EP3325113A1

EP3325113A1 - Device for controlling the physical resistance force produced by a patient, and physical rehabilitation assembly comprising such a device

Info

Publication number: EP3325113A1
Application number: EP16750404.2A
Authority: EP
Inventors: Gianfranco Tudico
Original assignee: Louisin Research And Development Ltd
Current assignee: Louisin Research And Development Ltd
Priority date: 2015-07-23
Filing date: 2016-07-22
Publication date: 2018-05-30
Anticipated expiration: 2036-07-22
Also published as: US20180207486A1; US10874904B2; EP3325113B1; PT3325113T; ES2727750T3; FR3039075A1; WO2017013243A1

Abstract

The device (10) comprises a frame (12), that is designed to be attached to a stationary structure element, at least one member (16) for applying the forces produced by the patient, mounted on the frame and free to rotate about an axis of rotation (X-X) that is fixed relative to the frame, a force sensor (24) that measures, in a direction radial to the axis of rotation, the traction component of the forces applied to the member, and an angle sensor (26) that measures the angular positioning of the member about the axis of rotation.

Description

Device for controlling the physical resistance forces produced by a patient, as well as a physical rehabilitation unit comprising such a device

The present invention relates to a device for controlling the physical resistance forces produced by a patient. The invention also relates to a set of physical rehabilitation of a patient, comprising such a control device.

In the field of physical preparation or functional rehabilitation, small elastic accessories are commonly used, such as bands commonly called Sandows (registered trademark) or spring cages. These accessories allow to work a patient, sitting or standing, in progressive resistance: to do this, the patient puts the accessory in tension and then maintains this tension without loosening for a given duration, all under the supervision of a therapist which controls that the posture of the patient is correct and that the intensity and direction of the resistance efforts produced by the patient are those expected for the exercise requested. This technique allows both to remuster and perform proprioceptive work. In addition, it requires only a small financial investment and equipment insofar as the aforementioned elastic accessories are inexpensive and take up almost no space. However, to be effective and not lead to muscular or joint stresses not adapted to the treated patient, the exercises performed by the patient must be visually controlled by the therapist, so that the patient can not use these accessories independently .

Isokinetic machines are also known which are generally used for the rehabilitation of athletes. The associated isokinetic method consists in making the patient work in resistance against constant velocity movements, the resistance exerted by the isokinetic machine being self-adapted to the effort developed by the patient. This method makes it possible to obtain, thanks to the self-adapted resistance that the machine regulates, a maximum muscular contraction, at a constant speed, on the total amplitude of a movement. However, isokinetic machines are cumbersome and very expensive, often only allowing to work the lower limbs of the patient because the latter is usually sitting on an instrumented seat of the machine.

Mechanical devices are also known which incorporate arrangements inducing a mechanical resistance to which the patient opposes during physical exercises. Examples of such devices are provided by US 2013/172155, US 2004/176226, DE 40 40 123 and US 6 662 651. No. 6,280,361 even proposes a device of this type, equipped with a motor to generate the resistance. We understand that these "Resistive" devices replace or supplement the elastic accessories, Sandow type, mentioned above, being more sophisticated since they can ship position sensors to provide the patient with feedback on the action of this patient on the device. However, due to the fact that the resistance that these devices oppose is predetermined by the intrinsic mechanical design of these devices, their reeducation effect on the patient and, more generally, the work they provide to the patient are not as free and as finely controllable as with Sandow type "passive" elastic accessories: the therapist is not sure that these devices do not distort the patient's work, by leading the patient to seek to adapt his gestures to the patient. apparatus, to the detriment of the realization of gestures of reeducation both free in all the direction of the space and directly controlled. The object of the present invention is to provide effective means of physical rehabilitation of a patient, which, while allowing their implementation by the patient in an autonomous manner, are easy and safe to use.

For this purpose, the subject of the invention is a device for controlling the physical resistance forces produced by a patient, as defined in claim 1.

The invention also relates to a set of physical rehabilitation of a patient, as defined in claim 10.

The control device according to the invention is simple to install and use, in order to help a therapist to perform rehabilitation of the lower limbs as well as the upper limbs of the patient, with a patient's work, regardless of whether he is sitting or standing, in progressive resistance which is controlled and, advantageously, compared to a prefixed instruction. For the purposes of the invention, the concept of "physical effort control" also covers the measurement and / or evaluation of these efforts. Thanks to the invention, the patient can perform a work in motion, which is both small and large amplitude and that in all directions of space, while, simultaneously, the efforts produced by the patient are applied to a freely rotating member of the control device: by means of this freely rotatable member which, by definition, opposes to the forces produced by the patient no additional resistance than that resulting from the frame, are measured, on the one hand, the traction component of the forces applied to this body by the patient, thanks to a force sensor, and, secondly, the angular positioning of these forces around the axis of rotation of this body, thanks to a sensor of angle. The measurements of the force sensor and the angle sensor are advantageously processed to check that the forces developed by the patient correspond to pre-programmed intensity and positioning instructions of the therapist, in particular by real-time feedback to the patient. patient, typically via a control display, so that the device and the assembly according to the invention can be used by the patient autonomously and safely. Thanks to the invention, the therapist widens his therapeutic range and diversifies the exercises proposed to the patients while keeping for these exercises the same freedom in the space. The device and the assembly according to the invention adapt to all situations and allow to work all the muscle groups and all the joints of patients.

Additional advantageous features of the device according to the invention are specified in the dependent claims.

The invention will be better understood on reading the description which follows, given solely by way of example and with reference to the drawings in which:

- Figure 1 is an elevational view of a rehabilitation system according to the invention;

FIG. 2 is a diagrammatic section along line II-II of FIG. 1, showing on a larger scale a control device according to the invention belonging to the assembly of FIG. 1;

FIG. 3 is a diagrammatic section along line III-III of FIG. 2; and

- Figure 4 is a schematic section along line IV-IV of Figure 1, illustrating different configurations of use of the rehabilitation package.

In Figures 1 to 4 is shown a set 1 physical rehabilitation of a patient. In addition to a device 10 for controlling the physical resistance forces produced by the patient, which will be detailed later, the rehabilitation unit 1 comprises a staircase 2, which is fixed to a wall or the like, and elastic bands to be tensioned by the patient, these bands being commonly called Sandows. Each of these elastic bands is provided, at one of its opposite longitudinal ends, to cooperate with the control device 10, as will be detailed later, while at its other end, each elastic band is designed to be held by the patient and / or attached to this patient, for example held by hand or attached to the wrist or the ankle of the patient. Insofar as the arrangements of connection between the elastic bands and the body of the patient are known as such, they will not be described here further, these arrangements not being limiting of the invention.

Among the elastic bands of the rehabilitation unit 1, there is a pair of elastic bands 3 which are represented in solid lines in FIGS. 1 and 4: these strips 3, which can be described respectively as left and right, are intended to be respectively connected to the two halves of the body of the patient, for example to his left arm and his right arm. Also among the elastic bands of the rehabilitation unit 1, there is a pair of long strips 4, these two long strips 4 being able, for the same reasons as those developed above for the short strips 3, to be respectively qualified as left-hand and right. Note that in Figures 1 and 4, the pair of long strips 4 is shown in phantom, while being drawn in duplicate only to illustrate various configurations of use of the set of rehabilitation 1: in use, a single band long left 4 and a single long straight band 4 are likely to be used.

Moreover, in use, more specifically during a given physical exercise, the patient is likely to put in tension either the short left band 3 or the long left band 4. It is the same for the straight strips, respectively short 3 and long 4, being noted that the patient is of course likely to simultaneously tension one of the left elastic bands, namely the short 3 or the long 4, and one of the straight elastic bands, namely the short 3 4. In practice, the elastic band (s) effectively used in the rehabilitation assembly 1 depend on the muscle groups and the joints of the patient that are to be made to work, as well as the posture of the patient during the treatment. exercise, being noticed that the patient can stand indifferently sitting or standing up.

In the continuation of the foregoing considerations, it will be noted that the rehabilitation unit 1 also comprises pulleys 5 which are respectively arranged in the upper right dial, the lower right dial, the lower left dial and the upper left dial of the espalier. 2, being restrained to the latter by any appropriate means, such as straps. Each of these pulleys 5 makes it possible to return one of the long elastic bands 4 during the tensioning of the latter, that is, to bend the direction in which this long strip extends: as shown schematically on 1 and 4, the pulleys 5 pass the long strips 4 of a substantially vertical orientation for their part extending between the control device 10 and the pulleys, at an inclined orientation with respect to the vertical for the part of these strips 4 extending between the pulleys 5 and the patient.

As shown in more detail in Figures 2 and 3, the device 10 comprises a frame 12 which, in use, is attached to the espalier 2, in particular to an intermediate horizontal bar of this espalier. The embodiment of the attachment between the frame 12 and the espalier 2 is not limiting, any mechanical fixing system, possibly adjustable, being appropriate, being noted that, advantageously, a removable system is preferred for, if need, release the device 10 vis-à-vis the espalier 2, typically for storage purposes of this device or when it is desired to use the espalier 2 of independently. As a variant not shown, the frame 12 is designed to be fixed not exclusively to a espalier, but, more generally, to any immovable structural element, for example directly to a wall.

In the exemplary embodiment considered in the figures, the frame 12 includes a tubular body 14, centered on a geometric axis X-X and with a circular base. When the device 10 is in use, the X-X axis preferably extends horizontally, it being understood that this axis X-X is fixed relative to the frame 12.

At each of its opposite axial ends, the body 14 movably carries a tubular member 16 coaxial with the axis X-X. Thus, as clearly visible in FIGS. 1 and 4, the two members 16 are arranged, in the direction of the axis XX, on either side of the frame 12. Each of the members 16 is mounted for free rotation around the outside. XX axis on the corresponding end of the body 14 of the frame 12, through a bearing 18.

The embodiment of the bearings 18 is not limiting as long as the members 16 are, independently of one another, freely rotatable about the axis XX with respect to the body 14. In practice, each bearing 18 integrates a stop system 20, known per se, which limits the rotational stroke around the axis XX of the corresponding member 16 towards the body 14 by approximately one turn, being reminded that over this entire stroke, the rotation relative between the member 16 and the body 14 is free, that is to say non-slaved kinematically.

As clearly visible in FIG. 2, each member 16 is provided with a fastener 22 making it possible to attach one of the elastic bands 3 and 4 to it indifferently. In the embodiment considered in the figures, the fastener 22 comprises an eyelet inside which is threaded the band 3 or 4 and fixed to the corresponding member 16. Whatever its embodiment, the fastener 22 is secured to the rest of the member 16 so as to be at least linked in rotation to this member 16 about the axis XX: it is understood that, in use, when the elastic band 3 or 4, attached to the member 16 by the corresponding fastener 22, is tensioned by the patient , the efforts F produced by this patient, in particular these efforts of resistance to maintain the elastic band in tension, are applied to the member 16 and thus impose on the latter its angular positioning around the axis XX. Thus, as indicated schematically in FIGS. 2 and 4, when one of the short elastic bands 3 is attached to the corresponding member 16, the orientation of this band 3 relative to the horizontal, resulting from its placing and its maintaining tension in response to the forces F produced by the patient, induces an identical angular positioning of the member 16 around the axis XX, by free rotation of this member relative to the frame 12, as indicated by the arrows R on the figures 2 and 3. Similarly, when one of the long elastic bands 4 is used by being returned by the corresponding pulley 5, the substantially vertical orientation of the portion of this band 4, extending from the member 16 to to the pulley 5, induces that the member 16 is rotated about the axis XX so that its attachment 22 is directed substantially vertically towards the corresponding pulley 5.

The device 10 further comprises, for each member 16, a force sensor 24 which, in the embodiment considered here, is advantageously integrated inside the tubular wall of the member 16. As an example non-limiting, the force sensor 24 includes one or more strain gauges, which are interposed between the corresponding fastener 22 and the rest of the member 16. Regardless of its embodiment, the force sensor 24 is sensitive to mechanical stresses applied to the member 16 in a direction radial to the axis XX, so that, within the device 10, each force sensor 24 makes it possible to measure, in a direction radial to the axis XX, the component of traction of the forces F applied by the patient to the corresponding organ 16.

The device 10 further comprises, for each member 16, a sensor other than the force sensor 24, namely an angle sensor 26 which makes it possible to measure the angular positioning of the member 16 around the axis X-X. According to a non-limiting embodiment, which is implemented in the example considered in the figures, each angle sensor 26 is a magnetoresistive sensor, including, on the one hand, a fixed portion 26A, which is fixedly connected to the 12, in this case via a bracket 28 for supporting the fixed portion 26A of the angle sensor 26, fixedly integrated inside the tubular body 14, and, secondly, a part mobile 26B, which is rotatably connected to the member 16 about the axis XX, being advantageously integrated inside the tubular wall of this member 16.

It will be understood that for each member 16, the measurements respectively provided by the force sensor 24 and by the angle sensor 26 make it possible to control the physical resistance forces F produced by the patient in order to put and maintain in tension the elastic band 3 or 4 used, without this body 16 opposes its own resistance: the measurement provided by the force sensor 24 allows to know the intensity of the forces F, more precisely the intensity of the tensile component of these efforts F, to which is sensitive the force sensor 24, and the measurement provided by the angle sensor 26 allows to know the spatial orientation, about the axis XX, of the elastic band used 3 or 4, more precisely the angular position of the member 16 around the axis XX imposed by the portion of this band, attached to the fastener 22.

The signals respectively provided by the force sensor 24 and the angle sensor 26 associated with each member 16, representative of the measurements respectively performed by these two sensors, are transmitted, typically by a wired link, to a unit 30 designed to process these signals and display the result of this treatment. Thus, in the exemplary embodiment considered here and as indicated only schematically in FIGS. 2 and 3, this unit 30 includes, on the one hand, electronic means 32 for processing the aforementioned signals, including, for example, a microprocessor and a computer memory, and, secondly, a screen 34 for displaying the output of the processing means 32. In practice, the processing means 32 and the display screen 34 operate in real time that the patient has, by observing the screen 34, an immediate feedback, the processing time and display near, on the resistance F forces that it produces, as well as on the angular position where the exercise was performed.

According to a preferred embodiment, the processing means 32 are designed to follow over the duration of a physical exercise the measurements respectively provided by the force sensor 24 and the angle sensor 26 associated with each member 16. The means processing 32 are then provided to determine the variation, as a function of time, of both the intensity of the tensile component of the forces F applied to the member 16 and the angular position of this member around the axis XX: the variation of this intensity and the variation of this angular position are advantageously displayed on the screen 34 as the physical exercise unfolds, for example in the form of curves or other graphic forms. This feedback can also be accompanied by sound effects.

In the immediate extension of the foregoing considerations, the processing means 32 are advantageously designed to both memorize an instruction, typically pre-recorded by a therapist, and to compare this instruction with at least one characteristic of the variation of the intensity of the instruction. the traction component of the forces F and / or the variation of the angular position of the corresponding member 16. The result of this comparison is either made available in real time to the patient via the display screen 34 , either memorized for subsequent analysis by the therapist, these two alternatives can of course be cumulated. It is understood that this provision allows the therapist to set physical rehabilitation instructions to the patient before the beginning of a rehabilitation exercise, so that during this exercise, the patient can be controlled, in real time by himself and / or delayed by the therapist, as for the respect of these instructions of reeducation.

The characteristic or characteristics of the variation of the intensity of the tensile component of the forces F, which are compared by the processing means 32 to pre-recorded instructions, are advantageously chosen from: - the maximum value of this intensity,

- the minimum value of this intensity,

the number of times this intensity passes between a predetermined low value and a predetermined high value,

the duration and the speed of passage of this intensity from a predetermined low value to a predetermined high value,

the duration and the speed of passage of this intensity from a predetermined high value to a predetermined low value,

the duration during which this intensity remains equal to or lower than a predetermined low value, and

the duration during which this intensity remains equal to or greater than a predetermined high value.

In practice, the above-mentioned low and high values are set by the therapist, with tolerances that are themselves adjustable.

The characteristic or characteristics of the variation of the angular position of each member 16, which are compared by the processing means 32 to pre-recorded instructions, are advantageously chosen from:

the maximum value of this angular orientation,

the minimum value of this angular orientation, and

the duration during which this angular orientation remains between two predetermined values.

In practice, the two aforementioned values are adjusted by the therapist, with tolerances, themselves adjustable.

As a purely illustrative detailed example, for a physical exercise during which the patient must stand up and use at least one of the short straps 3, the therapist sets the instructions stored by the device 10 so that:

during the entire duration of the exercise, the member 16 attached to the band 3 is to be oriented angularly so that the strip extends horizontally away from it at the most that between the two orientations drawn in dashed lines in Figure 4, and

- between the beginning and the end of the exercise, the band 3 is to be tensioned ten times, each time from a substantially zero voltage to a voltage of intensity equivalent to 10 kg + 1 kg, the band 3 being maintained, each time, at rest and under full voltage for ten seconds, while passing each time between rest and full voltage in less than two seconds.

Of course, based on this example and the explanations given so far in this document, it is understood that the device 10 and the rehabilitation package 1 allow to perform a variety of physical exercises, in this case amplitude gain exercises, evaluation of the maximum strength of a limb at the beginning and end of rehabilitation, specific muscle strengthening, both analytical and global , both in load and in discharge, and in the muscular chain, until the proprioceptive work and the reproduction of sports gestures, against resistance opposed by the bands 3 and 4.

Claims

1. Device (10) for controlling the physical resistance forces produced by a patient, comprising:

a frame (12) which is designed to be fixed to a stationary structural element

(2), such as a wall or a staircase,

at least one member (16) for applying the forces (F) produced by the patient, which is mounted on the frame with free rotation about an axis of rotation (X-X) fixed with respect to the frame,

for the or each member (16), a force sensor (24) which measures, in a direction radial to the axis of rotation (X-X), the tensile component of the forces applied to the member, and

- For the or each member (16), an angle sensor (26) which measures the angular positioning of the member about the axis of rotation (X-X).

2. - Device according to claim 1, characterized by two members (16), which are respectively arranged on either side of the frame (12) and which are, independently of one another, freely rotatable around the same rotation axis (XX).

3.- Device according to one of claims 1 or 2, characterized in that the or each member (16) has a generally tubular shape within which are integrated at least partially the force sensor (24) and the angle sensor (26) associated with this member. 4.- Device according to any one of the preceding claims, characterized in that the or each member (16) includes a fastener (22) for fixing an elastic band (3,

4) to put in tension by the patient, such as a Sandow, this fastener being connected in rotation to the rest of the organ around the axis of rotation (XX), and in that the force sensor (24) includes at least one strain gauge which is interposed between the fastener and the rest of the organ.

5.- Device according to any one of the preceding claims, characterized in that the angle sensor (26) is magnetoresistive and includes a fixed portion (26A), which is fixedly connected to the frame (12), and a movable portion (26B), which is rotatably connected to the associated member (16) about the axis of rotation (XX).

6. - Device according to any one of the preceding claims, characterized in that the device (10) further comprises electronic means (32) for processing the signals respectively provided by the force sensor (24) and the sensor d angle (26).

7. - Device according to claim 6, characterized in that the device (10) further comprises a screen (34) for displaying the output of the processing means (32).

8. - Device according to one of claims 1 to 5, characterized in that the device (10) further comprises electronic means (32) for processing the signals respectively provided by the force sensor (24) and the sensor angle (26), said processing means (32) being adapted to follow in time the measurement provided by the force sensor (24) and to determine the variation, as a function of time, of the intensity of the component pulling forces (F) applied to the associated member (16), and these processing means (32) being also adapted to follow in time the measurement provided by the angle sensor (26) and to determine the variation , as a function of time, of the angular position of the associated member (16) around the axis of rotation (XX).

9. - Device according to one of claims 1 to 5, characterized in that the device (10) further comprises electronic means (32) for processing the signals respectively provided by the force sensor (24) and the sensor angle (26), these processing means (32) being adapted to both:

to follow in time the measurement provided by the force sensor (24), to determine the variation, as a function of time, of the intensity of the tensile component of the forces (F) applied to the associated member (16); ), and to compare, at a pre-recorded setpoint, at least one characteristic of the variation of said intensity, such as its maximum value, its minimum value, the number of times said intensity passes between a low value and a high value, the duration and the rate of passage of said intensity between a low value and a high value, the duration during which said intensity remains lower than a low value, and the duration during which said intensity remains greater than a high value, and

- to follow in time the measurement provided by the angle sensor (26), to determine the variation, as a function of time, the angular position of the associated member (16) around the axis of rotation (XX) ), and to compare, with a pre-recorded instruction, at least one characteristic of the variation of said angular position, such that its maximum value, its minimum value, and the time during which said angular orientation remains between two predetermined values.

10.- Set (1) of physical rehabilitation of a patient, comprising:

a device (10) for controlling the physical resistance stresses (F) produced by the patient, which is in accordance with any one of the preceding claims, and

one or more elastic bands (3, 4) to be tensioned by the patient, such as Sandows, each elastic band being, at one end, attached to one or one of the members (16) of the device (10) while at the opposite end, each elastic band is adapted to be held by and / or attached to the patient.