WO2017039550A1 - Mechanism for treating movement disorders occurring on extremities as a result of nervous system damages - Google Patents

Abstract

This invention, related to the mechanism about treating movement disorders arising in extremities as a result of nervous system damages bringing movement capability to the target organ by activating hand, arm, leg and foot joints developed to grant freedom of movement for people in their daily lives by accelerating neurologic recovery in movement disorders caused by nervous system damages- is essentially formed of 1st Motor (1), 2^nd Motor (2), 3^rd Motor (3), 4^th Motor (4), motor box (5), covering motors, pressure gauge (6) measuring the arising pressure, inflexible string (7), flexible mechanism (8) linked on the string (7), splint (9) linked to the target organ of the patient, encoder angle gauge (10) measuring the angle during the movement towards joint of the target organ, camera (1 1), infrared camera (12) tracking temperature of muscles running on the target organ, EMG (13) tracking electrophysiology in the muscles of the target organ, electrotherapy (14) activating the muscles in the target organ by transmitting electric current, sound wave module (15) tracking mass changes in muscles of the target organ by sound waves, marker and camera (16) connecting markers on the patient and performing movement efficiency analyses by tracking the markers electronically, biofeedback control mechanism (17) by which movement learning and execution levels of the patients can be tracked during treatment and control mechanism (18) enabling the operator to start and control the mechanism.

Description

DESCRIPTION

MECHANISM FOR TREATING MOVEMENT DISORDERS OCCURRING ON EXTREMITIES AS A RESULT OF NERVOUS SYSTEM DAMAGES

This invention is about a mechanism developed in direction with the use of technological opportunities for the purpose of speeding up the neurological improvement of the movement disorders occurring due to damages in the nervous system by exercising hand, arm, leg, foot joints so that the target organ gains locomotion, thus treating movement disorders occurring on extremities due to nervous system damages in order to provide individuals gain their independency in performing their daily activities. The nervous system providing the movement is separated into two parts; the I^s and 2" Motor neurons. While the 1^st Motor neuron is composed of brain and spinal cord, the 2^nd Motor neuron contains the nerves coming out of the spinal cord and spreading all around the body. In the brain, the movements to be performed are planned. The order for the movements planned is transmitted from the spinal cord to the nerves in the body. As the muscle receiving the movement order contracts, the movement occurs.

In any stage of life, damages in nervous system and in line with this, problems in movements can occur. Cases, where problems occur due to damages during brain development process starting from fertilization period ending at age 3, are defined as cerebral palsy (spastic child). The children, who confront problems in their spine and spinal cord during foetal period, are called children with spina bifida. Problems occur in the roots of spines or spinal cords of these children. Accordingly, movement problems are seen in the muscles controlled by the nerves affected. Similar movement problems due to such damages can be seen even after brain development is completed. Two of the most important factors causing such damages are blood circulation problems and traumas. Movement problems occur in the body parts affected, depending on the properties of the brain part damaged. In line with the circulation problems, one half of

l the brain is damaged. Accordingly, movement problems occur in the body parts crosswise to the damaged side of the brain. This is called paralysis or stroke in public. However in traumas affecting the entire brain, problems can be seen in terms of all body movements. As a result of a pressure occurring on the spinal cord due to a trauma, which can happen in any stage of life, movement orders cannot be properly transmitted to the lower parts of the body. Therefore, when a problem occurs in spinal cord, in the muscle initially a flappy appearance is observed, then after some time contractions occur. After a certain time, legs lose the moving ability. The roots coming out of the spinal cord drag also the membrane in which the spinal cord lays, pass through the holes on the spine and spread all around the body. In case of suffering from a trauma by any means, no movement order can be transmitted to the muscles found under the traumatized area. The most commonly seen congenital disorder is the congenital brachial plexus palsy. Nerves can be injured during injection or by any other reason. Accordingly, problems occur in movements of the muscles stimulated by the nerves injured.

Cerebral palsy (Spastic child) disease occurs due to any damage on the brain being developed during prenatal, intranatal and postnatal period. This disease can occur due to a developmental impairment, trauma, infection or anoxia (lack of oxygen in the brain) in the brain in the early years of life.

An individual with cerebral palsy, due to the damage in his/her brain, cannot normally use some of the muscles in his/her body, therefore cannot move and perform activities such as walking, talking, eating or playing in the way the other children do. Since cerebral palsy is not a progressive disease, life expectancy of such children or individuals is normal. This disease arises in the first years of life and it is permanent. However the damage level in the brain does not change or get worse in general terms. Only an increase in contractions is seen depending on growth of the child. Development of the brain starts in early pregnancy and continues during childhood. Any incident damaging the brain within the first 3 years of life leads to cerebral palsy. Depending on the function of the brain part damaged, a variety of contractions and involuntary movements are seen in children suffering from cerebral palsy;

Spasticity: It is characterized by the resistance against passive movement. It increases with voluntary movement.

Dystonia: It is characterized by involuntary muscle contractions that cause bending or twisting movements

Athetoid: It is characterized by involuntary, slow, snake-like movements.

Ataxia: It is characterized by balance and coordination problems.

Hypotonia: It is the term defining children, who do not have any contraction but whose bodies are in state of a "sack of jelly".

Children with cerebral palsy, depending on the function of the brain part damaged, demonstrate symptoms such as stiffness or contractions in muscles, involuntary movements and incapability of performing functions providing independency in daily life. These can accompany with problems in feeding, breathing, urine-stool control as well as additional problems such as learning difficulties, development deficiency or seizure disorder. These children can get better or worse because of the additional issues which may develop in time. In order to prevent any further complications and enhance their life quality; required treatments should be commenced at the earliest age possible.

Purpose of the cerebral palsy rehabilitation is initially to forestall the structural problems arising from the contractions and involuntary movements, then to increase the functional capacity. The movements considered as functional capacity are standing on front arms, standing on hands, turning, grovelling, sitting, crawling, standing on knees, standing up and walking.

The main problem of a child with cerebral palsy is not the physical contractions, but the damage in the central nervous system (brain). Treatment of the damaged part in the brain is not possible with the present systems. What should be done is to try to use the brain's plasticity and to teach the sound parts of the body how to perform some of the tasks of the damaged parts. The learning process proceeds from easy to hard. The more we simplify these movements, the sooner the child can start performing them. As the movements are exercised more often, the solid parts in the brain eventually learn these movements and the child will start using these movements also during daily life. The best example proving the effectiveness of this treatment is the rehabilitation in water.

In the state of art, rehabilitation in water is applied for treating cerebral palsy. In this rehabilitation, it is expected that the water supports the child so he/she can repeat the movement more frequently. As a result of these frequent repetitions, the brain learns the movements. Even after active movement is achieved, the treatment is continued in order to strengthen the structure. However, it is not always possible to have access to a water environment, pool or sea.

In the state of art, it is known that there are many treatment methods applicable as a solution for cerebral palsy. Vojta technique is a treatment method developed based on the consideration of that there are neurologically over-structured points in the body and performed as applying a certain amount of pressure on these points for a certain period of time. In this treatment method, the child feels pain and this is not a preferable situation. In the state of art, for the treatment of cerebral palsy disease by Bobath therapy, the spasticity determined in the child should be inhibited in the first phase. Then, the muscular tonus is normalized and normal tonus is stimulated to be used in the function.

Even though this treatment system is still being used, the stretching method it uses for inhibiting the contraction is not well accepted. The reason is that the stretching has a temporary effect, the muscle loses its functionality during intense stretching exercises and the muscle has a proper posture as a result of stretching starts contracting again while moving. In the state of art, for the treatment of cerebral palsy disease, appropriate positions are imposed so that the child's movements are activated. In the state of art, there is a treatment method called Adeli Suit therapy. In Adeli Suit therapy, the treatment is done in a cage by using Semi-elastic bands, strings as well as a suit in order to correct the individual's posture. By applying pressure on the points required, the individual's posture is corrected. However, this treatment cannot be applied on small children. Besides, since most the movements are performed in the cage by the suit and system itself, learning progress of the brain is not so fast.

In the state of art, the contractions seen in the children with cerebral palsy are highly severe and even getting worse during the growth phase of children. Therefore, children with cerebral palsy should immediately start doing exercises so that the maximum movement capacity that they can reach should be achieved as soon as possible.

It is known that there are various types of applications regarding cerebral palsy disease. This is about the device for prevention of the disorder stated in the patent document no. 2001/033367. In this application, every time the user shows tendency to make an involuntary movement forward or to have a humpy posture or sitting position, the shoulder strap stretching towards springs the user back as a warning. It is all about a user being exposed to an alert or warning for every wrong movement, thus becoming immediately aware of and correcting his/her posture and sitting disorder.

In the Lokomat treatment system, by using the technological resources, only issues related to walking are treated. The patients get on a treadmill. They are hung up by a hanger system. Weight of the patient is determined by sensors and the supports required are arranged accordingly. The patient is encouraged to work on walking movement on the treadmill with the help of the apparats put on feet. In this rehabilitation, the brain should be taught of the body movement first, then the arm and leg movements. Unless these movements are not taught in advance, a sufficient result cannot be achieved from the walking exercises. Especially in the children with cerebral palsy, special care should be given to the functions in the development stages (ex: standing on hands, standing on knees). Starting walking exercises before the abovementioned functions are activated can lead to structural impairments, since a child's body is not yet ready for bearing weight. Spina bifida is caused when the development of spine and spinal cord is not properly completed . due to folic acid deficiency in the first months of pregnancy. It has two types: Open spina bifida and closed spina bifida. In closed spina bifida cases, the spine development is completed. The membrane around the fluid, in which the spinal cord is found, is called dura. Dura extends from the brain all the way down to coccyx area. Due to the structural problems in dura, there may be pressure on the roots coming out of the spinal cord. In this regard, the most commonly and frequently seen problems are split cord syndrome, tethered filium terminale and lipoma. In open spina bifida, the spine cannot complete its development. Dura herniates out of the non-developed area in the spine and forms a sac. In this sac, sometimes there is only fluid, without any nervous roots passing through the sac, but goes all the way as they should. This is called meningocele. On the other side, if , the nervous roots extending from the spinal cord enter into the sac, this is called meningomyelocele. Undeveloped part of the spine can be anywhere in the spine. Even on the neck spinal development problems can be seen. Problems occurring upper parts of the spine would affect more parts of the body. Any structural problems occurring in lower parts of the spine affect more body parts. In children with spina bifida, the spine gets longer in children depending on growth. Because of the abnormal adhesions on the spine, the spine cannot accompany this growth and gets stretched. As a result of this, the orders given by the brain cannot be transmitted to lower parts of the body as required. Therefore, in such cases, the children face more movement problems. Due to the problems regarding circulation of the cerebrospinal fluid, hydrosephalus (water head) can be seen in the children with spina bifida. For treatment of hydrosephalus, pressure-sensitive shunts, which would let the fluid that can compress thus harm the brain drain into the abdominal cavity, are applied. If shunt insertion is not done on time, the brain gets damaged in a way leading the children with spina bifida suffer also from cerebral palsy. Since this fact is well-known today, the risk of hydrocephalus is evaluated for each child with spina bifida and shunt is applied. In the treatment of spina bifida, therapies addressing the problems in the muscles stimulated by the affected nerves are done. In this context, muscle strengthening, electro-therapy and orthosis applications are used. The most common method used to strengthen muscles of such children is working with weights. This method of treatment may even harm the child. When a muscle, which is already having difficulty in performing movements, is exposed weight training; the child activates his/her compensatory mechanisms to perform the movements. This leads to structural impairment. The child faces difficulty in performing the movements while working with weight. This causes the child to get bored from the treatment and not to attend the therapy. In electrotherapy methods, the purpose is to activate the movements by electrical stimulation on the motor points of muscles. Usually motor point of the muscle, which cannot perform the movement, cannot be found, so the surrounding locomotor muscles are stimulated instead. Purpose of the electrotherapy is only externally stimulating the muscles by electrical activity. However, there is another issue about children with spina bifida that requires to be solved prior to this treatment. Since these children have congenital neural problems, the brain part, which is controlled by the nerves and responsible for giving movement orders, is not developed due to long- term lack in functionality. In spina bifida treatments, therapies required for developing such brain parts should be applied so that the movement orders released from these parts can help improvement of the damaged nerves and the movement orders passing through these parts can activate the muscles. In orthosis methods, the entire movement of a non-functional muscle is performed by orthosis. The movement task is not taken over by the muscle, but the orthosis. The longer a muscle does not need to move, the sooner atrophy occurs and the chance for treatment is lost. In orthosis applications, high attention should be paid, orthosis should be chosen carefully, orthoses performing the entire movement should be avoided and the ones only for protecting the structure should be used instead. In brachial plexus, the nerves providing the arm movement extend from the spinal holes in the neck area. These are C5-C6-C7-C8-T1 (C= cervical-neck-, T-thoracic-chest area). These extending nerves first unite with each other in an area close to armpit then separate again. They form a node. This node is called brachial plexus. The nerves extending from this node provide the movement of the arm muscles. In cases, where the labour is hard and the child is pulled from the neck, these nerves get stretched due to the rotation in the neck. Sometimes stretching can be so much that these nerves break at the points where they extend from the spine. There are mainly three sections in this node. If the upper section of this node is datnaged, the muscles around shoulder are affected. Any damage in the middle section affects elbow muscles. And when the lower section is injured the wrist muscles lose their ability to move. Sometimes a full-entrapment occurs and the arm cannot move by any means. The diagnosis is put forward depending on the determination of disability in the arm. EMG is used as a diagnostics tool. In all available treatment methods, a positioning time of 21 days is given. In some treatments opposite T position of the shoulder (like how police signals to stop traffic) is applied where as in some of them hands are placed on stomach. According to the oldest treatment system, the arm is kept in opposite T position for a long time after the initial 21 -day period is over. This is the wrongest treatment method. Because the muscles that require the most training are the ones bringing the hand to the opposite T position. Since these muscles are already in the opposite T position, holding the hand in this position for a longer time prevents the muscle's need for movement. In this way, there is no opportunity left for learning the movement. The electrotherapy methods used for treatment of spina bifida are applicable in the same way for treatment of brachial plexus. One of the most effective treatment methods of brachial plexus is vojta therapy. In the vojta therapy method, the purpose is activating the reflex movement by applying pressure on the neutrally sensitive points on the arm. The same pressure applications are done also on the healthy arm. When the pressure is applied on the healthy arm, the child suffers from pain.

Usually damages occur in an undeveloped brain, due to blood circulation impairment or trauma. Poor blood circulation driven damages are called cerebrovascular problems. In this case, since the brain-feeding vessels get clogged, cell deaths occur in the brain mass fed by the clogged vessel. If these cells are in the movement-controlling part of the brain, movement ability can be lost in the opposite side of the body. This is called paralysis or stroke in public. Stroke patients lose locomotion in one of their arms and legs. First of all, feet locomotion is gained back. Problems occur in locomotion of ankles. When the ankle of a stroke patient is pulled, he/she shows a tendency to pull his/her ankle back. This causes the patient to step on side of his/her foot thus walk harder. Arm movement can be elicited much later compared to leg movements. If the arm rehabilitation is not properly done, contractions occur instead of active movements. , , , .

A contracted arm has a typical paralyzed posture. Brunsstrom technique is the most common method used in treatment of stroke patients. Its purpose is to elicit movement by using contractions. In this approach, the paralyzed arm position is divided into three stages. After the 3^rd stage, the contraction is considered as activated. After being activated, the contraction initiates a synergy, an associated movement occurs. The purpose is to elicit isolated movements by using this synergy. In this method of paralysis treatment, what we assert is that any contraction would be prevented. After a treatment, where contraction is prevented, independency is much more easily gained. PNF is another method used to treat paralysis. Here, a better use of activated movement elicited is targeted. In other words, the intention here is to bring a movement that has been elicited by a variety of techniques up to a more active level. However, in the loose period following the stroke, which is the most important period according to us, not much can be done by PNF treatment method. Bobath concept is also one of the methods used in stroke rehabilitation. Treatment of stroke patients is based on the similar principles of the abovementioned treatments applied on children. Stretching method is used more commonly. After a certain time, by using a variety of tools, it is intended to elicit movements on the non-functional side based upon the movements performed by the other side. However, we are totally against the stretching principle applied in this treatment. Because stretching causes the muscle to lose its quality, thus leads to contraction again, when it obtains a new movement order from the brain.

Lokomat system is also used in treatment of stroke patients. Since there is no function in this system for activating movement in arms and legs, it is inadequate to achieve any success.

The traumatic injuries, where only one side of the brain is damaged, are treated as stroke patients. In case that all movement-controlling brain parts get damaged, the entire body becomes stiff. Both arms and legs lose locomotion. The most common treatment applied in such cases is to try to maintain the range of movement by having the patients do passive arm and leg movements. Since such exercises are not frequently applicable, limitation in range of movement of the joints occurs depending on contractions. This creates a negative impact on quality of life of patients. Regarding the invention, which we elaborated in our legal application no.TR 2013/11368, improvements based on the methods for re-teaching the brain body, arm, leg movements so that the movement ability can be gained back. The motors are connected directly, with flexible strings, to the splint wrapped around the target organ of the patient. In this condition, it is not so possible to efficiently measure the force applied. Besides, the mechanism occupying too much space limits its portability. In this regard, it is hard to disassemble the mechanism and move it to another place. This invention, which is about a mechanism developed in direction with the technological opportunities for the purpose of speeding up the neurological improvement of the movement disorders occurring due to damages in the nervous system by exercising hand, arm, leg, foot joints so that the target organ gains locomotion thus treating movement disorders occurring on extremities due to nervous system damages in order to provide individuals gain their independency in performing their daily activities, overcomes all the disadvantages mentioned above and its main feature is, in respect to teaching the brain arm and leg movements, applying a physiotherapy to the patient, by enabling the controlled movement of hands, fingers, arms and legs with the help of sensors like encoder and electrical motors being operated under the surveillance of cameras as well as ultraviolet cameras.

Individuals having damage in their nervous system cannot perform all the movements directed by the damaged area. Therefore, the functions enabling independency in daily life cannot be executed completely. In the treatment of such disorders, hand, arm and leg movements are taught again to the brain. All arm and leg movement functions are taught in a simplified way.

Cerebral palsy refers to all the movement and posture disorders that occur depending on any kind of damage in the brain developing during prenatal, intranatal and postnatal period. Treatment of the damaged brain part is not possible with any of the present treatment systems. The only treatment to be applied should be teaching the healthy parts of the brain to take over the tasks of the damaged part by using neuroplasticity (the brain's ability to change shape). This can only be achieved by teaching these movements to the brain. The learning process proceeds from easy to hard. This process should be executed by simplifying these movements and providing the child the oppbrtunity of performing them. While teaching a movement to a new brain part, there are few matters, which require attention. First of all, it should be ensured that the movement is performed slowly. During the performance of the movement, it should be ensured that the child is allowed to perform the movement and the movement is really achieved by only him/her. Secondly, there are two muscles creating the movement. While the first muscle works for performance of the movement, the second muscle's function is to control the speed of the movement. In the current treatment systems, only the first muscle is activated and no importance is given to the second muscle. And this prevents the child from learning the movement. During the performance of movement, both muscles; the one performing the movement as well as the one controlling its speed; should be stimulated. If we give the wrist training as an example, while pushing the wrist downwards we should also apply force, but much less than the force we put while lifting it up. In this way, it is ensured that the upwards-lifting muscle's movement is taught and the downwards-lowering muscle controlling the speed is activated. Thirdly, the communication of every muscle is provided through different nerves. In our method, movement of both upward and downward ways of the relevant muscle can be taught. The functioning mechanism of the brain is based on the cooperative work of the first and the second muscle. There is no possibility to achieve teaching any movement to the brain if we only stimulate the first muscle. This way of training is against the functioning mechanism of the brain. It is also required that an impulse is sent to the brain through both ways of the second muscle. In order to stimulate the ways to and from the brain of both first and second muscle; the movement is paused, then oriented to the reverse direction for a while and proceeded again in the desired direction. Since this is in more accordance with the functioning mechanism of the brain, the brain can learn the movement better. Thirdly, after a certain period of time, spastic children suffer from problems regarding the tonus of the muscles operating the movements activated by the damaged part of the brain. Therefore contractions occur in such children's bodies. The movements are always in direction of the contracted muscle. In the current treatment systems, it is thought that contractions can be eliminated by strengthening not the contracted muscle but the muscle operating the movement on the reverse direction of the contracted muscle. But the contracted muscle is the weak muscle, which does not know the movement. The only way to eliminate the contraction is to give resistance to the contracted muscle so that the brain needs to give movement order in direction of the contracted muscle. The brain that learns to give movement order in the direction of the contracted muscle would stop giving contraction order.

It is very hard to teach the families how the abovementioned treatment systems should be applied to the child. Since teaching these treatments is highly time consuming, the independence level the child can access decreases. Therefore, it is much more beneficial to have these treatments to be applied by an electronic system, in which the required programs are installed, rather than being applied by the families.

Regarding the training of arms and legs, the movements of lifting up the arms above the shoulder and lowering down will be taken as an example in order to explain the arm movement.

A splint is put on the arm in a way to prevent the elbow from bending. The splint is provided with a flexible mechanism on it. This flexible mechanism is attached to the motor with inflexible strings. Two strings are attached to the motors, one being placed at foot level, the other one at head level. By pulling upwards and pushing downwards the control lever attached to the strings, the arm is brought right beside the body. When pulled from up above the arm is lifted up to the head level. With the help of the sensors, force meter or tensiometer, the motor at the head level pulls the shoulder up in a way to stimulate the movement. The motor at the foot level pulls down in a way to control the movement. But the motor below does not provide enough power to prevent the movement. The motors ensure that the movement is performed under control and with a certain speed from the starting point to the end point. When the child wants to participate, the sensors become activated, sense the movement and allow the child to perform the entire movement. When the child stops moving, the sensors sense this and activate the motors to proceed the movement. While the movement is performed, the power of the motor, which provides the upwards-lifting movement, remains constant and the power of the downwards-lowering motor exceeds a little more than the power of the motor performing the upwards-lifting movement. The motor performing the downwards-lowering movement does not ever elicit the movement. In this process, only a pause takes place. The arm is lifted upwards in this way when the pause occurs. Timing of the pause changes according to the requirement.

The sensors detect arm contraction arising within different intervals during occurrence of the movement and allow execution of the movement in arm's contraction direction so as not to prevent occurrence of the movement. In addition to this, they allow execution of the movement by granting maximum resistance without preventing the movement. In this way, the contracted muscle is taught the movement by granting resistance to it. This operation continues until the contracted muscle allows full execution of the movement in the space of the joint. Thus, all actions on the arms and legs are activated by splints ensuring execution of the movement when arm contraction is seen in different intervals during occurrence

These sensors are force meter, tension meter, encoder angle gauge, infrared camera, EMG and sound wave module. Force meter and tension meter can be placed on the engine, string or flexible mechanism. The force arising during execution of the movement is measured on the string. Encoder angle gauge is placed onto the area of joint during functioning of the target organ. It can instantly track the angle arising during movement of the joint via the camera across it. Infrared camera tracks the muscle functions on the target organ according to changes in temperature. Temperature increase during functioning of muscles and movement execution status may be tracked. Electrodes are attached to the muscles on the target organ via EMG. Electrophysiological changes arising on muscles during movements can be followed-up via electrodes. Functioning level of the muscles can be identified. Sound wave module may be placed on the muscles functioning on the target organ. Mass change in the muscle during execution of movements may be folio wed-up via sound waves.

Wrist flexion/extension:

During practicing the wrist, the splint is put on the palm. The splint is connected to the flexible mechanism. The flexible mechanism is connected to front and rear motor by the string. Shoulder and elbow joints are fixed. It is ensured that shoulder and elbow joints do not move. While the front motor is pushing up the wrist, the motor on the opposite side creates resistance in reply to the movement.

Hip flexion/extension:

During practicing the hip, the splint is put on the ankle. The flexible mechanism is connected to front and rear motor by the string. While the front motor is pushing up the leg through the ankle, the rriotor on the opposite side creates resistance in reply to the movement.

Shoulder flexion/extension:

During practicing the shoulder, the splint is put on the wrist. The splint is connected to the flexible mechanism. The flexible mechanism is connected to front and rear motor by the string. Elbow joints may/may not be fixed. In case of fixing, it is ensured that elbow joints do not move. While the front motor is pushing up the arm through the shoulder, the motor on the opposite side creates resistance in reply to the movement.

External/Internal Shoulder Rotation:

During practicing the shoulder, the splint is put on the wrist. The splint is connected to the flexible mechanism. The flexible mechanism is connected to front and rear motor by the string. The shoulder is positioned so as to be vertical to the body. While the front motor is pushing up the forearm through the shoulder, the motor on the opposite side creates resistance in reply to the movement.

Hand finger flexion/extension: During practicing the hand fingers, the splint is put on every finger other than the thumb. The splint is Connected to the flexible mechanism. The flexible mechanism is connected to front and rear motor by the string. While the front motor is bending and pushing the hand lingers, the motor on the opposite side creates resistance in reply to the movement.

Hip abduction/adduction:

When the patient is put to the bed vertically during practicing the hip, the splint is put on the ankle. The splint is connected to the flexible mechanism. The flexible mechanism is connected to front and rear motor by the string. While the motor on the side is opening the single leg and foot of the patient laying on his back laterally and closing them inward, the motor on the opposite side creates resistance in reply to the movement.

For usage of front and rear motors when the patient is put on the mechanism vertically in the hip movement, connection accessories and rollers reach out from front and rear motors to the sides. In this way, functioning of motors at different axes can be ensured.

When the patient is put on the mechanism horizontally, usage of side motors is ensured. Side motors enable execution of the movement by replacing front and rear motors.

Ankle plantarflexion/dorsiflexion:

During practicing the ankle, the splint is put on the upper part of the heel.

The splint is connected to the flexible mechanism. The flexible mechanism is connected to front and rear motor by the string. The patient is put on the mechanism horizontally. While the front motor is pushing and drawing the ankle, the motor on the opposite side creates resistance in reply to the movement Thumb abduction/adduction:

During practicing the thumb, the splint is put on the thumb. The patient is put on the mechanism horizontally. The splint is connected to the flexible mechanism. The flexible mechanism is connected to front and rear motor by the string. Wrist, shoulder and elbow joints are fixed. While the front motor is executing inside-outside movement of the thumb, the motor on the opposite side creates resistance in reply to the movement. Elbow flexion/extension:

During practicing the elbow, the splint is put on just under the wrist. The splint (9) is connected to the flexible mechanism. The flexible mechanism is connected to front and rear motor by the string. The patient is put on the mechanism horizontally. While the front motor is pushing and drawing the elbow, the motor on the opposite side creates resistance in reply to the movement.

Knee flexion/extension:

During practicing the knee, the splint is put on a just under the ankle. The splint is connected to the flexible mechanism. The flexible mechanism is connected to front and rear motor by the string. The patient is put on the mechanism face-down. While the front motor is pushing and drawing the ankle, the motor on the opposite side creates resistance in reply to the movement. It is possible for the splint used in the mechanism that its location may be changed if deemed necessary by the operator or physiotherapists depending on the treatment method applied to the target organ.

When functional exercises are commanded by the physiotherapists in rehabilitation centres and by the families at home, exercising during desired periods may not be possible as the commanding person gets tired. As exercising during desired periods is possible by this mechanism, brain shall learn the movements faster. Hereinafter this invention is explained in more detail, by referring to the drawings attached and using sampling method. In these drawings;

Figure 1 is the general view of the mechanism.

Figure 2 is the detailed general view of the mechanism.

Figure 3 is the general view showing how finger flexion extension movement works in the mechanism.

Figure 4 is the general view showing how thumb abduction adduction movement works in the mechanism.

Figure 5 is the general view showing how wrist flexion extension movement works in the mechanism.

Figure 6 is the general view showing how front arm pronation supination movement works in the mechanism.

Figure 7 is the general view showing how elbow flexion extension movement works in the mechanism.

Figure 8 is the general view showing how shoulder flexion extension movement works in the mechanism.

Figure 9 is the general view showing how shoulder abduction adduction movement works in the mechanism.

Figure 10 is the general view showing how shoulder external rotation internal rotation movements work in the mechanism.

Figure 11 is the general view showing how horizontal shoulder abduction adduction movement works in the mechanism.

Figure 12 is the general view showing how hip flexion extension movement works in the mechanism.

Figure 13 is the general view showing how shoulder flexion extension movement works in the mechanism when a side roller is used.

Figure 14 is the general view showing how hip abduction adduction movement works in the mechanism.

Figure 15 is the general view showing how it works in the mechanism when a side roller is used.

Figure 16 is the general view showing how it works in the mechanism when a side roller is used.

Figure 17 is the general view showing how knee flexion extension movement works in the mechanism.

Figure 18 is the general view showing how ankle plantarflexion dorsiflexion movement works in the mechanism.

Figure 19 is the general view showing how hip flexion extension movement works when four way motors are used.

Reference Descriptions:

NO NAME OF THE COMPONENT

1 1^st Motor

2 2^nd Motor

3 3^rd Motor

4 4^th Motor

5 Motor box

6 Pressure gauge (Loadcell)

7 String

8 Flexible mechanism

9 Splint

10 Encoder (angle gauge)

11 Camera

12 Infrared Camera

13 EMG

14 Electrotherapy

15 Sound wave module

16 Marker and Camera

17 Biofeedback control mechanism

18 Control mechanism This invention -related to the mechanism about treating movement disorders arising in extremities as a result of nervous system damages bringing movement capability to the target organ by activating hand, arm, leg and foot joints developed to grant freedom of movement for people in their daily lives by accelerating neurologic recovery in movement disorders caused by nervous system damages- is essentially formed of 1^st Motor (1), 2^nd Motor (2), 3^rd Motor (3), 4^th Motor (4), motor box (5), covering motors, pressure gauge (6) measuring the arising pressure, inflexible string (7), flexible mechanism (8) linked on the string (7), splint (9) linked to the target organ of the patient, encoder angle gauge (10) measuring the angle during the movement towards joint of the target organ, camera (11), infrared camera (12) tracking temperature of muscles running on the target organ, EMG (13) tracking electrophysiology in the muscles of the target organ, electrotherapy (14) activating the muscles in the target organ by transmitting electric current, sound wave module (15) tracking mass changes in muscles of the target organ by sound waves, marker and camera (16) connecting markers on the patient and performing movement efficiency analyses by tracking the markers electronically, biofeedback control mechanism (17) by which movement learning and execution levels of the patients can be tracked during treatment and control mechanism (18) enabling the operator to start and control the mechanism. The invention is used as following:

1^st Motor (1), 2^nd Motor (2), 3^rd Motor (3) and 4^th Motor (4) of the mechanism may be technically known and used as well as power generating motors. In our invention, electric powered step motor or servomotors are preferred.

11^st Motor (1) and 2^nd Motor (2) face each other. 3^rd Motor (3) is located at the side in a vertical axis to the mechanism. 4^th Motor (4) faces the 3^rd Motor. 3^rd Motor (3) and 4^th Motor (4) may march on the rails. Their locations may be adjusted according to height of the patient or direction of movement as desired.

There are servomotors in 1^st Motor (1), 2^nd Motor (2), 3^rd Motor (3) and 4^th Motor (4) as at least one for each. By increasing number of servomotors, movements desired to be executed by the patient may be identically practiced. Therefore, the instructed movement may be taught in a way practically usable in daily life.

There are motor boxes (5) on the 1^st Motor (1), 2^nd Motor (2), 3^rd Motor (3) and 4^th Motor. The motor box (5) protects the engines (1, 2, 3 and 4).

The string (7) developed by the invention may be technically known and used fixed inflexible materials and products establishing connection between engines (1, 2, 3 and 4) and flexible mechanism (8).

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The flexible mechanism (8) developed by the invention can connect the inflexible string (7) and splint (9). In return of inflexibility of the string (7), the flexible mechanism (8) is used to make data collection of sensors more efficient. In the mechanism, needed flexibility of the string (7) is compensated by the flexible mechanism (8). Therefore, more efficient data can be collected via sensors despite fixed and inflexible structure of the string (7).

Pressure gauges (6) are placed on the 1^st Motor (1), 2^nd Motor (2), 3^rd Motor (3) and 4^th Motor or connected string (7) as sensors. The pressure gauge (6) adjusted response of the motors (1, 2, 3 and 4) to the patient according to tension arising on the string (7). The pressure gauge (6) detects responses of the user to the movement during the period of reducing assistance for assisted movements requested in treatment and it also adjusts power applied by the motors (1 , 2, 3 and 4). The string (7) going the 1^st Motor (1), 2^nd Motor (2), 3^rd Motor (3) and 4^th Motor is connected with splint(9) on the user. The splint (9) is put on the target organ or limb of the user which is required to be activated. The splint (9) is put on the target organ or limb of the user and connected to the motor or roller used in treatment by the string (7) through front and back of the user.

There is a control mechanism (18) enabling operator to control and track the entire mechanism. The control mechanism (18) ensures operation of the entire mechanism and enables operator to command.

There are general and common issues applicable to all disorders for the method used for treatment of aforesaid disorders. To name the first, the movement should definitely be executed slowly. While commanding the movement, it should be felt that the user is executing the movement and he should be allowed to execute it by himself. Secondly, there are two muscles forming the movement. While the first muscle is executing the movement, the second controls speed of execution of the movement. While commanding the movement, not only the main muscle executing the movement should be activated but also the second muscle controlling speed of the movement should also be stipulated. If we take wrist practice as an example, a small portion of the power consumed to lift the wrist should be used to apply repulsive force downwards. In this way, both movement of lifting muscle is taught and lowering muscle is activated. Thirdly, contact of each muscle with the brain is ensured via different nerves. When we try to teach the movement to only a single muscle, we will learn movement of upwards and downwards direction of that muscle. On the other hand, as a principal, first and second muscles work together in the functioning mechanism of the brain. When we activate the first muscle, the brain shall not learn the movement. This is at odds with the functioning mechanism of the brain. What should be done is to transmit stimulation to the brain through upwards and downwards direction of the second muscle. When we stop while commanding the movement and drive in the counter direction a bit and return to the desired again, paths going down/up to the brain of the first and second muscles shall be stipulated together. And as it is more consistent with functioning mechanism of the brain, the movement shall be learnt better by the brain.

The motors (1, 2, 3 and 4) developed by the invention area used on opposite sides. While commanding a movement to the user, a motor draws and the motor on the opposite side moves in the reverse direction with less power. Therefore, the movement is transmitted to the user in a way most resembling to functioning mechanisms of his muscles and this movement is taught to him. Pressure gauge (6) as force meter, gravity meter and tension meter may be placed on the motors (1, 2, 3 and 4), string (7) or flexible mechanism (8). It measures the force or tension arising on the strain while the patient is executing the movement. The pressure gauge (6) developed by the invention may measure the change in torque force arising in the motors (1, 2, 3 and 4) in addition to measuring activities in the mechanism. The change in torque force arising in the motors (1, 2, 3 and 4) indicates movement execution efficiency of the patient. When the patient starts to execute the movements by himself, the decrease in torque force of the motors (1, 2, 3 and 4) indicates that the movement can be executed.

Encoder angle gauge (10) is placed onto the area of joint during functioning of the target organ. It can instantly track the angle arising during movement of the joint via the camera (11) across it.

Infrared camera (12) tracks the muscle functions on the target organ according to changes in temperature. Temperature increase during functioning of muscles and movement execution status may be tracked. Electrodes are attached to the muscles on the target organ via EMG (13). Electrophysiological changes arising on muscles during movements can be followed-up via electrodes. In this way, functioning level of the muscles can be identified.

Sound wave module (15) may be placed on the muscles functioning on the target organ. Mass change in the muscle during execution of movements may be followed-up via sound waves.

By the invention, whether the user executes the determined movements or not may be tracked by placing markers on the user via marker and camera system (16). Treatment efficiency, in terms of execution of the movements, may be tracked during the treatment. The markers on the user may be tracked via cameras located around the mechanism. Movement of markers can be recorded via camera and whether the movements are executed or not can be checked.

By the invention, biofeedback control mechanism (17) can be used during activation of the mechanism and treatment of the user. By the biofeedback control mechanism (17), while the movements are executed by the user via the mechanism, audio and visual alert can be received when the movement is properly executed by the user. This audio and visual alert indicates proper execution of the movement by the user and conditions him. In addition to the user, the audio and visual alert also gives instant information to the physician or operator about movement analysis of the user. It can instantly indicate movement analysis and efficiency of the user to the physician or operator.

The biofeedback .control mechanism (17) developed by the invention can be used by technically known and used televisions placed out of the mechanism. The television should be placed in a way that can be seen by both the user and practicing physician or operator.

Via the marker and camera (16) system brought by the invention, the user's movement is analyzed and his efficiency is brought into open. By assessing instant movement efficiency of the user during execution of the movement, electrical stimulation is transmitted to his target muscles if his movement execution efficiency is considerably low. In electrotherapy (14), electrodes are connected to the areas of target muscles depending on the applied treatment and executed movements. Electrodes enable functioning of the target muscles by transmitting electrical stimulation to them. By the marker and camera system, the muscles that cannot be activated by the user are detected according to the results of the movement efficiency analysis. Electrical stimulation is transmitted to the detected unused muscles via electrotherapy (14) mechanism.

Movement analysis results obtained during use of the mechanism by the user can be transferred to a central evaluation unit via wireless communication networks so as to be used for treatment of disorders related to nervous system damages. The date transferred to the evaluation unit can be externally tracked by the physician or operator administering the treatment. Especially during treatment period of the patients, the data of first and following stages of the treatment may be compared by the physician or operator. It is not compulsory to use the string (7) developed by the invention for connection between the string (7) and splint (9). Not only direct connection between the string (7) and splint (9) is possible but also the flexible mechanism (8) may be located on any point on the string (7). It is not compulsory to use the flexible mechanism (8) brought by the invention for connection between the string (7) and splint (9). Not only direct connection between the string (7) and splint (9) is possible but also the flexible mechanism (8) may be located on any point on the string (7). In general implementation of the mechanism, the splint (9) is put on the target organ or limb desired to be treated. The splint (9) is connected to the flexible mechanism (8). The string is connected to the front and rear connection points of the flexible mechanism (8). The string (7) connected to the flexible mechanism (8) is linked to the motor executing the movements determined for treatment of the selected target organ or limb. The movements required by treatment are ensured via motors under control of the sensors on the string (7) or motors (1, 2, 3 and 4).

The movements applied to the target organs or limbs for treatment method of aforesaid disorders are as following:

In practice for arms and legs;

Let's take the movement of shoulder lifting and downing to understand how movements are executed for the arms.

A splint (9) is put on the arm so as to prevent bending of elbow. The flexible mechanism (8) is on the splint (9). The flexible mechanism (8) is connected to the motors by inflexible strings (7). One of the strings (7) is connected to 2 Motor (2) on leg part and other string (7) is connected to the 1^st Motor (1) on the head part. The arm comes next to the body by pushing up and down the arm thanks to the strings (7). The arm rises at head level by push up. The sensors connected to the motors and force or tension measuring pressure gauge (6) pulls the shoulder to push it up so as to create 1^st Motor (1) movement at head part. 2^nd Motor (2) on the leg part pushes the movement down so as to control it. However, the 2^nd Motor (2) on the lower part does not apply power as near as to prevent execution of the movement. The motors ensure execution of the movement under control and at a certain sp$ed frOrii the starting to finishing point of the movement.

When the kid wishes to execute the movement, the sensors detects the movement by stepping in and allows the kid to execute the movement. When the kid leaves executing the movement, the sensors detect it arid motors continue to command the movement. While power of the motor ensuring push up in every second remains stable, the power of the motor ensuring push down exceeds the power of former engine by a slight difference for a very short period of time. The engine ensuring push down movement never generates the movements. Only cessation occurs in this action. The movement of pushing up arm occurs in standstill as explained. The timing of movement of cessation differs depending on the needs.

The sensors detect arm contraction arising within different intervals during occurrence of the movement and allow execution of the movement in arm's contraction direction so as not to prevent occurrence of the movement. In addition to this, they allow execution of the movement by granting maximum resistance without preventing the movement. In this way, the contracted muscle is taught the movement by granting resistance to it. This operation continues until the contracted muscle allows full execution of the movement in the space of the joint. Thus, all actions on the arms and legs are activated by splints (9) ensuring execution of the movement. Wrist flexion/extension:

During practicing the wrist, the splint (9) is put on the palm. The splint is connected to the flexible mechanism (8). The flexible mechanism is connected to front and rear motor by the string. Shoulder and elbow joints are fixed. It is ensured that shoulder and elbow joints do not move. While the front motor is pushing up the wrist, the motor on the opposite side creates resistance in reply to the movement.

Hip flexion/extension:

During practicing the hip, the splint (9) is put on the ankle. The flexible mechanism (8) is connected to front and rear motor by the string. While the front motor is pushing up the leg through the ankle, the motor on the opposite side creates resistance in reply to the movement.

Shoulder flexion/extension:

During practicing the shoulder, the splint (9) is put on the wrist. The splint (9) is connected to the flexible mechanism (8). The flexible mechanism (8) is connected to front and rear motor by the string. Elbow joints may/may not be fixed. In case of fixing, it is ensured that elbow joints do not move. While the front motor is pushing up the arm through the shoulder, the motor on the opposite side creates resistance in reply to the movement. External/Internal Shoulder Rotation:

During practicing the shoulder, the splint (9) is put on the wrist. The splint (9) is connected to the flexible mechanism (8). The flexible mechanism (8) is connected to front and rear motor by the string. The shoulder is positioned so as to be vertical to the body. While the front motor is pushing up the forearm through the shoulder, the motor on the opposite side creates resistance in reply to the movement. Hand fi ger flexion/extension! ■ I Γ< · i · · : ' j I ' ' : ί

During practicing the hand fingers, the splint (9) is put on every finger other than the thumb. The splint (9) is connected to the flexible mechanism (8). The flexible mechanism (8) is connected to front and rear motor by the string. While the front motor is bending and pushing the hand fingers, the motor on the opposite side creates resistance in reply to the movement.

Hip abduction/adduction:

When the patient is put to the bed vertically during practicing the hip, the splint (9) is put on the ankle. The splint (9) is connected to the flexible mechanism (8). The flexible mechanism (8) is connected to front and rear motor by the string. While the motor on the side, is opening the single leg and foqt of the patient laying on his back laterally and closing them inward, the motor on the opposite side creates resistance in reply to the movement.

For usage of front and rear motors when the patient is put on the mechanism vertically in the hip movement, connection accessories and rollers reach out from front and rear motors to the sides. In this way, functioning of motors at different axes can be ensured.

When the patient is put on the mechanism horizontally, usage of side motors is ensured. Side motors enable execution of the movement by replacing front and rear motors. Ankle plantarflexion/dorsiflexion:

During practicing the ankle, the splint (9) is put on the upper part of the heel.

The splint (9) is connected to the flexible mechanism (8). The flexible mechanism (8) is connected to front and rear motor by the string. The patient is put on the mechanism horizontally. While the front motor is pushing and drawing the ankle, the motor on the opposite side creates resistance in reply to the movement. Thumb abduction/adduction:

During practicing the thumb, the splint (9) is put on the thumb. The patient is put on the mechanism horizontally. The splint (9) is connected to the flexible mechanism (8). The flexible mechanism (8) is connected to front and rear motor by the string. Wrist, shoulder and elbow joints are fixed. While the front motor is executing inside-outside movement of the thumb, the motor on the opposite side creates resistance in reply to the movement.

Elbow flexion/extension:

During practicing the elbow, the splint (9) is put on just under the wrist. The splint (9) is connected to the flexible mechanism (8). The flexible mechanism (8) is connected to front and rear motor by the string. The patient is put on the mechanism horizontally. While the front motor is pushing and drawing the elbow, the motor on the opposite side creates resistance in reply to the movement.

Knee flexion/extension:

During practicing the knee, the splint (9) is put on a just under the ankle. The splint (9) is connected to the flexible mechanism (8). The flexible mechanism (8) is connected to front and rear motor by the string. The patient is put on the mechanism face-down. While the front motor is pushing and drawing the ankle, the motor on the opposite side creates resistance in reply to the movement.

Forearm supination movement

During practicing the forearm, the splint (9) is put on the wrist. The splint (9) is connected to the flexible mechanism (8). The string (7) is fastened to the flexible mechanism (8) so as to cover around the wrist. The flexible mechanism (8) is connected to front and rear motor by the string. Shoulder and elbow joints are fixed. It is ensured that shoulder and elbow joints do not move. While the front motor is turning the ankle in its axis, the motor on the opposite side creates resistance in reply to the movement. Practicing the movement from different axes simultaneously during the treatment applied to the target organ ensures that the movement is taught so as to be used in daily life. For instance, it is ensured in hip flexion/extension movement that 3^rd Motor (3) and 4^th Motor (4) executes the movement from sides in addition to use of 1^st Motor (1) and 2^nd Motor (2). Therefore, it is enabled that the movement is executed at both horizontal and vertical axes simultaneously. It is ensured by use of all motors (1, 2, 3 and 4) from different axes that the movements taught can be consistently repeated in the right direction. For example, during the hip flexion extension movement, muscles of hip making pulling up and pushing down movement do not work individually but also the muscles providing the stability also work so that a movement in a plain plane occurs during such movement. In order to cause the muscles providing the stability to function, it is also necessary to cause Motor 3 (3) and Motor 4(4) to function so that it is necessary to teach the determined movement. The contribution of Motor 3 (3) and Motor 4(4) to the movement may also be used in other movement groups. The invention, mechanism to treat movement disorders arising in extremities due to nervous system damages, can be integrated to where the patient is located or the bed on which he lays. It can be integrated personal bed of the patient, sickbed or examination bed. By the mechanism developed to be used for treatment of nervous system damages, the users are allowed to simultaneously execute the treatment movements indicated above. The splints (9) connected to relevant limbs may be connected to the motors (1, 2, 3 and 4) by use of more than one string (7). Execution of more than one movement simultaneously can also be ensured by increasing number of motors in the sections where the motors (1 , 2, 3 and 4) are located.

Claims

1- This invention is related to a mechanism to be μsed for treatment of disorders caused by nervous system damages and its features are as following:

- 1^st Motor (1) located on the front side of the mechanism used as power generating motors;

- 2^nd Motor (2) located on , the read side of the mechanism used as power generating motors;

- 3^rd Motor (3) and 4^th Motor (4) located on the read side of the mechanism used as power generating motors;

- Splint (9) put on the target organ or limb required to be moved by the user;

- Flexible mechanism (8) establishing the connection between the inflexible string (7) and splint(9);

- The string (7) establishing the connection between motors (1, 2, 3 and 4) and flexible mechanism (8);

- Pressure gauge (6) placed on the motor (1, 2, 3 and 4), string (7) or flexible mechanism as force meter, gravity meter and tension meter;

- It is placed on the junction area during functioning of the target organ.

- Encoder angle gauge (10) instantly tracking the angle arising during movement of the joint via the camera (11) across it;

- Infrared camera (12) tracking the muscle functions on the target organ according to changes in temperature;

- EMG (13) enabling follow-up of electrophysiological changes arising on muscles by electrodes connected to the muscles on the target organ;

- Sound wave module (15) placed on the muscles functioning on the target organ and enabling follow-up of mass change in the muscle during execution of movements and

- Range gear (12) enabling back-and-forth movement of the 9 Motor (11) on middle support (1.1) and side support ( 1.2). 2- It is a mechanism to be used treatment of nervous system damages indicated in Claim 1 and it has a marker and camera (16) system enabling creation of movement analysis via follow-up of the markers on the user by the cameras installed.

3- It is a mechanism to be used treatment of nervous system damages indicated in Claim 1 and it has a biofeedback control mechanism (17) enabling transmission of audio or visual alert during execution of the movements by the user.

4- It is a mechanism to be used treatment of nervous system damages indicated in Claim 1 and it has the feature of electrotherapy (14) by transmitting electrical stimulation to the target muscle.