WO2010054447A2

WO2010054447A2 - Rehabilitation device

Info

Publication number: WO2010054447A2
Application number: PCT/BE2009/000056
Authority: WO
Inventors: Bruno Lequeux
Original assignee: Bruno Lequeux
Priority date: 2008-11-14
Filing date: 2009-11-10
Publication date: 2010-05-20
Also published as: BE1018843A3; CA2779680A1; WO2010054447A3; EP2362802A2

Abstract

The invention relates to a device (10, 80) for the physical rehabilitation and/or training of a person, that comprises a base (20, 90) and a mobile member (30, 100) capable of moving relative to the base (20, 90) according to one degree of freedom, guided by guiding means and slowed down by adjustable braking means, wherein the mobile member (30, 100) is provided with accessory attachment means (60, 70) for gripping or securing the limbs of said person. The device (10, 20) includes an assembly of position sensors (120) and pressure sensors (130) that can be secured on the mobile member (30, 100), on a gripping accessory (60, 70) secured on the mobile member and/or on the person, and a controller (110) capable of receiving signals transmitted by said position sensors (120) and pressure sensors (130) that enable the controller (110) to perform a biomechanical three-dimensional analysis, and to model and objectify the existing force momentum and the quality of the muscular exercise executed in order to provide movement rules and instructions to the person so that he/she can correctly execute a physical rehabilitation and/or training programme.

Description

Rehabilitation device

TECHNICAL FIELD [0001] The invention relates to the field of devices that can be used for the rehabilitation and rehabilitation of patients, for the training and weight training of sportsmen and for the prevention of physical problems and the well-being of persons. DESCRIPTION OF THE STATE OF THE ART [0002] It is recognized that for the rehabilitation of patients, control of the parameters of the movements performed is essential. Among the modes of mobilization, we distinguish the following modes: the isotonic mode, in which the effort provided by the muscle is constant; the isometric mode, in which the muscle provides a determined effort, and the limb does not move; the isokinetic mode, in which the limb moves at a predetermined speed, and provides a variable effort. The practitioner wishes to select among these various modes, the one that is best suited to the purpose. WO0110508 discloses a rehabilitation device comprising position detectors can be attached to a patient member and able to transmit position signals of the member or members to which the detectors are attached and a controller capable of receiving and recording the said signals and to communicate to the patient instructions as to the exercise to be performed. This device therefore makes it possible to choose a program of movements to be performed by the patient and to check the correct execution of this movement program. However, this device is purely passive and only allows to measure positions and angles, and incidentally, the forces exerted by the foot of the patient on the ground (Examples 6 and 7). However, it does not allow to impose a movement on a member of the patient, or to apply a force on this member. The applicant of the present invention has developed a device for proprioceptive rehabilitation and / or physical training, known as the name "Giroplan" and described in EP0240497. The "Giroplan" is made up of 3 interconnected elements: (1) A 360 ° turntable on which accessories can be mounted that allow to work all parts of the body. The plate has an adjustable brake, which adjusts the braking torque. (2) An electronic interface connected to the turntable brake which defines and controls the treatment by determining for example a range of motion to be traversed, a modular resistor best suited to the needs of patients, a speed of execution to be achieved or not not exceed, posture times at locations beneficial to the patient, a fixed number of Insistence Amplitudes to be performed in each direction, (3) a database that keeps the processing data and allows to visualize its evolution. This device has many advantages, such as its simplicity, its lightness, which allows the therapist to use it at the bedside of patients and / or in home visits, its flexibility for a wide class of exercises and pathologies. This apparatus having an adjustable and controllable electromagnetic brake and a measurement of the angle of the turntable allows the user to perform in a controlled manner any type of exercise in which the resistance force and the speed of execution can be variable in a programmed amplitude. However, it does not allow exercises in which the force, motion or combination is imposed by the device in a passive, active, isokinetic or isotonic (concentric or eccentric) mode. It also does not allow to track the position and movement of a patient's limb in the three dimensions of space and to impose a movement, while measuring the reaction force and to visualize and model precisely the target musculature. in action of the patient, or to apply a force on this member, by measuring the resulting displacement and thus objectifying in real time the scope of the three-dimensional rehabilitation initiated by the Giroplan. There is therefore a need for a device that is simple, lightweight and transportable, usable for a wide class of pathologies and training, and that allows to impose the patient exercises in which the force and / or movement (position, speed, acceleration) of a specific limb or segment of the patient is imposed by the device. Summary of the invention

The invention provides a device for rehabilitation and / or physical training of a person. The device comprises a base and a movable member adapted to move relative to the base according to a degree of freedom guided by guide means. The movable member is provided with means for fixing accessories for gripping or fixing members of the said person. According to the invention, the device comprises a set of position and / or pressure sensors placed on the movable member, the accessories, or on the body of the user. The device comprises a controller receiving position and exerted pressure information capable of inferring in real time the biomechanical characteristics of the movements performed by the user, to model the quality of muscle work and to give back movement instructions to the user. the person to properly carry out the rehabilitation and / or physical training program. We thus have a portable device, flexible of use, which can be easily adapted which makes it possible to exploit all the registers of the functional reeducation: Neurology, Pediatrics, Geriatrics, Rheumatology, Traumatology, Orthopedics, Traumatology, hemiplegia, the physical preparation of athletes. [0007] Preferably, slave motor means directly drive said movable member and are able to impose on the user movements: passive or active, isometric, isokinetic or isotonic (concentric or eccentric). They advantageously comprise a torque servomotor comprising a stator with a large number of poles and a rotor comprising permanent magnets, the rotor directly driving the movable member. By "large number of poles" is meant, in the context of the present invention, a number greater than 6, typically 32 or 64. [0008] In a first embodiment of the invention, the mobile member is a plateau capable of moving according to a degree of freedom of rotation relative to the base. The torque servomotor is in this case a rotary motor, and the guide means are circular.

In a second embodiment of the invention, the movable member is a carriage adapted to move with a degree of freedom of translation relative to the base. The torque servomotor is in this case a linear motor, and the guide means are also linear. The controller is advantageously connected to a display that indicates to the person instructions to move, the movements actually made and corrections to make. The instructions can also be transmitted in sound form, for example by tones, or a voice synthesis device.

The attachment means of accessories may comprise a plurality of parallel dovetail grooves in which the accessories can be fixed. This gives a great flexibility in the choice of positions of the accessories. Preferably, the set of position sensors comprises radio-identification radio-tags, also known as "RFID tags" (Radio Frequency Identification).

Brief description of the drawings

[0013] FIG. 1 is a perspective view of a first embodiment of a device according to the invention in which the movement is rotary.

[0014] FIG. 2 is a perspective view of a second embodiment of a device according to the invention in which the movement is linear. [0015] FIG. 3 is a block diagram showing components of a device according to the invention, and their interactions.

Figs. 4a and 4b are respectively a view from above and a view from below of a device according to the first embodiment of the invention. Figs. 5a, 5b and 5c are respectively a bottom view of a plate, the top of a base and the side of a device according to the first embodiment of the invention.

[0018] FIG. 6 is a bottom view of a device according to the second embodiment of the invention. Figs. 7a, 7b and 7c are respectively a bottom view of a carriage, the top of a base and the side of a device according to the second embodiment of the invention.

[0020] FIG. 8 is an anterior view and a rear view of a person on which position sensors of a device are disposed according to the invention.

Figs. 9a, 9b and 9c are respectively a view of the dorsal surface and the palmar surface of a hand, and of the plantar surface of a foot of a person on which position sensors and pressure sensors are arranged. a device according to the invention.

Detailed description of the invention

Referring to FIG. 1, there is described a first embodiment of the invention: the rotary rehabilitation device 10. The arrangement of the base 20, the plate 30 and its accessories is in all respects similar to the "Giroplan" of the aforementioned prior art . The device 10 comprises a base 20 on which is rotatably mounted a plate 30. The base 20 can be positioned in various inclinations by being hinged by means of a hinge 40 to a base 50. The position of the base 20 is then maintained by means of a telescopic rod and fastening means. The plate 30 is rotatably mounted on the base 20. It is possible to mount on this plate 30 various accessories for gripping or fixing a limb. Fig. 1 represents the example of a footrest 60 in which the foot of the patient is held by means of a strap, which allows the person to apply a pressure force or traction. It is advantageous to be able to fix these accessories at various points on the surface of the base, in order to adjust for example the radius of a rotational movement. As in the Giroplan, the base can be placed on the ground to allow the user among others to work standing on the plate 30, but can also be mounted vertically on a stand, a wall, as shown in FIG. 1, or placed on a table. Unlike the aforementioned "Giroplan", the device according to the invention comprises a dynamometric servomotor (not shown in FIG. 1), a controller and a display 75, such as a screen that communicates instructions to the person . Furthermore, in addition to the possibility of placing position and / or pressure sensors at various locations on the plate 30, positional and / or pressure sensors can be placed on certain accessories and / or on the person. selected points. These sensors will be described in more detail below.

[0023] FIG. 2 is a perspective view of a second embodiment of a device according to the invention in which the movement is linear. This device also comprises a base 90. A carriage 100 can move in translation over a distance of, for example, 1m. A linear servo motor, described in more detail below, controls the movement of the carriage. A controller 110 controls the device and displays instructions on the display device 75,

[0024] FIG. 3 is a block diagram showing components of a device according to the invention, and their interactions. The controller 110 receives signals from the position sensors 120 and / or the pressure sensors 130. Depending on the exercise program that has been selected, the controller 110 transmits to the rotary servo motor 150 or linear 140 positional instructions angular, torque or angular velocity in the rotary embodiment, or position, force or velocity in the linear embodiment. The engine 140,150 can also transmit indications of angular position or torque, or linear position or force. The controller 110 also transmits to a display 75 instructions to the patient, as to the exercise to be performed (total number of repetitions / remaining) and the intensity of the exercise. In isokinetic exercise, the patient is instructed to perform a movement with a predetermined speed. A graph bar on the screen indicates to the patient the actual speed achieved. In addition, a representation mode, such as a color, indicates whether the realized speed is lower, higher than a desired range, or located in that range. The controller 110 simultaneously gives instructions to the motor 150, 140 to adapt the resistance to be overcome by the muscle. The device of the invention thus gives a permanent visual or auditory feedback. The position sensors 120 may be "RFID tags" (Radio Frequency Identification). The acquisition of the position of the tags is carried out with a period of the order of one millisecond, in the three dimensions of the space, from a reader placed on the base of the device or on the user. It is also possible to use gyroscope transmitters. The position sensors 120 make it possible to know the position of the device 10, 80 with respect to the wall fixing system as well as its inclination and the position of the accessories relative thereto, and finally to determine precisely the different positions of the body segments. affected by the exercise performed. [0025] FIG. 4a is a top view of the rotary rehabilitation device 10. The plate 30 has a plurality of dovetail section grooves 160. It is thus possible to attach one or more accessories in selected positions on the surface of the plate 30. can thus adapt the device to the desired amplitude of movement and the size of the patient. Fig. 4b is a view from below of this same device. The base 50 is articulated to the base 20 by means of hinges 40. A telescopic rod or rod 170 makes it possible to adjust the angle of inclination of the base 20 with respect to the base 50. It is thus possible to vary the type of movements. to achieve and obtain trajectories in the three dimensions of space.

[0026] FIG. 5a, is a view from below of a plate 30 of the rotary rehabilitation device. Permanent magnets 180 are aligned in a ring on the periphery of the plate. These magnets 180 are arranged to produce a magnetic field perpendicular to the plane of the plate, and oriented alternately upwardly and downwardly with respect to this plane. Fig. 5b is a top view of a base. Coils 190 are arranged in a ring and face the permanent magnets 180. Inside these coils 190 is disposed a slideway comprising a rail 200 and movable elements 210. This slide ensures that a predetermined distance is maintained between the magnets 180 permanent and windings 190 and allows the rotation of the board

30. FIG. 5c is a side of the device 10. The choice of the type of motor and slide has made a very compact device. [0027] FIG. 6 is a bottom view of a device 80 according to the second embodiment of the invention. On a base 90 are mounted the coils 190 of a linear motor and the rail 200 of a slide. A carriage 100 is secured to one or more movable elements 210 sliding on the rail 200. When the carriage 100 is large, one can mount wheels 220 to guide its movement. A handle 70 is mounted on the carriage 100. [0028] FIG. 7a is a bottom view of a carriage of a device according to the second embodiment of the invention, showing the permanent magnets 180 and the movable elements 210 of the slideway fixed to the carriage 100. FIG. 7b is a top view of a base 90, the rail 200 of the slideway and the coils 190 of the linear motor. Fig.7c is a side view next arrow A of Fig.6 of this same device.

[0029] FIG. 8 is an anterior and posterior view of a person on which are disposed position sensors of a device according to the invention. Sensors are advantageously arranged at a selection of the positions, according to the necessities of the exercise: external malleolus (ME), internal malleolus (Ml), external condyle (CE), internal condyle (Cl), anterior anterior iliac spine (EIAS ), Sacrum Top (SAC), Epicondyle (EpC), Epitrochlea (EpT) ₁ Acromion (ACR), Sternum (STE), 7th Cervical (C7), Mastoid Apophysis (MAS), Forehead (FRO). Subsets of individual sensors may be formed to follow a particular limb or segment of a member.

[0030] FIG. 9a view of the dorsal surface on which position sensors have been installed at the following points: distal end of the phalanges, outer face of the distal end of the 1st, 2nd and 4th metacarpals, radial styloid process (thumb side), styloid apophysis cubital (small finger side). The

FIG. 9b is a view of the palmar surface of a hand on which pressure sensors have been installed at the following points: distal end of the phalanges, distal end of the 2nd and 4th metacarpals, external face of the distal end of the 2nd and 4th 4th metacarpal, thenar eminence (inch side), hypothenar eminence (small finger side). The set of position and pressure sensors of a hand can advantageously be arranged in a glove. Fig. 9c is a view of the plantar surface of a person's foot on which position sensors and pressure sensors are arranged at the following points: (OF1 to OF5 and OP1 to OP5) Toes 1 to 5 (sensors of force and position), (MF1 and MF5) External face of the Distal End of the 1st and 5th

Metatarsals, (PLF) Force Sensor Plantar Face, (TP) Heel Position Sensor, (TFI) Force Sensor Inner Face Heel, (TFE) Force Sensor External Face Heel. All these sensors can also advantageously be installed in a sock. Both in the first embodiment, rotary, than in the second embodiment, linear, of the invention is advantageously used a torque servo motor, combined with a slide which maintains the distance between the stator and the motor rotor. The torque motor comprises a stator with a large number of poles comprising coils. The rotor has magnets _ft

permanent. This avoids the need for a speed reducer. The rotor directly drives the turntable or moving carriage. In the rotary embodiment, the field is directed in the axis of rotation. No rotation shaft is needed, the support being provided by the slide. In the linear embodiment, the field is perpendicular to the base. The slide may be a ball slide, provided by THK, and described in US 5265963, or a friction slide.

The following examples show that, for the same movement, the device according to the invention can induce totally different modes of execution thanks to the servomotor and / or the sensors of the present invention.

Example 1: Classic strengthening of the quadriceps muscle

Fig.1 shows an exercise of flexion / extension of the knee where the servo motor alone via the controller can impose the user different modes of operation: passive or active, isometric, isokinetic or isotonic (concentric or eccentric) but in a global way because we use here only the stress sensors and position of the servo-motor. Example 2: Specific strengthening of the vastus medialis of the quadriceps muscle [0036] As in Fig.1, the person flexes / extends the knee. A pressure sensor placed on the internal face of the forefoot makes it possible to force the patient to press more or less heavily on the latter during the flexion and extension movement to cause the more or less intense contraction of the vast internal quadriceps. Depending on the intensity of the pressure exerted on the sensor placed on the internal face of the forefoot (or from the sensor MF1 of Fig. 9c if the sock is used), according to the resistance applied by the motor and the position different position sensors placed on the lower limb and pelvis (Fig.8 ME, Ml, CE, Cl, EIAS, SAC, Fig. 9c MP1, MP5, TP position), it is possible to model in real time the moments of force of the different segments involved of the lower limb (three-dimensional biomechanical data) and more particularly of the knee and thus determine at what intensity works the vastus internal of the quadriceps. Example 3: Neuromotive Regulation for a Patient hemiplegic

For the same type exercise can be used two pressure sensors, one placed below the forefoot and the other under the heel (or from the PLF sensor of Fig. 9c if using the sock) , which allow: 1. To force the patient to distribute pressure evenly over the forefoot and heel. 2. to help the patient to control this pressure distribution by increasing the resistance in a definite way if the speed of execution slows down and / or if the pressure decreases under the heel according to neurological criteria defined with respect to the capabilities of the patient.

Throughout the exercises, the device of the invention dialogue with the patient, displays its result and promotes consistency in the effort, both in the control of it as in the creation of a beneficial rhythm by sonic, visual or pressure-sensitive points of reference that guarantee the proper movement. The device of the invention is not limited to the simple "Muscular Strengthening", it is a new "Platform for Functional Rehabilitation and physical preparation of athletes". The device of the invention allows to gather as many therapeutic possibilities in a single system while objectifying their realization. This device thus makes it possible to visualize and concretize via a controller the distribution of the moments of force of a three-dimensional movement carried out induced by the device. Based on biomechanics and biometrics it allows in particular to evaluate precisely and in real time the work of a muscle or muscle group of a targeted joint. The terms and descriptions used herein are provided for illustrative purposes only and are not limitations. Those skilled in the art will recognize that many variations are possible within the spirit and scope of the invention as described in the following claims and equivalents thereof; in these, all terms must be understood in their broadest sense unless otherwise indicated.

Claims

claims

1. Device (10,80) for the rehabilitation and / or physical training of a person comprising a base (20; 90) and a movable member (30; 100) movable relative to the base (20; 90; ) according to a degree of freedom, guided by guiding means and braked by adjustable braking means, the movable member (30; 100) being provided with means for fixing accessories (60, 70) for gripping or fixing of members of said person, characterized in that the device (10,20) comprises a set of position (120) and pressure (130) sensors which can be fixed to the movable member (30; 100), on a grasping attachment (60, 70) attached to the movable member and / or the person, and a controller (110) adapted to receive signals transmitted by said position (120) and pressure (130) sensors to the controller (110) to perform a three-dimensional biomechanical analysis, to model and objectify moments of forces in the presence and uality of the muscular work performed, in order to give the movement instructions and instructions to the person to properly carry out a rehabilitation and / or physical training program.

2. Device (10,80) according to claim 1, characterized in that it further comprises motor means (140; 150) adapted to impose a movement to said movable member (30; 100) comprising a servo-motor comprising a stator (190) with a large number of poles and a rotor with permanent magnets (180), said rotor directly driving said movable member (30; 100).

3. Device (10) according to any one of the preceding claims, characterized in that the movable member is a plate (30) adapted to move in a degree of freedom of rotation relative to the base (20).

4. Device (80) according to any one of claims 1 and 2, characterized in that the movable member is a carriage (100) adapted to move with a degree of freedom of translation relative to the base (90).

5. Device (10,20) according to any one of the preceding claims, characterized in that the controller (110) is connected to a display (75) which indicates to the person instructions to move, the movements actually performed and the correction to make.

6. Device (10,20) according to claim 1, characterized in that said accessory fixing means comprise a plurality of parallel dovetail grooves (160) in which the accessories can be fixed.

7. Device (10,20) according to any preceding claim characterized in that said set of position sensors

(120) includes radio-identification radio-tags,

8. Device (10,20) according to claim 7 characterized in that all of the position sensors (120) and / or pressure (130) can be divided into subassemblies.