therefore, it is possible to adjust the tension state of the elastic body of the abdominal muscles that deforms by palpation pressure, to simulate the muscular defense that occurs in the abdominal muscles, and to present it to the palpation finger of the palpated experience person by the muscular defense presentation unit It becomes possible.

その結果、腹膜炎を圧迫触診によって診断する際に、触診指が感じる筋性防御の状態を容易に再現し、体験者に腹筋の硬直化の状況を仮想的に体験させることができる。これにより、本発明の筋性防御擬似提示装置を利用して、実際に筋性防御を体験することが困難な医学生などへ実践的な教育を行えるようになる。   As a result, when diagnosing peritonitis by pressure palpation, it is possible to easily reproduce the state of muscular defense felt by the palpation fingers and allow the experience person to virtually experience the situation of stiffening of the abdominal muscles. This makes it possible to provide practical education to medical students who are difficult to actually experience muscular defense by using the muscular defense simulated presentation apparatus of the present invention.

また、触診指が触れる人体モデルの腹部には、実際の皮膚と触感が類似する人工皮膚が貼着されていることにより、さらに係る擬似提示を実際の圧迫触診の状況に近似させることが可能となる。   In addition, artificial skin similar in touch to actual skin is affixed to the abdomen of the human body model touched by the palpation finger, and this pseudo-presentation can be further approximated to the actual pressure palpation situation. Become.

さらに、本発明にかかる筋性防御擬似提示装置は、上記構成に加え、「前記筋性防御が起きる患部に相当する患部位置に設けられ、前記圧迫触診による前記腹筋弾性体の変形を検出する患部検出手段と、検出された前記患部位置における前記腹筋弾性体の変形に応じ、前記患部位置が前記圧迫触診されたことを前記体験者に報知する報知手段とをさらに具備する」ものであっても構わない。   Further, the muscular defense pseudo presenting device according to the present invention is, in addition to the above configuration, “affected part provided at an affected part position corresponding to the affected part where the muscular defense occurs and detecting deformation of the elastic body of the abdominal muscle by the pressure palpation. It may further comprise a detecting means and a notifying means for notifying the experiencing person that the affected part position has been subjected to the pressure palpation according to the detected deformation of the abdominal muscle elastic body at the affected part position. I do not care.

ここで、腹膜炎によって筋性防御が起きる腹部の箇所は、腹膜炎の原因となる症状によって各々異なっている。そのため、係る症状を的確に診断する場合には、症状に応じて適切な場所を圧迫触診によって押さえる必要がある。そこで、症状に応じた患部に相当する箇所に患部検出手段を設けることにより、腹膜炎の起因症状をより正確に再現することが可能となる。   Here, the location of the abdomen where muscular defense is caused by peritonitis varies depending on the symptoms causing peritonitis. Therefore, when diagnosing such a symptom accurately, it is necessary to press an appropriate place by compression palpation according to the symptom. Therefore, by providing the affected part detection means at a location corresponding to the affected part corresponding to the symptom, it is possible to more accurately reproduce the symptom caused by peritonitis.

したがって、本発明の筋性防御擬似提示装置によれば、患部検出手段によって、腹膜炎の起因症状に応じて体験者が正しい位置を圧迫触診したか否かが判断される。そして、患部検出手段によって正しい位置が圧迫触診され、腹筋弾性体の変形が検出されると、係る状態を体験者に対して報知手段によって報知することが可能となる。ここで、報知手段による報知としては、例えば、音声及び光などの体験者が視覚的或いは聴覚的に係る状況を認識することができるものが挙げられる。これにより、体験者は、筋性防御を疑似的に体験することが可能となるとともに、症状に応じて筋性防御が起こる患部の正確な位置を模擬的に学習することが可能となる。さらに、円弧部の内円弧側が互いに対向した状態で配された一対の棒支持体に腹筋弾性体が架渡され、上腹部等の形状に合わせて略略円弧状に形成されていることにより、腹筋弾性体には円弧部の法線方向に張力がかかることになる。そのため、実際の腹筋の動きにより近づけることが可能となる。また、比較的簡易な構成で形成されているため、張力の調整等も容易に行える。 Therefore, according to the muscular defense pseudo presenting device of the present invention, it is determined by the affected part detection means whether or not the experienced person has pressed and palpated the correct position according to the symptoms of peritonitis. Then, when the correct position is pressed and palpated by the affected area detection means and the deformation of the abdominal muscle elastic body is detected, the state can be notified to the experience person by the notification means. Here, the notification by the notification means includes, for example, one in which an experienced person such as voice and light can visually recognize the situation concerned. Thereby, the experience person can experience the muscular defense in a pseudo manner, and can also learn the exact position of the affected part where the muscular defense occurs according to the symptom. Further, the abdominal muscle elastic body is stretched over a pair of rod supports arranged with the inner arc sides of the arc portion facing each other, and is formed in a substantially arc shape according to the shape of the upper abdomen, etc. Tension is applied to the elastic body in the normal direction of the arc portion. Therefore, it is possible to make it closer to the actual movement of the abdominal muscles. Moreover, since it is formed with a relatively simple configuration, it is possible to easily adjust the tension.

さらに、本発明にかかる筋性防御擬似提示装置は、上記構成に加え、「前記筋性防御は、胃潰瘍及び急性虫垂炎の少なくともいずれか一方に起因する前記腹膜炎によって生じ、前記患部位置は、前記胃潰瘍及び前記急性虫垂炎の少なくともいずれか一方を特定可能な前記患部に相当する位置に設けられている」ものであっても構わない。   Furthermore, the muscular defense pseudo presenting device according to the present invention includes, in addition to the above-described configuration, “The muscular defense is caused by the peritonitis caused by at least one of gastric ulcer and acute appendicitis, and the affected part position is the gastric ulcer. And at least one of the acute appendicitis may be provided at a position corresponding to the affected part that can be identified.

したがって、本発明の筋性防御擬似提示装置によれば、体験者は、胃潰瘍及び急性虫垂炎によって起こる腹膜炎の患部の正しい位置を学習することが可能となる。   Therefore, according to the muscular defense pseudo presenting device of the present invention, the experience person can learn the correct position of the affected part of peritonitis caused by gastric ulcer and acute appendicitis.

さらに、本発明にかかる筋性防御擬似提示装置は、上記構成に加え、「前記筋性防御を示すモデルとなる想定患者の年齢、性別、体型、及び前記腹膜炎の起因症状を含む擬似提示条件に基づいて、前記筋性防御提示部によって擬似提示される前記筋性防御の硬直度を制御する条件制御手段を」さらに具備するものであっても構わない。 Furthermore, the muscular defense pseudo presenting device according to the present invention includes, in addition to the above-described configuration, “pseudo presentation conditions including the age, sex, body type of the assumed patient to be a model showing the muscular defense, and symptoms caused by the peritonitis” On the basis of this, a condition control means for controlling the degree of rigidity of the muscular defense that is pseudo-presented by the muscular defense presentation unit ”may be further provided.

したがって、本発明の筋性防御擬似提示装置によれば、腹筋弾性体に加えられる張力の状態を制御することが可能となる。すなわち、圧迫触診によって生じる腹膜炎の筋性防御の強さ、換言すれば、腹筋の硬直化の度合い（硬直度）は、個々の患者に応じて異なっている。例えば、腹筋の力が強い成人男性の患者に比べ、高齢者や成人女性は腹筋の力が比較的弱いため、鋭い痛みを実際に訴えているにも関わらず、筋性防御の反応がそれほど強く出ないことがある。さらに、胃潰瘍や急性虫垂炎などの原因に応じて筋性防御の硬直化の度合いが変化することもある。そこで、腹筋弾性体の張力の強度を、種々の提示条件に応じて異なるように変化させることにより、体験者は筋性防御の複数のケースをそれぞれ擬似的に体験することが可能となる。   Therefore, according to the muscular defense pseudo presenting device of the present invention, it is possible to control the state of tension applied to the abdominal muscle elastic body. That is, the strength of muscular defense against peritonitis caused by pressure palpation, in other words, the degree of rigidity (rigidity) of abdominal muscles varies depending on the individual patient. For example, compared to adult male patients with strong abdominal muscles, elderly and adult women have relatively weak abdominal muscles, so the response of muscular defense is much stronger even though they are actually complaining of sharp pain. May not come out. Furthermore, the degree of stiffening of the muscular defense may change depending on causes such as gastric ulcer and acute appendicitis. Thus, by changing the tension strength of the abdominal muscle elastic body so as to differ according to various presentation conditions, the experience person can experience a plurality of cases of muscular defense in a pseudo manner.

本発明の効果として、医学生などの学習者が実際に体験することがほとんど困難な腹膜炎による筋性防御を、仮想的に体験することが可能となる。これにより、医療現場で係る状況に遭遇した場合でも、筋性防御を体験した経験の乏しい医師であっても、筋性防御を的確に判断し、その後の処置を速やかに行うことができる。   As an effect of the present invention, it is possible to virtually experience muscular defense due to peritonitis that is almost difficult for a learner such as a medical student to actually experience. Thereby, even if it encounters the situation which concerns on a medical field, even if it is a doctor with little experience which experienced muscular defense, it can judge muscular defense correctly and can perform subsequent treatment promptly.

以下、本発明の一実施形態である筋性防御擬似提示装置１について、図１乃至図４に基づいて説明する。ここで、図１は本実施形態の筋性防御擬似提示装置１の概略構成を模式的に示す平面図であり、図２は筋性防御擬似提示装置１の概略構成を模式的に示す上方からの説明図であり、図３は筋性防御擬似提示装置１の側方からの概略構成を示す説明図であり、図４は筋性防御擬似提示装置１における圧迫触診の例を模式的に示す説明図である。   Hereinafter, a muscular defense pseudo presenting apparatus 1 according to an embodiment of the present invention will be described with reference to FIGS. 1 to 4. Here, FIG. 1 is a plan view schematically showing a schematic configuration of the muscular defense simulated presentation apparatus 1 of the present embodiment, and FIG. 2 is a top view schematically showing a schematic configuration of the muscular defense simulated presentation apparatus 1. FIG. 3 is an explanatory view showing a schematic configuration from the side of the muscular defense simulated presentation apparatus 1, and FIG. 4 schematically shows an example of compression palpation in the muscular defense simulated presentation apparatus 1. It is explanatory drawing.

本実施形態の筋性防御擬似提示装置１は、図１乃至図３に示すように、略実寸大の人体を模して形成され、頭部２、胸部３、腹部４、及び脚部５等を主に有して為る人体モデル６と、人体モデル６の腹部４の表面に貼着され、実際の皮膚と触感及び弾力性などを同一にして形成された人工皮膚７と、人体モデル６の腹部４の内部の腹空間８に内包して配され、上腹部９及び下腹部１０の各々に形成される膨らみに合わせて円弧状に曲折された円弧部２０を有し、内円弧側を互いに対向するようにしてそれぞれ設置された一対の棒支持体１１からなる弾性体支持部１２と、前述した一対の棒支持体１１の間に架渡して支持され、人体モデル６の腹部４に人間の腹筋の動きを擬似的に提示可能な弾性素材から形成された腹筋弾性体１３と、弾性体支持部１２によって支持される腹筋弾性体１３に所定の張力（図２における矢印方向に相当）を調整しながら加え、腹膜炎の患者を診断する際に生じる腹筋の筋性防御を、圧迫触診を行った医学生などの体験者（図示しない）に擬似的に提示する筋性防御提示部１４とを主に具備して構成されている。 As shown in FIGS. 1 to 3, the muscular defense simulated presentation apparatus 1 of the present embodiment is formed to imitate a substantially actual human body, and includes a head 2, a chest 3, an abdomen 4, a leg 5, and the like. A human body model 6, an artificial skin 7 that is adhered to the surface of the abdomen 4 of the human body model 6 and has the same touch and elasticity as the actual skin, and the human body model 6 The abdomen 4 has an arcuate part 20 that is enclosed in the abdominal space 8 inside the abdomen 4 and is bent in an arc shape in accordance with the bulges formed in each of the upper abdomen 9 and the lower abdomen 10. The elastic body support portion 12 composed of a pair of rod support bodies 11 installed so as to face each other and the pair of rod support bodies 11 are supported and supported by the human body model 6 on the abdomen 4 of the human body model 6. An abdominal muscle elastic body 13 formed of an elastic material capable of presenting the movement of the abdominal muscle in a pseudo manner, and an elastic body Applying a predetermined tension (corresponding to the direction of the arrow in FIG. 2) to the abdominal elastic body 13 supported by the holding part 12 while adjusting the muscle strength of the abdominal muscles that occurs when diagnosing a patient with peritonitis, perform a pressure palpation And a muscular defense presentation unit 14 that presents it in a pseudo manner to an experienced person (not shown) such as a medical student .

さらに、本実施形態の筋性防御擬似提示装置１は、腹膜炎を起こす個々の症状に応じて筋性防御が起きる患部に対応する患部位置Ｐに設けられ、当該患部位置Ｐにおける圧迫触診による腹筋弾性体１３の変形を検出する圧力検出スイッチ１５と接続した患部検出部１６と、圧力検出スイッチ１５によって検出される腹筋弾性体１３の変形に応じ、患部位置Ｐが圧迫触診されたことを体験者に音声信号ＶＳを通じて音声Ｓによって報知する音声報知部１７と、筋性防御を疑似提示するモデル患者の年齢、性別、体型、及び腹膜炎の起因症状などの種々の擬似提示条件１８に基づいて、筋性防御の硬直度及び患部位置Ｐを腹筋弾性体１３に加える聴力を調整することによって変化させて制御する条件制御部１９とを具備して構成されている。ここで、圧力検出スイッチ１５及び患部検出部１６が本発明における患部検出手段に相当し、音声信号ＶＳにより音声Ｓを発する音声報知部１７が本発明における報知手段に相当する。なお、本実施形態の筋性防御擬似提示装置１では、患部位置Ｐとして胃潰瘍及び急性虫垂炎の場合に、筋性防御が示される患部に相当する箇所が設定されている。さらに、擬似提示条件１８の変更は、人体モデル６に接続されたキーボード等の操作部（図示しない）によって行われる。   Furthermore, the muscular defense pseudo presenting apparatus 1 of the present embodiment is provided at an affected part position P corresponding to an affected part where muscular defense occurs according to each symptom causing peritonitis, and the abdominal muscle elasticity by compression palpation at the affected part position P is provided. The affected part detection unit 16 connected to the pressure detection switch 15 for detecting the deformation of the body 13 and the experience that the affected part position P has been subjected to pressure palpation according to the deformation of the abdominal elastic body 13 detected by the pressure detection switch 15 Based on the voice notification unit 17 for notifying by the voice S through the voice signal VS and various pseudo presentation conditions 18 such as the age, sex, body shape, and symptoms of peritonitis of the model patient who pseudo-presents muscular defense. And a condition control unit 19 that changes and controls the hearing rigidity applied to the abdominal muscle elastic body 13 to control the stiffness of the defense and the affected part position P. Here, the pressure detection switch 15 and the affected part detection unit 16 correspond to the affected part detection unit in the present invention, and the voice notification unit 17 that emits the voice S by the voice signal VS corresponds to the notification unit in the present invention. In the muscular defense pseudo presenting apparatus 1 according to the present embodiment, a location corresponding to an affected part where muscular defense is shown is set as the affected part position P in the case of gastric ulcer and acute appendicitis. Further, the pseudo presentation condition 18 is changed by an operation unit (not shown) such as a keyboard connected to the human body model 6.

また、弾性体支持部１２を構成する一対の棒支持体１１は、上腹部９及び下腹部１０の膨らみに略一致するように略円弧状に曲折して形成された円弧部２０と、円弧部２０の両端から略鉛直方向（図３における紙面下側に相当）に向かって垂設された一対に垂部２１とによって主に構成されている。さらに、垂部２１の底端は、人体モデル６の腹空間８の中に設置された支持板部２２に接続されている。これにより、互いの内円弧側が対向するようにして一対の棒支持体１１が配されている。なお、本実施形態では、棒支持体１１は、主にアルミニウム金属を主素材として用いられている。   In addition, the pair of rod supports 11 constituting the elastic body support 12 includes an arc portion 20 formed by bending in a substantially arc shape so as to substantially match the bulges of the upper abdomen 9 and the lower abdomen 10, and an arc portion It is mainly constituted by a pair of hanging portions 21 that are suspended from both ends of 20 in a substantially vertical direction (corresponding to the lower side in the drawing in FIG. 3). Furthermore, the bottom end of the hanging part 21 is connected to a support plate part 22 installed in the abdominal space 8 of the human body model 6. Thus, the pair of rod supports 11 are arranged so that the inner arc sides face each other. In the present embodiment, the rod support 11 is mainly made of aluminum metal as the main material.

さらに、上述した一対の棒支持体１１に架渡された状態で腹筋弾性体１３が支持されている。具体的には、棒支持体１１の円弧部２０の上縁に腹筋弾性体１３の裏面を当接させ、係る当接箇所から下方に向かって引張り方向を変化させた状態で支持されている。さらに腹筋弾性体１３の各々の両端は、前述した筋性防御提示部１４とそれぞれ接続されている。そして、係る筋性防御提示部１４及びこれに接続した条件制御部１９によって擬似提示条件１８に基づいて腹筋弾性体１３に加えられる張力が変化させられる。   Further, the abdominal muscle elastic body 13 is supported in a state of being stretched over the pair of rod supports 11 described above. Specifically, the back surface of the abdominal muscle elastic body 13 is brought into contact with the upper edge of the arc portion 20 of the rod support 11 and is supported in a state where the pulling direction is changed downward from the contact portion. Further, both ends of each abdominal muscle elastic body 13 are connected to the muscular defense presentation unit 14 described above. And the tension | tensile_strength added to the abdominal-muscle elastic body 13 is changed based on the pseudo presentation conditions 18 by the muscular defense presentation part 14 and the condition control part 19 connected to this.

次に、本実施形態の筋性防御擬似提示装置１における使用方法について具体的に説明する。始めに、筋性防御擬似提示装置１は、腹筋弾性体１３に圧迫触診による触診圧（押圧）が掛けられていない状態では、弾性支持体１２によって一定の張力が加えられた引張状態で支持されている（図３参照）。   Next, the usage method in the muscular defense simulated presentation apparatus 1 of this embodiment is demonstrated concretely. First, the muscular defense pseudo presenting apparatus 1 is supported in a tension state in which a constant tension is applied by the elastic support body 12 in a state where the abdominal muscle elastic body 13 is not subjected to palpation pressure (pressing) by pressure palpation. (See FIG. 3).

そして、筋性防御を擬似的に体験する体験者によって、腹膜炎を発症する患部に相当する患部位置Ｐを触診指によって圧迫触診（図４における矢印Ｆ方向に相当）が行われる。このとき、圧迫触診は人工皮膚７の上から押圧され、係る人工皮膚７は押圧に応じて弾性変形する。一方、人工皮膚７の下で当接した状態で配設された腹筋弾性体１３も人工皮膚７の弾性変形とともに変形する（図４参照）。   Then, an experienced person who experiences muscular defense in a simulated manner performs a pressure palpation (corresponding to the direction of arrow F in FIG. 4) at the affected part position P corresponding to the affected part that develops peritonitis with a palpation finger. At this time, the pressure palpation is pressed from above the artificial skin 7, and the artificial skin 7 is elastically deformed in response to the press. On the other hand, the abdominal muscle elastic body 13 disposed in contact with the artificial skin 7 also deforms along with the elastic deformation of the artificial skin 7 (see FIG. 4).

このとき、筋性防御提示部１４によって腹筋弾性体１３に加えられる張力を調整することにより、実際の腹膜炎の際に生じる筋性防御と略同様の腹筋の硬直状態を再現することができる。すなわち、腹膜炎の際に医師などが、当該患部を触診すると、腹筋が急激な硬直状態となり、非常に硬くなる。本実施形態の筋性防御擬似提示装置１は、係る筋性防御の状態を擬似的に提示することができる。その結果、圧迫触診を行った体験者の触診指に対して、筋性防御と同様の感触を提示することができる。これにより、従来は非常に限られた人数の医学生しか体験することができなかった感触を、容易にかつ複数回にわたって繰り返し体験することができる。その結果、実際の診療現場で係る筋性防御をいきなり体験することがなくなり、その後の適切な処置を速やかに行うことができる。これにより、医学生等により実践的な医学指導が可能となる。 At this time, by adjusting the tension applied to the abdominal muscle elastic body 13 by the muscular defense presentation unit 14, it is possible to reproduce the abdominal muscle rigidity that is substantially the same as the muscular defense that occurs during actual peritonitis. That is, when a doctor or the like palpates the affected part during peritonitis, the abdominal muscles become stiff and very stiff. The muscular defense pseudo presenting apparatus 1 of the present embodiment can present the muscular defense state in a pseudo manner. As a result, it is possible to present a touch similar to the muscular defense to the palpation finger of the experience person who has performed the pressure palpation. As a result, it is possible to easily and repeatedly experience a touch that could be experienced only by a very limited number of medical students. As a result, there is no sudden experience of muscular defenses at the actual medical site, and appropriate subsequent treatment can be promptly performed. Thereby, practical medical guidance is possible by medical students and the like.

さらに、本実施形態の筋性防御擬似提示装置１は、弾性変形する腹筋弾性体１３の下方で、かつ腹膜炎を生じる患部に相当する患部位置Ｐに圧力検出スイッチ１５が設けられ、腹筋弾性体１３の変形を検出することができる。これにより、体験者によって患部位置Ｐに該当する箇所が圧迫触診された場合、音声信号ＶＳ及び音声Ｓによって体験者に係る患部位置Ｐが的確に触診されたことを報知することができ、体験者は聴覚を通じてこれを認識することができる。すなわち、腹膜炎の診断の際の正確な診断位置を圧迫触診したか、否かの評価が客観的に行われれ、係る正確な診断位置を学習することができる。これにより、筋性防御が生じる的確な患部を学習し、実際の診断時に戸惑いを感じることが少なくなる。 Furthermore, the muscular defense pseudo presenting apparatus 1 of the present embodiment is provided with a pressure detection switch 15 below the elastically deforming abdominal muscle elastic body 13 and at the affected part position P corresponding to the affected part causing peritonitis. Can be detected. Thereby, when the location corresponding to the affected part position P is pressed and palpated by the experience person, it can be notified by the audio signal VS and the voice S that the affected part position P related to the experience person has been palpated accurately. Can recognize this through hearing. That is, it is objectively evaluated whether or not an accurate diagnosis position at the time of peritonitis diagnosis has been compressed and palpated, and the accurate diagnosis position can be learned. As a result, it is possible to learn an accurate affected part in which muscular defense occurs, and to feel less confused during actual diagnosis.

以上、本発明について好適な実施形態を挙げて説明したが、本発明はこれらの実施形態に限定されるものではなく、以下に示すように、本発明の要旨を逸脱しない範囲において、種々の改良及び設計の変更が可能である。   The present invention has been described with reference to preferred embodiments. However, the present invention is not limited to these embodiments, and various modifications can be made without departing from the spirit of the present invention as described below. And design changes are possible.

すなわち、本実施形態の筋性防御擬似提示装置１において、人間（人体）の全姿を模して形成されたものを示したが、これに限定されるものではなく、頭部、及び四肢などを省略し、胸部３及び腹部４からなる胴体部のみで構成されるものであっても構わない。さらに、報知手段として、音声信号ＶＳ及び音声Ｓによって体験者の聴覚を通じて報知（認識）させるものを示したが、これに限定されるものではなく、例えば、ランプ等を明滅させ、視覚を通じて報知するものや、人体モデル６の上肢や脚部などを動かすことによって行うものであっても構わない。また、本実施形態の筋性防御擬似提示装置１において、胃潰瘍及び急性虫垂炎から生じる腹膜炎の例について示したが、これに限定されるものではなく、その他の腹膜炎を生じる症状を擬似提示するものであっても構わない。例えば、外傷による腹膜炎、或いは癌に起因する腹膜炎を擬似提示するものであってもよい。これにより、医学生は腹膜炎を生ずる多くのケースについて筋性防御を仮想的に体験することができる。   That is, in the muscular defense pseudo presenting device 1 of the present embodiment, a device that imitates the whole figure of a human (human body) is shown. However, the present invention is not limited to this, and the head, limbs, etc. May be omitted, and it may be configured only by the body part including the chest part 3 and the abdomen part 4. Furthermore, as the notification means, the one that is notified (recognized) through the auditory sense of the experience person with the audio signal VS and the voice S is shown, but is not limited to this, and for example, the lamp is blinked and notified through the visual sense. It may be performed by moving an object or the upper limb or leg of the human body model 6. Moreover, in the muscular defense pseudo presentation apparatus 1 of the present embodiment, an example of peritonitis resulting from gastric ulcer and acute appendicitis has been shown, but the present invention is not limited to this, and pseudo presents other symptoms that cause peritonitis. It does not matter. For example, pseudo-presentation of peritonitis due to trauma or peritonitis due to cancer may be presented. This allows medical students to virtually experience muscular defenses for many cases that cause peritonitis.

筋性防御擬似提示装置の概略構成を模式的に示す平面図である。It is a top view which shows typically schematic structure of a muscular defense pseudo presentation apparatus. 筋性防御擬似提示装置の概略構成を模式的に示す上方からの説明図である。It is explanatory drawing from the top which shows typically schematic structure of a muscular defense pseudo presentation apparatus. 筋性防御擬似提示装置の側方からの概略構成を模式的に示す説明図である。It is explanatory drawing which shows typically schematic structure from the side of a muscular defense simulated presentation apparatus. 筋性防御擬似提示装置における圧迫触診の例を模式的に示す説明図である。It is explanatory drawing which shows typically the example of the pressure palpation in a muscular defense pseudo presentation apparatus.

符号の説明Explanation of symbols

１ 筋性防御擬似提示装置
６ 人体モデル
７ 人工皮膚
８ 腹空間
９ 上腹部
１０ 下腹部
１１ 棒支持体
１２ 弾性体支持部
１３ 腹筋弾性体
１４ 筋性防御提示部
１６ 患部検出部（患部検出手段）
１７ 音声報知部（報知手段）
１９ 条件制御部（条件制御手段）
Ｐ 患部位置 DESCRIPTION OF SYMBOLS 1 Muscular defense pseudo presentation apparatus 6 Human body model 7 Artificial skin 8 Abdominal space 9 Upper abdominal part 10 Lower abdominal part 11 Rod support body 12 Elastic body support part 13 Abdominal muscle elastic body 14 Muscular defense presentation part 16 Affected part detection part (affected part detection means)
17 Voice notification part (notification means)
19 Condition control unit (condition control means)
P affected area

Claims (4)

人体を模して形成され、前記人体の腹部に相当する箇所が人工皮膚によって被覆された人体モデルと、
前記人体モデルの腹部の内部に形成された腹空間に前記人工皮膚と略当接した状態で配設され、前記人体の腹筋の収縮及び伸長動作を擬似的に提示する弾性変形可能な素材で形成された腹筋弾性体と、
前記腹筋弾性体に所定の張力を加えた状態で支持する弾性体支持部と、
前記人工皮膚の上方から体験者によって圧迫触診の手技が模擬的に行われたとき、腹膜炎の患者に確認される前記腹筋の筋性防御を、前記体験者の触診指に疑似的に提示する筋性防御提示部とを具備し、
前記弾性体支持部は、前記人体モデルの腹部の上腹部及び下腹部に合わせて略円弧状に曲折して形成された円弧部を有し、該円弧部の内円弧側を互いに対向させた状態で前記人体モデルの腹空間に配された一対の棒状支持体を具備しており、
前記腹筋弾性体は、前記一対の棒状支持体の間に架渡して支持されており、
前記筋性防御提示部は、前記一対の棒状支持体の間に架渡して支持された腹筋弾性体に対し、前記円弧部の法線方向に調整しながら張力を加えることにより前記腹筋の筋性防御を提示することを特徴とする筋性防御疑似提示装置。 A human body model that is formed to imitate a human body, and a portion corresponding to the abdomen of the human body is covered with artificial skin,
In said inside which is formed on the ventral space belly portion of the human body model is provided with an artificial skin and a substantially abutting state with the elastic deformable material which presents a contraction and expansion operation of the human body abdominal artificially The formed abdominal muscle elastic body,
An elastic body support part for supporting the abdominal muscle elastic body in a state where a predetermined tension is applied;
A muscle that artificially presents the muscular defense of the abdominal muscles confirmed by a patient with peritonitis to the palpation finger of the experiencer when a pressure palpation procedure is simulated by the experiencer from above the artificial skin A sexual defense presentation unit ,
The elastic body support part has an arc part formed by bending in an approximately arc shape in accordance with the upper and lower abdomen parts of the abdomen of the human body model, and the inner arc sides of the arc part are opposed to each other And a pair of rod-shaped supports arranged in the abdominal space of the human body model,
The abdominal muscle elastic body is supported across the pair of rod-shaped supports,
The muscular defense presentation unit applies a tension to the abdominal elastic body supported between the pair of rod-shaped support members while being adjusted in the normal direction of the arc portion, thereby improving the muscular property of the abdominal muscles. A muscular defense pseudo-presentation device characterized by presenting defense . 前記筋性防御が起きる患部に相当する患部位置に設けられ、前記圧迫触診による前記腹筋弾性体の変形を検出する患部検出手段と、
検出された前記患部位置における前記腹筋弾性体の変形に応じ、前記患部位置が前記圧迫触診されたことを前記体験者に報知する報知手段と
をさらに具備することを特徴とする請求項１に記載の筋性防御擬似提示装置。 An affected part detecting means provided at an affected part position corresponding to the affected part where the muscular defense occurs, and detecting deformation of the elastic body of the abdominal muscle by the pressure palpation;
The information processing apparatus according to claim 1, further comprising notification means for notifying the experience person that the affected part position has been subjected to the pressure palpation according to the detected deformation of the abdominal muscle elastic body at the affected part position. Muscular defense pseudo-presentation device. 前記筋性防御は、
胃潰瘍及び急性虫垂炎の少なくともいずれか一方に起因する前記腹膜炎によって生じ、
前記患部位置は、
前記胃潰瘍及び前記急性虫垂炎の少なくともいずれか一方を特定可能な前記患部に相当する位置に設けられていることを特徴とする請求項２に記載の筋性防御擬似提示装置。 The muscular defense is
Caused by the peritonitis resulting from at least one of gastric ulcer and acute appendicitis,
The affected part position is
The muscular defense pseudo presenting apparatus according to claim 2, wherein the pseudo muscular defense pseudo presenting apparatus is provided at a position corresponding to the affected part capable of identifying at least one of the gastric ulcer and the acute appendicitis. 前記筋性防御を示すモデルとなる想定患者の年齢、性別、体型、及び前記腹膜炎の起因症状を含む擬似提示条件に基づいて、前記筋性防御提示部によって擬似提示される前記筋性防御の硬直度を制御する条件制御手段をさらに具備することを特徴とする請求項１乃至請求項３のいずれか一つに記載の筋性防御擬似提示装置。 Stiffness of the muscular defense that is pseudo-presented by the muscular defense presentation unit based on the pseudo-presentation condition including the age, sex, body type, and the symptom of the peritonitis that is assumed as a model showing the muscular defense The muscular defense pseudo presenting device according to any one of claims 1 to 3, further comprising condition control means for controlling the degree.
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