WO2007014423A1

WO2007014423A1 - Exercise apparatus

Info

Publication number: WO2007014423A1
Application number: PCT/AU2006/001089
Authority: WO
Inventors: Robert Barnard; Reuben Vanderzalm
Original assignee: Medvet Science Pty, Ltd.
Priority date: 2005-08-02
Filing date: 2006-08-01
Publication date: 2007-02-08

Abstract

Exercise apparatus for exercising the lower limbs of a patient undergoing dialysis, when in a seated position facing the apparatus. The apparatus comprises a wheeled frame manoeuvrable into a position in front of the user and being open to permit the user's legs to extend into the apparatus. A resistance system is carried by the frame and is operative to apply a resistance to user-induced movement in one direction under effort applied by the user and to apply a return loading to the user when that effort is released. A footrest mounted in a lower part of the frame for movement in a front to rear direction, is coupled to the resistance system such that forwards movement of the footrest by knee and hip extension of the user will occur against the resistance of the resistance system. Facility is also provided for exercising plantar flexion, dorsi flexion, and hip abduction and adduction.

Description

EXERCISE APPARATUS

The present invention relates to exercise apparatus for use by patients undergoing dialysis.

Patients with end stage renal disease usually suffer from a variety of chronic health conditions that contribute to limited physical fitness and limited strength which can impede a patient's capacity to undertake daily work and leisure activities. The research suggests that the decline in strength and fitness need not occur if patients undertake appropriate exercise. Dialysis typically takes place in sessions lasting several hours perhaps every second or third day. While indications are that patients would prefer to undertake exercise actually during dialysis and this is undertaken in some dialysis units, the physical gains made by patients exercising during dialysis are currently not as great as those made by patients exercising outside of dialysis and it is believed that this is principally due to the absence of equipment that can be used by patients to exert themselves to the necessary intensity during dialysis.

As would be well understood, dialysis normally takes place while the patient is seated usually in a special chair designed for that purpose with a range of adjustments. The invention seeks to provide apparatus for exercising and strengthening the lower limbs of the patient when seated while undergoing dialysis.

According to the present invention there is provided resistance exercise apparatus for exercising the lower limbs of a seated patient, the apparatus comprising a frame manoeuvrable into position in front of the seated patient, the frame being open to permit access by the legs of the patient when performing exercise, and resistance exercise devices carried by the frame and engageable by the lower limbs to enable at least some of: knee and hip extension, plantar flexion, dorsi flexion, knee flexion, hip abduction and adduction.

Although the invention has particular utility to dialysis patients it is not restricted in its broad scope to that specific usage and it can also be used as a rehabilitative aid for other patients that are required to be seated for extended periods of time. In one form of the invention, the apparatus includes a common resistance system, such as an adjustable set of weights, to which each of the exercise devices can be operatively connected.

Further according to the present invention there is provided exercise apparatus for exercising the lower limbs of a user in a seated position facing the apparatus, the apparatus comprising a wheeled frame manoeuvrable into a position in front of the user and being open to permit the user's legs to extend into the apparatus, a resistance system carried by the frame and operative to apply a resistance to user-induced movement in one direction under effort applied by the user and to apply a return loading to the user when that effort is released, a footrest mounted in a lower part of the frame for movement in a front to rear direction, means for coupling the footrest to the resistance system such that forwards movement of the footrest by knee and hip extension of the user will occur against the resistance of the resistance system, means coupled to the resistance system for exercising dorsi flexion, and means coupled to the resistance system for exercising plantar flexion.

Preferably, the apparatus also includes means coupled to the resistance system for exercising hip abduction and adduction.

Preferably, the apparatus also enables exercising knee flexion. This function may be performed by the means for exercising dorsi flexion.

Advantageously the resistance system uses an adjustable weight which is raised under effort applied by the patient and which lowers when that effort is eased. Alternatively, the resistance system could comprise one or more springs, rubber bands, elastic bands, one or more gas springs, or a hydraulic system. However the system formed by the rising and falling weight is to be preferred as the weight can easily and accurately be adjusted to provide a required degree of resistance to suit a particular user.

Preferably, the footrest and the means for exercising the other defined types of movement are coupled to the resistance system by a cable system.

In one preferred form, the means for exercising plantar flexion comprises, for each foot, a sling suspended from a cable and extending over an adjacent pulley. Preferably, the means for exercising dorsi flexion comprises, for each foot, a sling suspended from a cable and passing over an adjacent pulley. Preferably the means for exercising hip abduction and adduction comprises, for each foot, a sling suspended from a cable and passing around an adjacent pulley.

The pulleys associated with the slings used for exercising plantar flexion are preferably mounted to the frame forwardly of, and at a higher level than, those associated with the slings for exercising dorsi flexion.

The pulleys associated with the slings for exercising plantar flexion may be carried by supports which enable the pulleys to be displaced from their operative position to a stowed, inoperative, position which may be towards the rear of the apparatus. This can ensure that the interior of the frame remains free and unobstructed when those pulleys are not in use.

The pulleys associated with the slings for enabling hip abduction and adduction are mounted at each side of the frame preferably in positions which are adjustable in a fore-aft direction to permit adjustment to suit particular users.

In the preferred embodiment, a main cable is coupled to the resistance system and the other cables are coupled to the main cable either permanently or releasably and either directly, or indirectly via further cables. The various cables are routed along cable paths defined by cable pulleys mounted principally in the base part of the frame.

According to a further aspect of the invention there is provided a method of exercising a seated patient undergoing dialysis, comprising manoeuvring the exercise apparatus as defined above into position in front of the patient and using the apparatus to exercise at least some of the following in accordance with an exercise program determined for that patient: knee and hip extension, plantar flexion, dorsi flexion, knee flexion, hip abduction and adduction.

An embodiment of the invention will now be described by way of example only with reference to the accompanying drawings in which:

Figure 1 is a schematic plan view of the exercise apparatus in accordance with the preferred embodiment and including a range of exercise devices;

Figure 2 is a schematic side view of the apparatus shown in Figure 1;

Figure 3 is a schematic side view showing an exercise device used for plantar flexion of the foot;

Figure 4 is a schematic side view showing an exercise device for exercising dorsi flexion of the foot. This figure also illustrates schematically how this exercise device can also be used for knee flexion;

Figure 5 is a schematic view from the front of an exercise device for hip abduction and adduction;

Figure 6 is a perspective view from the front showing the apparatus in greater detail, with the pulleys of the exercise device for plantar flexion being shown in an inoperative, stowed, position;

Figure 7 is a fragmentary perspective view equivalent to Figure 6 but showing the apparatus from one side; and

Figure 8 shows in greater detail the rear part of the apparatus in which one of the pulleys of the exercise device for plantar flexion is shown in its operative position and the other in its inoperative position.

The exercise apparatus in accordance with the preferred embodiment of the invention provides so-called resistance training and comprises a frame 2 mounted on castor wheels 4 which are lockable whereby the apparatus can be manoeuvred into position in front of a seated patient and then locked into position. The frame 2 is open at the front to permit the legs of the patient to pass freely into the interior of the frame so as to undertake the various exercise routines as will be described. The interior space of the frame 2 is sufficient to avoid interference between the frame and the user's legs when the hips are abducted through the full range of motion with the knees folly extended and the feet plantar flexed.

At its rear, the frame 2 is configured to carry a resistance system formed by a variable stack of weights 6 which are raised and lowered along vertical supports 8 in a controlled manner as a result of effort by the user. The arrangement of the weights 6 and the vertical supports 8 is substantially the same as that used on or in conventional resistance training equipment as may be found in gyms. The base of the frame 2 has extensions 2a rearwardly of the weight stack 6 and the extensions 2a carry the rear set of castor wheels 4 in order to provide a structure which remains stable during operation of the apparatus. The weight stack 6 is linked to a main cable 9 (see Figures 6 to 8) which passes from the stack upwardly around an upper pulley 10a (see Figures 2 and 6) and then downwardly towards the base part of the frame 2 in which it passes over one or more pulleys 1 Ob for selective coupling by additional cables to different exercise devices within the apparatus to provide a range of hip, leg, knee and foot exercises. As will be described, when the main cable is pulled under effort exerted by the user, the weights are raised and subsequently lowered in a controlled manner while resisted at least to an extent by effort exerted by the user. It is to be noted that the cables are not shown in the schematic illustrations of Figures 1 and 2, and some, but not all, of the cables are shown in the more detailed illustrations of Figures 6 to 8.

The exercise devices as provided within the apparatus will now be described.

A first exercise device comprises a footrest 20 for the two feet of the user. The footrest comprises a forwardly-facing, upwardly inclined, platform 22 carried by a trolley mounted within a central part of the base of the frame for movement in a fore-aft direction from the front of the frame towards the rear of the frame. For this purpose, the trolley has rollers by which it is mounted on laterally-spaced longitudinal rails 24 within the base part whereby the footrest 20 lies between the two rails 24. A supplementary cable linked to the trolley extends forwardly around a forward pulley 1 Oc at the forward end of the frame in the base part thereof and then rearwardly to be coupled with the main cable 9 during use. With the soles of the feet resting firmly platform 22 of the footrest 20, the user can push the footrest 20 towards the rear of the frame against the resistance caused by the effort needed to raise the weights. The user then relaxes the effort whereby the weights fall in a user-controlled manner thereby returning the trolley to the forward end of the frame. This cycle of movement provides knee and hip extension which predominantly strengthens the quadriceps and gluteal muscle groups.

A second exercise device is used for plantar flexion of the foot. It comprises two slings 26, one for each foot (see Figure 3). Each sling 26 is coupled to a supplementary cable passing over a pulley 28 at a height approximately equivalent to waist height of the seated patient. The cable is routed towards the rear of the frame and then passes downwardly to the base of the frame in which it follows a forwards and then rearwards path via a forward pulley 1Od, to be coupled with the main cable 9 so that when the sling cable is pulled the weights will be raised. The sling pulleys 28 are located within the central part of the frame as considered in a fore-aft direction and are laterally spaced so that the user can place one foot in each sling 26 with the legs spread apart by a comfortable distance. In order to prevent the pulleys 28 from impeding access into the interior of the framework while other exercises are being undertaken, it is preferred that each pulley 28 is carried by an arm 30 mounted at the rear of the frame for swinging movement between an inoperative, stowed, position at the rear of the frame in which the arms 30 project sideways and an operative position (this is the position shown in Figures 1 and 2) in which the arms 30 extend forwardly from the rear of the framework to locate the pulleys at the required position. Figures 6 and 7 show the pulleys 28 in their inoperative position and Figure 8 shows one pulley 28 in its operative position and the other pulley 28 in its inoperative position. When the toe part of the foot (the distal third) is within the sling 26, the toe part can be pushed rearwardly and downwardly (as shown by the arrow A in Figure 3) against the resistance caused by the consequent lifting of the weights.

A third exercise device is used for exercising dorsi flexion of the foot, again using a pair of slings 26 which may be the same slings 26 as those used for plantar flexion. In this case, the slings 26 (see Figure 4) are carried by supplementary cables passing over pulleys 32 mounted towards the rear of the frame at a lower level than the pulleys 28 for exercising plantar flexion. The pulleys 32 are likewise spaced apart by a distance to suit operation with the legs of the user extending forwarding and spaced apart by a comfortable distance. The cable passes from the sling 26 around the rear pulley 32 and then downwardly towards the base of the frame to be routed via further pulleys such as the forward pulley 1 Od to an appropriate position for coupling with the main cable 9 so that when the cable is pulled, the weights are raised. For this exercise, the entire foot is placed through the sling 26 so that the sling lies forwardly of the toe portion. The effort then required to pull the toe forwards (as shown by arrow B in Figure 4).will then be resisted by raising the weights via the cables.

This device can also be used for knee flexion. In that case the device is set up as described above except the foot is inserted through the sling as far as the ankle. The effort required to pull the foot downwardly and forwardly (as shown by arrow C in Figure 4) is resisted by raising the weights via the cables.

A fourth exercise device for hip abduction and adduction, again uses a pair of foot slings 26 which may be the same as those used for the exercises discussed above. In this case each sling 26 (see Figure 5) is associated with a pulley 36 mounted at each side of the frame approximately midway along its length. With each of the exercise devices previously described, the effort applied by the user is basically in a rearwards/forwards direction, however for hip abduction/adduction, the movement is basically a lateral movement achieved by swinging each leg laterally from an outer position to an inner position with the legs extending forwardly. For this purpose, the pulley 36 associated with each sling is oriented with its plane transverse to the fore-aft axis. The pulleys 36 are positioned at approximately the same height as the pulleys 32. The associated supplementary cable passes around the pulley 36 downwardly around a second pulley 1Oe at the base of the frame to be routed via one or more further pulleys such as the forward pulley 1Od for connection to the main cable 9 whereby when the sling cable is pulled, the weights will be raised. In use, the entire foot will be inserted through the sling so that the sling supports the ankle and each leg is separately swung laterally from an outer position to an inner position (as shown by arrow D in Figure 5) thereby raising the weights which act to resist that movement. The leg is then allowed to return to its outer position under the effect of the falling weights with the user again trying to resist that movement.

With the first, second and third exercise devices previously discussed, as the required movement is in a fore-aft direction, to an extent the devices are inherently self- compensating for different leg lengths and all can accommodate the normal range of leg lengths. However with the lateral movement which takes place with this fourth exercise device, it is possible that some fore-aft adjustment in the position of the pulley 36 may be required to accommodate a range of different leg lengths. For this purpose it is preferred that each pair of upper and lower pulleys (36, 1Oe) are mounted to a common support 38 which is movable along the associated side of the frame into a selected fore-aft position to suit a particular user. The support 38 can be locked in its selected position simply by friction forces as the forces exerted on the assembly during operation will be transverse to the side of the frame and thereby not acting in a sense to cause displacement in a fore-aft direction.

Although it is preferred for the apparatus to include exercise devices for all of the various exercises discussed, it is possible that other versions of the apparatus may omit at least one of the exercise devices, for example that for hip abduction/adduction. In the embodiment described, a separate device is provided for exercising plantar flexion using the slings. In an alternative it is envisaged that this facility could be incorporated on the platform 22 primarily used for exercising knee and hip extension.

Depending on the specific design of the various cable paths through the apparatus and possible redundancies in the length of the various cables when their associated exercise devices are not actually in use, it is possible that each of the cables could be permanently connected to the main cable either directly or indirectly through other ones of the supplementary cables. Alternatively, however, it may be necessary for certain of the supplementary cables to be connected to the main cable (directly or indirectly) only when the associated exercise device is in use, and in that case a suitable quick connect/disconnect cable coupling can be incorporated. For those of the exercise devices which use slings which interact with various parts of the foot, the apparatus may be supplied with just a single pair of slings which are able to be removably coupled to the outer ends of each set of supplementary cables of the particular exercise device. Alternatively each exercise device may be provided with its own set of foot slings purpose- designed to suit the particular exercise activity.

Figures 1 and 2 show in broken lines certain of the pulleys mounted to the frame for routing the supplementary cables and the main cable and represent one of many possible cable routing arrangements which could be used. To an extent, this will depend on the detailed design of the frame.

It is to be understood that the specific design of the overall frame may differ from that shown. However, it is important that the framework provides an "open" interior into which the legs of a patient seated directly in front of the apparatus can extend and can move while performing the various exercises without physical impediment from other parts of the apparatus.

Although the exercise apparatus has particular utility for dialysis patients, nevertheless it can also be used as a rehabilitative aid for patients that for various reasons are required to be seated for extended periods of time. Such patients include both the elderly population and patients that have suffered an injury, and are forcibly sedentary due to a lack of lower body muscular strength.

The embodiment has been described by way of example only and modifications are possible within the scope of the invention.

Throughout this specification and claims which follow, unless the context requires otherwise, the word "comprise", and variations such as "comprises" or "comprising", will be understood to imply the inclusion of a stated integer or group of integers or steps but not the exclusion of any other integer or group of integers.

Claims

CLAIMS:

1. Resistance exercise apparatus for exercising the lower limbs of a seated patient, the apparatus comprising a frame manoeuvrable into position in front of the seated patient, the frame being open to permit access by the legs of the patient when performing exercise, and resistance exercise devices carried by the frame and engageable by the lower limbs to enable at least some of: knee and hip extension, plantar flexion, dorsi flexion, knee flexion, hip abduction and adduction.

2. Resistance exercise apparatus according to claim 1, having a common resistance system, such as an adjustable set of weights, to which each of the exercise devices can be operatively connected.

3. Resistance exercise apparatus for exercising the lower limbs of a user in a seated position facing the apparatus, the apparatus comprising a wheeled frame manoeuvrable into a position in front of the user and being open to permit the user's legs to extend into the apparatus, a resistance system carried by the frame and operative to apply a resistance to user-induced movement in one direction under effort applied by the user and to apply a return loading to the user when that effort is released, a footrest mounted in a lower part of the frame for movement in a front to rear direction, means for coupling the footrest to the resistance system such that forwards movement of the footrest by knee and hip extension of the user will occur against the resistance of the resistance system, means coupled to the resistance system for exercising dorsi flexion, and means coupled to the resistance system for exercising plantar flexion.

4. Resistance exercise apparatus according to claim 3, including means coupled to the resistance system for exercising hip abduction and adduction.

5. Resistance exercise apparatus according to claim 3 or claim 4, having means for exercising knee flexion.

6. Resistance exercise apparatus according to any one of claims 3 to 5, wherein the resistance system uses an adjustable weight which is raised under effort applied by the patient and which lowers when that effort is eased.

7. Resistance exercise apparatus according to any one of claims 3 to 6, wherein the footrest and the means for exercising the other defined types of movement are coupled to the resistance system by a cable system.

8. Resistance exercise apparatus according to claim 7, wherein the means for exercising plantar flexion comprises, for each foot, a sling suspended from a cable and extending over an adjacent pulley.

9. Resistance exercise apparatus according to claim 7 or claim 8, wherein the means for exercising dorsi flexion comprises, for each foot, a sling suspended from a cable and passing over an adjacent pulley.

10. Resistance exercise apparatus according to claim 8 and claim 9, wherein the pulleys associated with the slings used for exercising plantar flexion are mounted to the frame forwardly of, and at a higher level than, those associated with the slings for exercising dorsi flexion.

11. Resistance exercise apparatus according to claim 8 or claim 10, wherein the pulleys associated with the slings for exercising plantar flexion are carried by supports which enable the pulleys to be displaced from their operative position to a stowed, inoperative, position towards the rear of the apparatus.

12. Resistance exercise apparatus according to claim 4 and any one of claims 7 to 11, wherein the means for exercising hip abduction and adduction comprises, for each foot, a sling suspended from a cable and passing around an adjacent pulley.

13. Resistance exercise apparatus according to claim 12, wherein the pulleys associated with the slings for enabling hip abduction and adduction are mounted at each side of the frame in positions which are adjustable in a fore-aft direction to permit adjustment to suit particular users.

14. Resistance exercise apparatus according to claim 7 or any claim dependent on claim 7, wherein a main cable is coupled to the resistance system and the other cables are coupled to the main cable either permanently or releasably and either directly, or indirectly via further cables.

15. A method of exercising a seated patient undergoing dialysis, comprising manoeuvring resistance exercise apparatus according to any one of claims 3 to 14 into position in front of the patient, and using the apparatus to exercise at least some of the following in accordance with an exercise program determined for that patient: knee and hip extension, plantar flexion, dorsi flexion, knee flexion, hip abduction and adduction.