JP4618795B2 - Rehabilitation equipment - Google Patents
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- JP4618795B2 JP4618795B2 JP2005206468A JP2005206468A JP4618795B2 JP 4618795 B2 JP4618795 B2 JP 4618795B2 JP 2005206468 A JP2005206468 A JP 2005206468A JP 2005206468 A JP2005206468 A JP 2005206468A JP 4618795 B2 JP4618795 B2 JP 4618795B2
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- 206010033799 Paralysis Diseases 0.000 claims description 41
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- 230000033764 rhythmic process Effects 0.000 description 3
- 238000005452 bending Methods 0.000 description 2
- 210000001145 finger joint Anatomy 0.000 description 2
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- 210000003414 extremity Anatomy 0.000 description 1
- 210000004247 hand Anatomy 0.000 description 1
- 238000003384 imaging method Methods 0.000 description 1
- 238000007654 immersion Methods 0.000 description 1
- 239000004973 liquid crystal related substance Substances 0.000 description 1
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この発明は、脳卒中の後遺症などにより身体の一部が麻痺した患者のリハビリのための装置に関する。 The present invention relates to an apparatus for rehabilitation of a patient whose body part is paralyzed due to sequelae of stroke or the like.
脳卒中の後遺症などにより身体の一部が麻痺した患者の麻痺部分を効果的に回復させるための方法や装置に関して精力的に研究と開発が進められている。
このような研究結果として、麻痺のある部位を患者自身が動かしているという感覚（動作主感覚）が大きいほど、感覚運動統合を行うと考えられている領域が活動することが知られており（非特許文献１）、こうした領域が随意運動に重要であり（非特許文献２）、さらに、その領域はリハビリの効果があった患者の初期によく活動することが分かっている（非特許文献３）。
また具体的なリハビリの方法や装置として、随意運動している健常側を鏡で写し、麻痺側が動いているような視覚入力を与えると、リハビリ効果があがることが分かっている（非特許文献４）。更に、患っている手指を強制的に動かす装置（特許文献１）や、患者の意志に基づいて麻痺した手指を動作させる装置（特許文献２）などが開発されている。
その他、手指を動かそうとする意思を、脳波の運動準備電位より捕らえようとする研究も行われている（非特許文献５，６）。
Research and development has been actively conducted on methods and devices for effectively recovering the paralyzed part of a patient whose body part has been paralyzed due to the aftereffects of stroke, etc.
As a result of such research, it is known that the greater the sensation that the patient is moving around the paralyzed part (motion principal sensation), the more active the region considered to perform sensorimotor integration ( (Non-patent document 1), such a region is important for voluntary movement (Non-patent document 2), and the region is known to act well in the early stages of patients who had a rehabilitation effect (Non-patent document 3). ).
In addition, as a specific rehabilitation method and apparatus, it is known that the rehabilitation effect is enhanced when a healthy side that is voluntarily moving is copied with a mirror and a visual input that the paralysis side is moving is given (Non-Patent Document 4). ). Furthermore, a device for forcibly moving the affected finger (Patent Document 1), a device for operating a paralyzed finger based on the patient's will (Patent Document 2), and the like have been developed.
In addition, studies have been conducted to capture the intention to move the fingers from the motor preparation potential of the electroencephalogram (Non-Patent Documents 5 and 6).
本発明は、脳卒中の後遺症などにより身体の一部が麻痺し、自発的に麻痺した部位を動かすことのできない患者のリハビリのための装置を提供する。 The present invention provides an apparatus for rehabilitation of a patient whose body part is paralyzed due to sequelae of stroke or the like and cannot move the part that has been spontaneously paralyzed.
本発明のリハビリ装置は、視覚入力により麻痺を伴う肢部を患者自身が動かしているという感覚（動作主感覚：エージェンシー）がリハビリテーションへ与える効果があり、実際の運動に伴う運動覚などの脳への入力も起こるため、高いリハビリ効果がある。
また本発明のリハビリ装置と、非侵襲脳機能計測と組み合わせ、新たな装置を構成することができる。非侵襲脳機能計測法によって得られる特定の領域の脳活動と、動作主感覚及びリハビリ効果の関係に着目し、最適なリハビリ内容の選択に用いることができる。適切なリハビリ運動を選択することによりリハビリ促進効果が期待される。
The rehabilitation device of the present invention has an effect of giving a sense of movement of a patient's own limbs with paralysis by visual input (motion sensation: agency) to rehabilitation. This also has a high rehabilitation effect.
In addition, a new device can be configured by combining the rehabilitation device of the present invention with noninvasive brain function measurement. Focusing on the relationship between the brain activity of a specific region obtained by the noninvasive brain function measurement method, the motion principal sense, and the rehabilitation effect, it can be used to select the optimum rehabilitation content. Rehabilitation promotion effect is expected by selecting an appropriate rehabilitation exercise.
即ち、本発明は、脳卒中の後遺症などにより身体の一部が麻痺した患者のリハビリのための装置であって、患者に麻痺した身体部分の正常な動きを見せる視覚刺激装置、身体駆動装置、患者の脳波を計測することにより得られる運動に関する信号を含む生体信号を検知する手段、及び検知した生体信号から身体を駆動させるためのデータを生成する手段、及び生成されたデータを身体駆動装置に送信する手段から成り、該脳波を計測することにより得られる運動に関する信号の検知又は外部信号をトリガーとして、該視覚刺激装置と協調して該身体駆動装置が患者に見せる身体部分の動きと同じ動きを強制的に開始し、一定時間その動きを継続するようにプログラムされたリハビリ装置である。
脳波を計測することにより得られる運動に関する信号を利用しない場合は、音などの外部信号を利用し、この信号をトリガーとして、身体駆動装置が該視覚刺激装置が患者に見せる身体部分の動きと同じ動きを強制的に開始する。
本発明は、更に、前記リハビリ運動に関連する脳領域の脳活動を検知する手段を備え、検知した脳活動の解析結果を前記データにフィードバックさせ、それに応じてリハビリ運動を選択することを含む上記のリハビリ装置である。
That is, the present invention is a device for rehabilitation of a patient whose body part has been paralyzed due to a sequelae of stroke, etc., and which shows normal motion of the paralyzed body part to the patient, body drive device, patient Means for detecting a biological signal including a signal related to movement obtained by measuring an electroencephalogram, means for generating data for driving the body from the detected biological signal, and transmitting the generated data to the body driving device It consists means for, as a trigger detection or external signals of the signal relating to exercise obtained by measuring the brain waves, bodily drive in cooperation with the visual stimulus device the same motion as the motion of the body part to be shown to the patient A rehabilitation device programmed to start forcibly and continue its movement for a certain period of time.
When signals related to movement obtained by measuring brain waves are not used, an external signal such as sound is used, and this signal is used as a trigger for the body drive device to be the same as the movement of the body part that the visual stimulation device shows to the patient. Force the movement to start.
The present invention further includes means for detecting a brain activity of a brain region related to the rehabilitation exercise, and includes feeding back an analysis result of the detected brain activity to the data and selecting a rehabilitation exercise accordingly. It is a rehabilitation device.
本発明のリハビリ装置は、リハビリ運動を、同一の運動内容の視覚刺激と同期させて患者に呈示するため、その運動を自己が行うという感覚（動作主感覚）を引き起こすことができる。さらに、脳機能を計測・解析を行ない、動作主感覚やリハビリテーション効果との関係を客観的に示し、その結果から、より適したリハビリ運動内容を選択する。これらは従来のリハビリシステムには無いものであり、顕著にリハビリを促進する効果がある。 Since the rehabilitation device of the present invention presents the rehabilitation exercise to the patient in synchronization with the visual stimulus having the same exercise content, it can cause a sense that the exercise is performed by itself (motion principal sense). Furthermore, the brain function is measured and analyzed, objectively showing the relationship with the main sense of movement and the rehabilitation effect, and more suitable rehabilitation exercise content is selected from the result. These are not present in conventional rehabilitation systems and have the effect of significantly promoting rehabilitation.
本発明のリハビリ装置は、リハビリの対象とする運動内容を可視化した視覚刺激を呈示する視覚刺激装置と、同様の運動を引き起こす身体駆動装置、麻痺を伴う患者からの生体信号を検出する装置を備える。身体の麻痺により、自発的に部位を動かすことができない患者については、例えば、脳波を計測することにより得られる運動に関する信号（例えば、脳波の運動準備電位）を「生体信号」とする。動作に不自由があるが、ある程度身体を動かすことのできる患者については、動きそのものを検出する、又は、筋電位などを計測することにより、生体信号とする。本発明のリハビリ装置においては、脳波を計測することにより得られる運動に関する信号をトリガーとして、視覚刺激と駆動装置を同期させて患者へ呈示する。これによりリハビリ運動を患者自身が行うという感覚（動作主感覚）を引き起こさせる。
The rehabilitation device of the present invention includes a visual stimulation device that presents a visual stimulus visualizing the content of exercise targeted for rehabilitation, a body drive device that causes the same motion, and a device that detects a biological signal from a patient with paralysis. . For a patient whose body part cannot be moved spontaneously due to paralysis of the body, for example , a signal related to exercise obtained by measuring an electroencephalogram ( for example, an exercise preparation potential of an electroencephalogram) is set as a “biological signal”. For a patient who has inconvenience in movement but can move the body to some extent, a biological signal is obtained by detecting the movement itself or measuring myoelectric potential. In the rehabilitation device of the present invention , a visual stimulus and a driving device are synchronized and presented to a patient using a signal related to movement obtained by measuring an electroencephalogram as a trigger. This causes a sensation that the patient himself performs rehabilitation exercise (motion main sensation).
さらに本装置は、患者の脳波を計測することにより得られる運動に関する信号をトリガーとして利用できない場合は、外部同期信号を用いてトリガーとして利用することができる。外部同期信号としては、例えば２秒ごとに「ピッ」という音を提示し、その音のリズムに合わせて患者にリハビリ運動をさせるといったことを想定している。音の提示と同時に身体駆動装置を動作させず、人が音を聞いてから動作に至る遅れ時間分を考慮して、身体駆動装置を動作させる。この遅れ時間を挿入することにより、動作主感覚を大きくすることが可能となる。
リハビリには、いくつかの運動が考えられるが、患者の症状に応じて最適な運動が存在する。その最適な運動を選択するために、リハビリ中の脳活動を非侵襲脳機能画像法(PET、fMRI、EEGなど)にて計測し、これをリハビリや動作主感覚効果との関係に注目し解析して解析を行ない。その解析結果からより適したリハビリ運動を選択する。
Furthermore, this apparatus can be used as a trigger using an external synchronization signal, when the signal regarding the exercise | movement obtained by measuring a patient's brain wave cannot be used as a trigger. As the external synchronization signal, for example, it is assumed that a beep sound is presented every 2 seconds and the patient is caused to perform rehabilitation exercise in accordance with the rhythm of the sound. The body driving device is not operated at the same time as the presentation of the sound, and the body driving device is operated in consideration of the delay time from when a person hears the sound until the operation is started. By inserting this delay time, it is possible to increase the main sense of action.
There are several types of exercise for rehabilitation, but there is an optimal exercise according to the patient's symptoms. In order to select the optimal movement, brain activity during rehabilitation is measured by non-invasive functional brain imaging (PET, fMRI, EEG, etc.), and this is analyzed by paying attention to the relationship with rehabilitation and movement main sensory effects. And analyze. A more suitable rehabilitation exercise is selected from the analysis result.
リハビリ運動（例えば、上肢の麻痺を伴う患者に、両手手指対向運動の視覚刺激呈示と共に機械による補助を伴う手指対向運動といった特定の運動）を行い、その際の脳活動を非侵襲脳機能画像法(PET、fMRI、EEGなど)にて計測する。手指の対向運動のリズム、パターンなどを変化させたリハビリ運動を幾種類か行わせ、動作主感覚が大きい、つまりリハビリ効果の大きいほど良く活動すると言われている感覚運動統合を行う脳領域の活動を観測する。観測結果をもとに、リハビリ運動内容を選択することでリハビリ効果を促進させることができる。 Perform rehabilitation exercises (for example, specific exercises such as hand-to-hand movements with mechanical assistance in addition to visual stimulation of two-handed finger-facing movements in patients with upper limb paralysis) and non-invasive brain function imaging (PET, fMRI, EEG, etc.) Brain area activity that performs sensory-motor integration, which is said to be more active as the main action sensation, that is, the greater the rehabilitation effect, by performing several types of rehabilitation movements that change the rhythm and pattern of the opposing movement of fingers Observe. Based on the observation results, the rehabilitation effect can be promoted by selecting the rehabilitation exercise content.
（１）患者に麻痺した身体部分の正常な動きを見せる視覚刺激装置とは、例えば、患者の正面に、CRT、液晶ディスプレイ、プラズマディスプレイ、有機ELディスプレイ、無機ELディスプレイ、SED(surface-conduction Electron-emitter Display)、FED(Field Emisson Displays)など通常のビデオ信号又は、コンピュータの画面を表示できる装置を置く。患者には、麻痺した部位が直接見えないように覆いをする。その上で、できる限り広い視野を確保し、画面に表示される麻痺部位が自分の身体の一部であるように見えるようにする。臨場感、没入感をより高くするために、HMD（Head Mount Display）、Ensphered Vision (http://intron.kz.tsukuba.ac.jp/vrlab_web/enspheredvision/enspheredvision_j.html)などを用いることも可能である。表示される映像としては、以下のようなものを用いる。実写の映像を用いる場合は、健常者に、患者の麻痺した身体部分の運動を行なってもらい、それを撮影し用いる。又は、患者自身の健常側の上肢運動を撮影し、麻痺側が運動しているように鏡像映像を作成し、用いる。コンピュータグラフィックスを用いる場合は、患者の麻痺している部位が健常な状態であるかのように動く動画を作成する。それらを、身体駆動装置と同期させる。 (1) A visual stimulation device that shows normal movement of a paralyzed body part to a patient, for example, CRT, liquid crystal display, plasma display, organic EL display, inorganic EL display, SED (surface-conduction electron) -Emitter Display), FED (Field Emisson Displays) and other devices that can display normal video signals or computer screens. Cover the patient so that the paralyzed area is not directly visible. On top of that, ensure as wide a field of view as possible so that the paralyzed area displayed on the screen appears to be part of your body. HMD (Head Mount Display), Ensphered Vision (http://intron.kz.tsukuba.ac.jp/vrlab_web/enspheredvision/enspheredvision_j.html), etc. can be used to increase the sense of presence and immersion. It is. The following images are used as displayed images. When using a live-action image, have a healthy person exercise the patient's paralyzed body part, photograph it, and use it. Alternatively, the upper limb movement of the patient's own healthy side is photographed, and a mirror image is created and used so that the paralyzed side is moving. When using computer graphics, a moving image is created that moves as if the patient's paralyzed site is in a healthy state. They are synchronized with the body drive.
（２）患者の生体信号を検知する手段は、患者の状態により用いる生体信号が異なるので、生体信号によって以下のような手段とする。
a)患者の一部が麻痺し、動作に不自由があるが、ある程度は動かすことができる場合は、身体駆動装置に取り付けられているセンサーからの信号を計算機に取り込む。センサーとしてはStrinGlove(NI帝人商事株式会社, http://www2.ni-teijinshoji.co.jp/news/050616.html）を用いることができる。即ち、各関節に、紐を取り付け、手首部分に、紐の長さを測定する装置を装備する。回転する軸に、紐が巻き付けてあり、紐の繰り出し量を軸の回転数と方向により検出する。関節が曲がることにより、手首までの紐の長さが変化する。紐の長さの変化から関節の曲がり角度を計測することが可能となる。
b)患者の身体の一部が麻痺し、自発的に麻痺部位を動かすことができない場合は、例えば脳波を計測し、運動に関する生体信号（運動をしようと意図すると運動に先立って信号が生ずる）を用いる。脳波計より出る電気信号をA/Dコンパータを介してデジタル信号として、計算機に取り込む。又は、健常側を同時に動かす運動をリハビリ運動とし、健常側の動作を検出する方法もある。
(2) The means for detecting a patient's biological signal is different from the biological signal used depending on the patient's condition.
a) If a part of the patient is paralyzed and incapable of movement but can be moved to some extent, the signal from the sensor attached to the body drive is taken into the computer. StrinGlove (NI Teijin Shoji Co., Ltd., http://www2.ni-teijinshoji.co.jp/news/050616.html) can be used as the sensor. That is, a string is attached to each joint, and a device for measuring the length of the string is provided on the wrist. A string is wound around the rotating shaft, and the feeding amount of the string is detected based on the rotation speed and direction of the shaft. By bending the joint, the length of the string up to the wrist changes. The bending angle of the joint can be measured from the change in the length of the string.
b) When a part of the patient's body is paralyzed and cannot move the paralyzed part spontaneously, for example, an electroencephalogram is measured, and a biological signal related to the movement (a signal is generated prior to the movement if the movement is intended) Is used. The electrical signal from the electroencephalograph is taken into the computer as a digital signal via the A / D converter. Alternatively, there is a method in which the movement of moving the healthy side at the same time is referred to as a rehabilitation movement and the movement of the healthy side is detected.
（３）検知した信号を身体を駆動させるためのデータに変換する手段としては、（２）のa,bともに生体信号を計算機に取り込む。計算機は、そのデータをトリガーとして、D/Aコンバータを介して、身体駆動装置を駆動する。身体駆動装置に関しては、後述する。また、身体駆動装置は、身体を駆動するとともに、その状態を把握するセンサーがついている。これらのセンサーを介して、計算機は患者の身体の状態を把握することができる。 (3) As means for converting the detected signal into data for driving the body, both a and b in (2) are taken into the computer. The computer uses the data as a trigger to drive the body drive device via the D / A converter. The body drive device will be described later. In addition, the body drive device has a sensor for driving the body and grasping the state thereof. Through these sensors, the computer can grasp the state of the patient's body.
（４）変換されたデータを身体駆動装置に送信する手段とは、例えば、D/Aコンバータを介して、計算機より身体駆動装置に取り付けた複数のアクチュエータを動作させる。 (4) The means for transmitting the converted data to the body drive device operates, for example, a plurality of actuators attached to the body drive device from a computer via a D / A converter.
（５）身体駆動装置の例として、上肢麻痺患者を対象とした身体駆動装置について説明する。手の甲側に装着し、各指の関節をアクチュエータにより独立して動かすことができる。各アクチュエータは、D/Aコンバータを介して、計算機に接続され、計算機の指示に従い、必要量動かすことができる。また、関節には角度センサーを装備し、現在の角度をA/Dコンバータを介して計算機に入力することができる。患者自身の意思で、身体駆動装置を動かすことも可能である。その際に動いた量は前述の角度センサーにより得ることができる。 (5) As an example of the body drive device, a body drive device for an upper limb paralysis patient will be described. It is mounted on the back side of the hand, and each finger joint can be moved independently by an actuator. Each actuator is connected to a computer via a D / A converter, and can be moved by a necessary amount in accordance with instructions from the computer. In addition, the joint is equipped with an angle sensor, and the current angle can be input to the computer via the A / D converter. It is also possible to move the body drive device at the patient's own will. The amount moved at that time can be obtained by the angle sensor described above.
（６）トリガーは、患者の状態により異なる。麻痺があるが、ある程度は動かせる場合は、患者の麻痺部を動かした動作を前述の角度センサーより入手し、それを計算機に入力することによりトリガーとする。麻痺により完全に麻痺部を動かせない場合は、脳波を計測し、事象関連電位を検出し、それを計算機に入力することによりトリガーとする。
さらに本装置は、患者の脳波を計測することにより得られる運動に関する信号をトリガーとして利用できない場合は、外部同期信号を用いてトリガーとして利用する。外部同期信号としては、例えば２秒ごとに「ピッ」という音を提示し、その音のリズムに合わせて患者にリハビリ運動をさせる。音の提示と同時に身体駆動装置を動作させず、人が音を聞いてから動作に至る遅れ時間分を考慮して、身体駆動装置を動作させる。
(6) The trigger varies depending on the patient's condition. If there is paralysis but it can be moved to some extent, the movement of moving the paralysis part of the patient is obtained from the angle sensor described above, and it is set as a trigger by inputting it to the computer. If the paralysis cannot be moved completely due to paralysis, the brain wave is measured, the event-related potential is detected, and it is input to the computer as a trigger.
Furthermore, this apparatus uses an external synchronization signal as a trigger when a signal related to movement obtained by measuring a patient's brain wave cannot be used as a trigger. As an external synchronization signal, for example, a beep sound is presented every 2 seconds, and the patient is caused to perform rehabilitation exercise in accordance with the rhythm of the sound. The body driving device is not operated at the same time as the presentation of the sound, and the body driving device is operated in consideration of the delay time from when a person hears the sound until the operation is started.
（７）「該視覚刺激装置と協調し該身体駆動装置が患者に見せる身体部分の動きと同じ動きを強制的に開始し、一定時間その動きを継続するプログラム」とは、身体駆動装置の動作パターンをあらかじめ計算機上に記録しておき、リハビリにあわせて、記録しておいた何種類もの関節の動かし方のパターンから選択することができる。 (7) “A program that forcibly starts the same movement of the body part that the body driving device shows to the patient in cooperation with the visual stimulation device and continues that movement for a certain period of time” Patterns are recorded in advance on a computer, and it is possible to select from various types of patterns for how to move the joints in accordance with rehabilitation.
（８）前記麻痺部分の領域の脳活動を検知する手段とは、例えば、(7)にあるように、各種のリハビリ運動のパターンを作成し、リハビリ運動中の脳活動を非侵襲脳機能画像法(PET、fMRI、EEGなど)にて計測する。動作主感覚が大きい、つまりリハビリ効果の大きいほど良く活動すると言われている感覚運動統合を行う脳領域の活動を観測する。観測結果をもとに、リハビリ運動内容を選択することでリハビリ効果を促進させることができる。 (8) The means for detecting the brain activity in the paralyzed area is, for example, as shown in (7), creating various rehabilitation exercise patterns, and showing the brain activity during the rehabilitation exercise as a non-invasive brain function image. Measured by law (PET, fMRI, EEG, etc.). Observe the activity of the brain area that performs sensorimotor integration, which is said to be more active as the main motion sensation is greater, that is, the greater the rehabilitation effect. Based on the observation results, the rehabilitation effect can be promoted by selecting the rehabilitation exercise content.
（９）検知した信号を解析し、最も活動の大きかったリハビリ運動が、その患者にとって最適の運動であることがわかる。運動解析を行なうことにより、最適なリハビリ運動を選択することができ、時間あたりの効果を最大にすることができる。 (9) By analyzing the detected signal, it can be seen that the rehabilitation exercise with the greatest activity is the optimum exercise for the patient. By performing the motion analysis, the optimal rehabilitation motion can be selected, and the effect per time can be maximized.
次に、本発明の具体的装置を、図１に沿って、軽度の上肢単麻痺（片側の上肢のみの麻痺）に対して用いる場合を想定して説明する。但し、本装置は、麻痺のある体部位や麻痺の程度にかかわらず適用できるものであり、軽度の上肢単麻痺（片側の上肢のみの麻痺）に対してのみ用いられるわけではない。
対象とするリハビリ運動としては、両手で同時に行う手指対向運動とする。特にここでは、第2指と第1指との対向運動とする。
視覚刺激としては、まず実際の患者の健側の運動を、患者の視点よりデジタルビデオで撮影して準備する。この画像を、PCなどに取り込み、健常側を、左右反転させ、麻痺側の映像として合成する編集をする。これにより健側、麻痺側が共に滑らかに動いているような映像を作り、視覚刺激とする。
自然な画像が生成できないばあいは、麻痺側をCGで作成して、合成するという手段も考えられる。
Next, the specific apparatus of the present invention will be described with reference to FIG. 1 assuming a case of mild upper limb simple paralysis (paralysis of only one upper limb). However, this device can be applied regardless of the body part with paralysis and the degree of paralysis, and is not used only for mild upper limb monoparalysis (paralysis of only one upper limb).
The target rehabilitation exercise is a finger-facing exercise that is performed simultaneously with both hands. In particular, here, the second finger and the first finger are opposed to each other.
As a visual stimulus, first, an actual patient's healthy movement is prepared by taking a digital video from the patient's viewpoint. This image is imported to a PC, etc., and the normal side is reversed left and right, and edited to be synthesized as a paralyzed video. As a result, an image in which both the healthy side and the paralyzed side move smoothly is used as a visual stimulus.
If a natural image cannot be generated, it may be possible to create and combine the paralyzed side with CG.
さらに、この視覚刺激と同様の、リハビリの対象とする両手手指対向運動を、他動的に引き起こすことのできる身体駆動装置を準備する。具体的な装置の例としては、麻痺を伴う手指の関節に、関節の自由度に対応する駆動装置（モーターなど）を装備し、関節の近位部、遠位部にまたがりその動力を伝えることのできる装置を装着する。
この視覚刺激、及び身体駆動装置による両手手指対向運動は、それぞれ同期させて患者へと呈示するわけであるが、この同期信号をとらえる手段としては、例えば、患者の患側の手指の関節角や位置、角速度などの運動の物理量を検出する手段が挙げられる。例えば、運動の開始時点に関しては、関節角や位置、角速度などの運動の物理量の変化量が閾値を越えることで捉えることができる。
Furthermore, a body drive device that can cause the two-handed finger-facing movement to be rehabilitated similarly to this visual stimulus can be prepared. As an example of a specific device, a finger joint with paralysis is equipped with a driving device (motor, etc.) corresponding to the degree of freedom of the joint, and the power is transmitted across the proximal and distal parts of the joint. Wear a device that can handle.
The visual stimulation and the two-handed finger-facing movement by the body drive device are presented to the patient in synchronization with each other. As means for capturing this synchronization signal, for example, the joint angle or position of the patient's affected finger And means for detecting a physical quantity of motion such as angular velocity. For example, the start point of the motion can be grasped when the amount of change in the physical amount of motion such as the joint angle, position, and angular velocity exceeds the threshold.
この際、麻痺側の手指が自動的に全く動かせない場合には、運動に関する生体信号（運動をしようと意図すると運動に先立って信号が生ずる）を用いる。脳波計より出る電気信号をA/Dコンパータを介してデジタル信号として、計算機に取り込む。又は、健常側を同時に動かす運動をリハビリ運動とし、健常側の動作を検出する方法もある。
検知した該運動開始時点の信号は、同期信号として、視覚刺激装置、及び身体駆動装置へと送り、それぞれを同期させて患者へと呈示する。あらかじめ、運動のパターンを用意しておき、それを繰り返し行なうことにより、リハビリ運動とする。
At this time, if the finger on the paralyzed side cannot be moved automatically at all, a biological signal related to the movement (a signal is generated prior to the movement if the movement is intended) is used. The electrical signal from the electroencephalograph is taken into the computer as a digital signal via the A / D converter. Alternatively, there is a method in which the movement of moving the healthy side at the same time is referred to as a rehabilitation movement and the movement of the healthy side is detected.
The detected signal at the time of starting exercise is sent as a synchronization signal to the visual stimulation device and the body drive device, and is presented to the patient in synchronization with each other. Prepare an exercise pattern in advance, and repeat it to make a rehabilitation exercise.
実際の運動の流れを図２に示す。
また、本発明のリハビリ装置と、非侵襲脳機能計測装置を組み合わせ、新たな装置を構成することができる。この装置の操作の流れを図３に示す。複数の視覚刺激、運動パターン（リハビリ運動）を作成する。各回においてリハビリ運動中の脳活動の非侵襲計測を行う。提示したリハビリ運動の中で最も脳活動の上昇したものがその患者にとっての最適なリハビリ運動となる。
患者自身の生体信号を利用できない場合は、外部信号を用いて図４に示す流れ図に沿ってリハビリ運動を行なうことができる。
The actual motion flow is shown in FIG.
In addition, a new device can be configured by combining the rehabilitation device of the present invention and a noninvasive brain function measuring device. The operation flow of this apparatus is shown in FIG. Create multiple visual stimuli and movement patterns (rehabilitation movements). Non-invasive measurement of brain activity during rehabilitation exercise at each session. Among the presented rehabilitation exercises, the one with the highest brain activity is the optimal rehabilitation exercise for the patient.
When the patient's own biological signal cannot be used, the rehabilitation exercise can be performed according to the flowchart shown in FIG. 4 using an external signal.
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