U.S. patent number 5,178,160 [Application Number 07/727,060] was granted by the patent office on 1993-01-12 for apparatus for the rehabilitation and measurement of musculoskeletal performances.
This patent grant is currently assigned to Diagnospine Research Inc.. Invention is credited to Serge Gracovetsky, George Papagiannis.
United States Patent |
5,178,160 |
Gracovetsky , et
al. |
January 12, 1993 |
Apparatus for the rehabilitation and measurement of musculoskeletal
performances
Abstract
An apparatus for the rehabilitation of the musculoskeletal
performance of a human body, comprising a handle and a set of three
cylinders capable of longitudinal extension and retraction, the
cylinders extending at angle with respect to each other and each
having one end rotatably connected to the handle and another end
rotatably connected to a rigid surface, the ends of the three
cylinders opposite the handle being spaced apart from each other.
By adjustably and independently controlling the longitudinal
extension and retraction of each of the cylinders, it becomes
possible to simulate objects being lifted or moved on the job at
various heights and in any particular angle and plane and thus use
the apparatus for rehabilitation purpose. The apparatus may also
comprise strain gauges preferably located between the end of each
cylinder attached to the rigid surface and the corresponding rigid
surface in order to measure the strain applied by the human body to
the handle, this measured strain being indicative of the
musculoskeletal performance. Thus, it becomes possible to use the
apparatus for diagnostic purpose, such as, for example to make
isometric and isokinetic measurements of the musculoskeletal
performance of the human body, by locking the cylinders and
allowing the same to extend or retract, respectively.
Inventors: |
Gracovetsky; Serge (St.
Lambert, CA), Papagiannis; George (Town of Mount
Royal, CA) |
Assignee: |
Diagnospine Research Inc.
(Montreal, CA)
|
Family
ID: |
24921171 |
Appl.
No.: |
07/727,060 |
Filed: |
July 8, 1991 |
Current U.S.
Class: |
600/595; 482/112;
482/5; 482/8 |
Current CPC
Class: |
A63B
21/0085 (20130101); A63B 24/0003 (20130101); A63B
21/00072 (20130101); A63B 21/00069 (20130101); A63B
21/008 (20130101); A63B 2220/56 (20130101) |
Current International
Class: |
A63B
21/008 (20060101); A63B 69/00 (20060101); A61B
005/117 () |
Field of
Search: |
;128/774,782,781,25R
;272/130,135,136,DIG.5 ;482/112,113,4,5,6,7,8 |
References Cited
[Referenced By]
U.S. Patent Documents
Other References
Don B. Chaffin et al. Occupational Biomechanics, pp. 105, 130 to
133, 199 to 201, 205, 211 (1984). .
The Pneumex Rehabilitation Cylinder, Advertising brochure
(undated). .
The CYBEX LIFTASK, Advertising brochure (undated)..
|
Primary Examiner: Hindenburg; Max
Assistant Examiner: Tucker; Guy V.
Attorney, Agent or Firm: Robic
Claims
We claim:
1. An apparatus for the rehabilitation of the musculoskeletal
performance of a human body, comprising:
a handle;
a set of at least three longitudinally extensible and retractable
cylinders, said cylinders extending at angle with respect to each
other and each having a first end rotatably connected to the handle
and a second end longitudinally opposite to said first end and
rotatably connected to a rigid surface, said second ends of said
cylinders being spaced apart from each other; and
control means for adjustably and independently controlling
longitudinal extension and retraction of each of said cylinders in
such a manner as to adjust the position of the handle at any
desired height and in any desired angle with respect to said rigid
surface,
wherein said handle is connected to said rigid surface exclusively
through said cylinders whereby the handle is free to move in any
desired direction.
2. The apparatus of claim 1, further comprising:
strain-measuring means to measure the strain applied by the human
body to the handle, said measured strain being indicative of the
musculoskeletal performance of said human body.
3. The apparatus of claim 2, wherein said strain measuring means
comprises:
a signal-emitting strain-gauge operatively connected to each of
said cylinders between the second end thereof and the corresponding
rigid surface,
means to determine the angular position of each cylinder with
respect to the others, and
means to compute the signals received from all the strain-gauges as
a function of the determined angular position of each cylinder.
4. The apparatus of claim 1, wherein each of said cylinder
comprises:
a hollow barrel filled up with a fluid, said barrel having a pair
of opposite ends;
a piston comprising a piston head slidably mounted within the
barrel, said piston head dividing said barrel into two separate
chambers, and a piston rod having a free end extending outwards the
barrel at one of the opposite ends thereof;
a fluid pipe extending between said opposite ends of said barrel,
said fluid pipe being in fluid communication with the chambers of
said barrel to place said chambers in fluid communication with each
other; and
adjustable valve means to control fluid flow within said fluid
pipe, said valve means being part of said control means.
5. The apparatus of claim 4, wherein the adjustable valve means of
each of said cylinder includes two separately adjustable control
valves to independently control the fluid flow on the in and out
stroke of the piston.
6. The apparatus of claim 1, wherein two of the three cylinders of
the set have their second ends connected to a same horizontal
surface acting as their respective rigid surfaces, and wherein a
third cylinder of the set has its second end connected to a
vertical surface perpendicular to said horizontal surface, said
vertical surface acting as the rigid surface of said third cylinder
and extending at equal distance from the second ends of the two
cylinders connected to the horizontal surface.
7. The apparatus of claim 6, wherein said horizontal surface is a
floor on which said human body may stand up.
8. An apparatus for the rehabilitation of the musculoskeletal
performance of a human body comprising:
a handle;
a set of at least three longitudinally extensible and retractable
cylinders, said cylinders extending at angle with respect to each
other and each having a first end rotatably connected to the handle
and a second end longitudinally opposite to said first end and
rotatably connected to a rigid surface, said second ends of said
cylinders being spaced apart from each other; and
control means for adjustably and independently controlling
longitudinal extension and retraction of each of said cylinders in
such a manner as to adjust the position of the handle at any
desired height and any desired angle with respect to said rigid
surface,
wherein said handle is connected to said rigid surface exclusively
through said cylinders whereby the handle is free to move in any
desired direction
wherein each of said cylinders comprises;
a hollow barrel filled up with a fluid, said barrel having a pair
of opposite ends;
a piston comprising a piston head slidably mounted within the
barrel, said piston head dividing said barrel into two separate
chambers, and a piston rod having a free end extending outwards the
barrel at one of the opposite ends thereof;
a fluid pipe extending between said opposite ends of said barrel,
said fluid pipe being in fluid communication with the chambers of
said barrel to place said chambers in fluid communication with each
other; and
adjustable valve means to control fluid flow within said fluid
pipe, said valve means being part of said control means and
including two separately adjustable control valves to independently
control the fluid flow on the in and out stroke of the piston,
and
wherein:
each chamber of the barrel is provided with a separately adjustable
exit valve; and
the fluid pipe is connected via an adjustable control valve to a
power source consisting of a source of pressurized fluid forming
part of said control means;
wherein, by properly adjusting the three control valves and two
exit valves of each cylinder, dynamic actuation of each cylinder
may be obtained.
9. The apparatus of claim 6, further comprising:
strain-measuring means to measure the strain applied by the human
body to the handle, said measured strain being indicative of the
musculoskeletal performance of said human body.
10. The apparatus of claim 9, wherein said strain measuring means
comprises:
a signal-emitting strain-gauge operatively connected to each of
said cylinders between the second end thereof and the corresponding
rigid surface,
means to determine the angular position of each cylinder with
respect to the others, and
means to compute the signals received from all the strain-gauge as
a function of the determined angular position of each cylinder.
11. The apparatus of claim 10, wherein two of the three cylinders
of the set have said second ends connected to a same horizontal
surface acting as their respective rigid surfaces, and where a
third cylinder of the set has its second end connected to a
vertical surface perpendicular to said horizontal surface, said
vertical surface acting as the rigid surface of said third cylinder
and extending at equal distance from the second ends of the two
cylinders connected to the horizontal surface.
12. The apparatus of claim 11, wherein said control means includes
a programmable computer.
13. The apparatus of claim 10, wherein said control means includes
a programmable computer.
14. An apparatus for the rehabilitation of the musculoskeletal
performance of a human body, comprising:
a) a handle;
b) a set of at least three longitudinally extensible and
retractable cylinders, said cylinders extending at angle with
respect to each other and each having a first end pivotably
connected to the handle and a second end longitudinally opposite to
said first end and pivotably connected to a rigid surface, the
second ends of said cylinders being spaced apart from each other;
and
c) control means for adjustable and independently controlling
longitudinal extension and retraction of each of said cylinders,
said control means comprising:
a power source operatively connected to each of the cylinders to
actuate the same and cause said longitudinal extension and
retraction of said cylinders, and
a programmable computer connected to said power source and to said
cylinders to monitor and control said longitudinal extension and
retraction of said cylinders in such a manner as to move the handle
along a preselected path at a preselected speed in order to force
the human body to perform a given task meeting some motion,
distance and time requirements in a dynamic manner;
d) wherein said handle is connected to said rigid surface
exclusively through said cylinders whereby the handle is free to
move in any desired direction.
15. The apparatus of claim 14, further comprising:
strain-measuring means to measure the strain applied by the human
body to the handle, said measured strain being indicative of the
musculoskeletal performance of said human body.
Description
BACKGROUND OF THE INVENTION
a) Field of the Invention
The present invention relates to an apparatus for the
rehabilitation and, optionally, measurement of the musculoskeletal
performance of a human body.
b) Brief Description of the Prior Art
Numerous apparatus are presently available in the market, for use
in the rehabilitation of "parts" of the body of a patient, such as
his or her wrist, shoulder ankle, knee or back.
These apparatuses which can be of very different structures,
usually incorporate strain gauges or similar devices that make them
also useful for measuring the isometric and/or isokinetic
musculoskeletal performance of the patient.
A first example of such an apparatus is the one sold by PNEUMEX,
INC. of Edmonton, Alberta, under the tradename "The Pneumex
rehabilitation cylinder". This apparatus comprises a pneumatic
cylinder that can be attached at one end by a suction cup and an
universal joint to any non porous surface, and at the other end to
the foot, knee, arm or wrist of the patient. The piston head within
the cylinder define two chambers that are connected by a pneumatic
line incorporating two manually adjustable control valves allowing
independent pressure on the in and out stroke. A pressure gauge is
also provided to give readings on both the in and out stroke.
Another example of apparatus is the one sold by CYBEX, a division
of LUMEX, INC., of Ronkonkoma, New York, under the tradename
LIFTASK. This other apparatus along with other apparatuses sold by
the same company under the tradename of the "Torso Rotation" and
"Trunk Extension/Flexion" units, is designed to complete testing,
rehabilitation and screening of the back of a patient.
It basically comprises a handle fixed to a rope wound onto a winch
whose rotation may be controlled by a motor. It also comprises an
electronic load cell and a velocity tranducer connected to a
computer to determine both the instantaneous forces and the
velocity of motion, where the patient is asked to pull up the
handle with his or her arms alone (arm lifting strength test), his
or her legs alone (leg lifting strength test), or his or her back
(torso lifting strength test).
If the rope is locked in position by preventing the winch from
rotating, isometric or "static" measurement of the body performance
can be obtained. Depending on the length of the rope and/or the
vertical position of the handle (when use is made of other
apparatuses of this type further comprising a vertical post along
which the winch may be adjusted), it is possible to simulate
objects being lifted or moved at various heights. Moreover, the
handle can be made removable and replaced by straps, tools, boxes
and the like for custom-designed job simulation.
If the rope is allowed to unwind with a given resistance and/or at
a given speed, isokinetic or "dynamic" measurements of the body
performance can be achieved (dynamic lift strength, dynamic back
extension strength, dynamic elbow flexion strength). Of course, the
velocity of the movement to be performed can be set by proper
adjustment of the motor controlling the winch to meet some
motion-distance/time requirements of the simulated job.
Measurements obtained with such an apparatus can be correlated with
theoretical values of the compression or torsion forces applied to
an articulation, such as, for example, the compression force on the
L.sub.5 /S.sub.1 disc of the spine, which values can be obtained by
resolution of mathematical equations applying to the particular
structure of the articulation being tested. Thus, it becomes
possible to evaluate the performance of a patient and/or the
difficulty of a given job and, as a result, determine whether
carrying out this job falls within standards like those established
by recognized organizations such as the National Institute for
Occupational Safety and Health (NIOSH) which, by way of example,
has established that predicted L.sub.5 /S.sub.1 compression values
above 3400N be considered as potentially hazardous to some people,
and values greater than 6400N as hazardous to everybody.
Other apparatuses are also known, wherein the patient or part of
his or her body is rigidly fixed in a vice-like structure that is
"articulated" in a single plane. This of course causes the patient
to move and perform the required job within this single plane
only.
OBJECTS OF THE INVENTION
An object of the present invention is to provide an apparatus that
is very simple in structure and yet very versatile and efficient in
operation, for use in the rehabilitation of the musculoskeletal
performance of a human body, especially his or her torso lifting
strength. With this apparatus, it is possible in particular to
simulate objects of any preselected size and weight being lifted
and moved at various heights and in any particular angle and plane,
thereby allowing custom-designed job simulation and thus efficient
rehabilitation.
Another object of the invention is to provide an apparatus of the
above mentioned type, which incorporates one or more strain-gauges
in its structure to make it useful for the evaluation and
measurement the musculoskeletal performance of the body of a
patient, especially his or her back. With this apparatus, it is in
particular possible to make both isometric and isokinetic
measurements of the patient's body performance in a very simple and
reliable manner.
A further object of the invention is to provide an apparatus of the
above mentioned type, which is particularly well adapted for use in
combination with, and under the control of an apparatus like the
one disclosed and claimed in Applicant's U.S. Pat. No. 4,971,069
issued on Nov. 20, 1990, which apparatus is presently being sold by
the Applicant under the trademark SPINOSCOPE for a full
three-dimentional dynamic free motion analysis of the trunk, spine,
pelvis and intersegmental movement of a patient.
SUMMARY OF THE INVENTION
In accordance with the invention, there is provided an apparatus
for the rehabilitation of the musculoskeletal performance of a
human body, comprising:
a handle;
a set of at least three cylinders capable of longitudinal extension
and retraction, these cylinders extending at angle with respect to
each other and each having one end rotatably connected to the
handle and another end rotatably connected to a rigid surface, the
other ends of the cylinders being spaced apart from each other;
and
control means for adjustably and independently controlling the
longitudinal extension and retraction of each of the cylinders.
Proper actuation and setting of the control means permits to adjust
the position of the handle at any desired height and in any
particular angle and then to lock this handle to cause the human
body to perform a given task such as pulling or pushing the handle,
or rotating it like a car steering wheel, in a given position and
in a static manner, or, alternatively, to allow this handle to move
in any prelected direction and/or plane at a given speed to cause
the human body to perform another given task meeting some motion,
distance and time requirements in a dynamic manner. Of course, such
a control may be assisted by a programmable computer.
In accordance with a preferred embodiment of the invention, the
above apparatus may also comprise strain-measuring means to measure
the strain applied by the human body to the handle, the measured
strain being indicative of the musculoskeletal performance of this
human body and thus being useful for the isometric (static) or
isokinetic (dynamic) evaluation of this body or of any other motion
undertaken.
Such a measurement can be combined with other measurements carried
out simultaneously on the patient with, for example, the apparatus
disclosed in the above mentioned U.S. Pat. No. 4,971,069, for the
dynamic evaluation of the flexibility of the spine of a patient
and, as a result of this evaluation, the detection and
identification of possible mechanical injuries in some portion of
this spine, especially the lumbar portion thereof.
BRIEF DESCRIPTION OF THE DRAWINGS
The invention and its advantages will be better understood upon
reading of the following non-restrictive description of a preferred
embodiment thereof, made with reference to the accompanying
drawings in which:
FIG. 1 is a schematic perspective view of an embodiment of the
apparatus according to the invention;
FIG. 2 is a schematic, diagramm showing how the angular portion of
each cylinder of the apparatus can be determined with respect to
each other;
FIG. 3 is a schematic representation of the apparatus according to
the invention in use with the apparatus of U.S. Pat. No. 4,971,069;
and
FIG. 4 is a side elevational view of one of the cylinders of the
apparatus, operating in a passive way;
FIG. 5 is a side elevational view of a one of the cylinders of the
apparatus, operating in an active way.
DESCRIPTION OF A PREFERRED EMBODIMENT
The apparatus 1 according to the invention as shown in FIG. 1,
comprises an interchangeable handle 3 that can be replaced,
whenever desired, by other handles of different size and/or shape,
the word "handles" including straps, tools, boxes and the like, for
any kind of job simulation.
The apparatus 1 also comprises a set of preferably three cylinders
5, 7, 9 capable of longitudinal extension and retraction. The
cylinders extend at angle with respect to each other and each of
them, say cylinder 5, has one end 11 rotatably connected to the
handle 3 and another end 13 rotatably connected to a rigid surface
15 through any kind of universal joint, such a ball-and socket
joint. Two of the three cylinders of the set, namely those numbered
7 and 9 are preferably connected to a same horizontal surface 17
which acts as a floor on which the patient may stand up. The third
cylinder 5 of the set is preferably connected to the surface 15
that is vertical and perpendicular to the horizontal surface, this
vertical surface being, for example, the wall of the room in which
the apparatus is mounted. This vertical surface preferably extends
at equal distance from the bottom ends of the two other cylinders
connected to the horizontal surface or floor 17.
Thus, the ends of the three cylinders opposite the handle 3 are
spaced apart from each other to give the resulting structure a
pyramidal shape which can be modified depending on the extension or
retraction state of each cylinder. The base of the pyramid can be
varied as needed, by changing the relative position of the
attachment points of the cylinders.
Referring to FIG. 4 which shows a first embodiment of the
invention, each cylinder comprises a hollow barrel 19 filled up
with a fluid that is preferably compressible, such as air. Each
cylinder also comprises a piston 21 including a piston head 23
slidably mounted within the barrel and a piston rod 25 having a
free end extending outwards the barrel at one end thereof. The
piston head 23 divides the barrel 19 into two separate chambers
that are connected to each other by means of a fluid pipe 27
extending between the opposite ends of the barrel. The fluid pipe
27 is in fluid communication with the chambers of the barrel to
place these chambers in fluid communication with each other.
Adjustable valve means including two separately adjustable,
electrically-operated control valves 29, 31 are mounted onto the
fluid pipe 27 to control fluid flow within this pipe. These control
valves are part of control means 33 (see FIG. 1) that will be
described hereinafter and are intended to be used for independently
controlling the fluid flow on the in and out stroke of the piston
21.
The apparatus using cylinders as shown in FIG. 4 may only work in a
passive manner. The same apparatus may however be made workable in
a dynamic or active manner if use is made of cylinders like the one
shown in FIG. 5, connected to a power source, such as an air
compressor 51. In this FIG. 5, the components of the cylinder that
are similar to those shown in FIG. 4, have been identified by the
same reference numerals. Each chamber of the barrel is provided
with an electrically-operated exit valve 53, 55 allowing air to
escape to atmosphere. The chambers of the barrel are also
interconnected by a fluid pipe 27 incorporating the same kind of
electrically-operated control valve 29, 31 as disclosed
hereinabove, the only difference being that the pipe 27 is
connected to the air compressor 51 via a further control valve 57.
Of course, valves 29, 31, 53, 55 and 57 are parts of the control
means 33 previously disclosed. If valves 53, 55 and 57 are closed,
the cylinder 5 is similar to the one shown in FIG. 4 and thus has a
passive configuration. If, however, valves 53 and 31 are closed and
valves 57, 29 and 55 are opened, the piston 21 will move to the
left and thus will be activated in a controllable manner. Of
course, the piston 21 may similarly be moved to the right.
The purpose of the control means 33 is to adjustably and
independently control the longitudinal extension and retraction of
each of the cylinders 5, 7 and 9.
Electromagnetic brakes 49 (see FIG. 4) or any similar devices that
are also part of the control means 33, may be incorporated into the
cylinders to lock the pistons or anyone of them whenever desired,
so that its or their length(s) remain(s) fixed.
Adjustment of the control valves and/or actuation of the brakes can
be made manually. However, adjustment of the valves and actuation
of the brakes are preferably made under control of a programmable
computer 35 capable of monitoring and adjusting the valves to
adjust the fluid flow according to any preselected pattern and at
any predetermined speed and/or to lock any cylinder at a given
state of extension to cause the handle 3 to move in any spatial
direction by proper extension and retraction of the three
cylinders.
Thus, proper actuation and setting of the control means permit to
adjust the position of the handle 3 at any desired height and in
any particular angle and then to lock this handle to cause the
human body to perform, a given task in a given position and in a
static manner, or alternatively, to allow this handle to move in
any preselected direction and/or plane at a given speed to cause
the human body to perform another given task meeting some motion,
distance and time requirements in a dynamic manner.
In accordance with a particularly preferred embodiment of the
invention, the apparatus 1 may also comprise strain-measuring means
to measure the strain applied by the patient to the handle 3 during
a job, the measured strain being indicative of the musculoskeletal
performance of this patient and thus useful for the isometric or
isokinetic evaluation of this patient.
The strain-measuring means may consist of one single strain-gauge
connected between the joining ends of the cylinders and the handle.
However, for better application and evaluation of the strain
applied to the whole system, use is preferably made of a set of
three signal-emitting strain-gauges such as 37 (FIG. 4) operatively
connected to the three cylinders between the ends thereof that
attached to the floor or to the wall, and the corresponding floor
or wall.
Means are provided to determine the angular position of each
cylinder with respect to the others. These means are connected to
means forming part of the computer 35 to compute the signals
received from all the strain-gauges as a function of the determined
angular position of each cylinder and thus give a proper evaluation
of the strain applied to the handle 3, in both strength and
direction.
The means to determine the angular position of each cylinder with
respect to each other may consist of electronic measuring tapes 39,
41 and 43 mounted between the cylinders 9 and 5, 5 and 7, and 7 and
9 respectively, at a same given height "h" from the ends of these
cylinders connected to the floor or wall (see FIG. 2). Each tape
gives a signal indicative of its length, which is equal to the
distance separating each pair of piston at said given height.
As the distances between the ends of the cylinders connected to the
floor and wall are set and known, it becomes very easy from the
signals received from the tapes, to mathematically determine the
position of the apex "A" of the pyramid where the handle 3 is
mounted, and its speed, and thus determine where this handle is
located in the space with respect to the floor 17 and wall 15, in
view of controlling the same.
The means to determine the angular position of each cylinder with
respect to each other may also consist of electronic measuring
tapes for measuring the length of travel of each piston. Since,
once again, the distances between the ends of the cylinders
connected to the floor and wall are set and known and the length of
the barrel of each cylinder is also known, it becomes very easy to
mathematically determine the position of the apex "A" of the
pyramid.
Alternatively, use could be made of LED's connected to the ends of
each cylinder and of a set of two spaced-apart cameras 45, 47 (see
FIG. 3) to track these LED's and determine their spatial position
in the room to determine in turn the position of the handle 3,
substantially in the same manner as such a tracking is carried out
on LED's attached to the patient's back in the SPINOSCOPE apparatus
forming the subject matter of U.S. Pat. No. 4,971,069.
In all cases, calibration means known per se may be provided if
necessary.
In the above description, it has been mentioned that all the
cylinders are rotatably connected to the handle 3. It is worth
mentioning however that these cylinders could be connected to each
other by pair, or to any other element in a cantilever manner,
thereby making it possible to generate torques in the handle 3
whenever desired such as, for example, to simulate actuation of a
driving wheel. Alternatively, the same torques could be generated
by an additional cylinder or a small pneumatic motor mounted at the
junction of the three cylinders with the handle.
As mentioned hereinabove, the apparatus 1 is particularly well
adapted for use in combination with, and under the control of the
apparatus known as SPINOSCOPE and disclosed in Applicant's U.S.
Pat. No. 4,971,069, which apparatus is shown in very schematic
manner in FIG. 3 and is presently in use for the non-invasibe
evaluation of the flexibility of the spine of a patient and the
detection and identification of possible mechanical injuries in the
lumbar portion of this spine. In such a case, the computer of the
SPINOSCOPE can be used to control the apparatus 1 to move the
handle in different directions (up and down, right or left, etc...)
while monitoring with the cameras 45, 47, the relative positions of
skin-markers 49 mounted on the back of the patient in the midline
of his spine and on the crest of his or her iliums, while this
patient holding the handle 3 during this measurement.
Numerous modifications or additions could be made to the above
described invention without departing from the scope of the
appended claims.
Thus, by way of example, use could be made of any kind of
electrically, pneumatically or hydraulically powered element
linearly extensible and retractable in place of the cylinders 5, 7
and 9. The word "cylinder" must therefore be interpreted as
encompassing such "elements".
* * * * *