U.S. patent application number 12/289402 was filed with the patent office on 2009-03-05 for methods and apparatuses for rehabilitation and training.
This patent application is currently assigned to Motorika Inc.. Invention is credited to Gad Binyamini, Haim Einav, Omer Einav, Eran Katzir, Benny Rousso, Doron Shabanov.
Application Number | 20090062698 12/289402 |
Document ID | / |
Family ID | 34842122 |
Filed Date | 2009-03-05 |
United States Patent
Application |
20090062698 |
Kind Code |
A1 |
Einav; Omer ; et
al. |
March 5, 2009 |
Methods and apparatuses for rehabilitation and training
Abstract
A method of rehabilitation using an actuator type that includes
a movement mechanism capable of applying a force that interacts
with a motion of a patient's limb in a volume of at least 30 cm in
diameter, in at least three degrees of freedom of motion of the
actuator and capable of preventing substantial motion in any point
in any direction in said volume, comprising: exercising a patient
at a first place of rehabilitation selected from a bed, a
wheel-chair, a clinic and a home, using an actuator of said
actuator type which interacts with a motion of said patient; and
second exercising said patient at a second place of rehabilitation
selected from a bed, a wheel-chair, a clinic and a home using a
second actuator of said actuator type which interacts with a motion
of said patient; wherein said first exercising and said second
exercising utilize a same movement mechanism design for moving the
actuators.
Inventors: |
Einav; Omer; (Moshav
Kfar-Monash - Emek Hefer, IL) ; Einav; Haim;
(Tel-Aviv, IL) ; Rousso; Benny; (Rishon-LeZion,
IL) ; Shabanov; Doron; (Tzur-Yigal, IL) ;
Katzir; Eran; (Rosh HaAyin, IL) ; Binyamini; Gad;
(Moshav Hagor, IL) |
Correspondence
Address: |
MARTIN D. MOYNIHAN d/b/a PRTSI, INC.
P.O. BOX 16446
ARLINGTON
VA
22215
US
|
Assignee: |
Motorika Inc.
Tortola
VG
|
Family ID: |
34842122 |
Appl. No.: |
12/289402 |
Filed: |
October 27, 2008 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10597633 |
Jul 6, 2007 |
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PCT/IL2005/000142 |
Feb 4, 2005 |
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12289402 |
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60542022 |
Feb 5, 2004 |
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60566078 |
Apr 29, 2004 |
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60566079 |
Apr 29, 2004 |
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60604615 |
Aug 25, 2004 |
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60633428 |
Dec 7, 2004 |
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60633429 |
Dec 7, 2004 |
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60633442 |
Dec 7, 2004 |
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Current U.S.
Class: |
601/5 ; 128/898;
601/33 |
Current CPC
Class: |
A61H 2230/505 20130101;
A63B 21/4043 20151001; A61H 1/0296 20130101; A61H 2201/5092
20130101; A63B 2024/0078 20130101; A61H 2201/5043 20130101; A61H
2230/065 20130101; G16H 20/30 20180101; A61H 2201/5061 20130101;
A63B 2220/50 20130101; A61B 5/224 20130101; A61B 34/30 20160201;
A61H 1/0274 20130101; A61H 2201/1215 20130101; A61H 2201/1607
20130101; A63B 2220/16 20130101; A61B 5/486 20130101; A61B 5/7475
20130101; A61H 2201/5023 20130101; A61H 2201/5048 20130101; A61H
2201/1659 20130101; A63B 21/0058 20130101; G09B 23/28 20130101;
G09B 23/32 20130101; A61B 5/16 20130101; A61H 2201/5058 20130101;
A63B 21/4047 20151001; A61H 2201/1635 20130101; A61H 2201/5007
20130101; A61H 2230/425 20130101; A61H 2230/085 20130101; A63B
2022/0094 20130101; A63B 71/0009 20130101; A61B 5/11 20130101; A61H
2201/1611 20130101; A63B 21/00181 20130101; A61H 2201/5069
20130101; A61H 1/0262 20130101; A61H 2201/1638 20130101; A63B
2071/065 20130101; A61H 2201/1642 20130101; A63B 23/03508 20130101;
A61H 2201/1238 20130101; A63B 23/1209 20130101; A61H 2201/0184
20130101; A61H 2201/501 20130101; A63B 2220/13 20130101; A61H
2201/5038 20130101; A63B 21/4021 20151001; A61H 1/0237 20130101;
A63B 2225/50 20130101; A61H 2201/5064 20130101; A61H 2230/655
20130101; A63B 21/00178 20130101 |
Class at
Publication: |
601/5 ; 128/898;
601/33 |
International
Class: |
A61H 1/02 20060101
A61H001/02; A61B 19/00 20060101 A61B019/00 |
Claims
1-50. (canceled)
51. A rehabilitation device, comprising: a joint having freedom of
motion in Phi and Theta spherical angles, said freedom allowing
positioning of said joint in substantially any angular position
within a range of at least 30 degrees in each angular direction; a
substantially rigid radial extension attached to said joint and
adapted for movement with a limb of a person at least one point
thereof; and a controller adapted to control motion of said joint
and thereby motion of said radial extension.
52. A device according to claim 51, wherein said joint comprises a
cantilevered joint.
53. A device according to claim 51, wherein said radial extension
is balanced such that said point remains stable if no force is
applied and moves if force is applied by said person.
54. A device according to claim 53, wherein said joint comprises
two joints, each separately balanced.
55. A device according to claim 53, wherein said balancing can be
varied to match a weight of an attachment selectively attached to
said extension.
56. A device according to claim 53, wherein said balancing can be
varied by said controller along a path of motion to match a change
in moment on said point.
57. A device according to claim 53, wherein said balancing can be
set to provide a neutral buoyancy to said limb.
58. A device according to claim 51, wherein said joint is a ball
joint.
59. A device according to claim 51, wherein said joint comprises
two orthogonal hinges with a common center of rotation.
60. A device according to claim 51, wherein said controller
comprises a mechanical controller.
61. A device according to claim 51, wherein said controller
comprises an electrical controller.
62. A device according to claim 51, comprising at least one brake
adapted to selectively resist said freedom motion.
63. A device according to claim 62, wherein said brake is
continuously controlled by said controller.
64. A device according to claim 62, wherein said brake is
uni-directional in only one of said Phi and Theta directions.
65. A device according to claim 62, wherein said brake is operative
in both said Phi and said Theta directions.
66. A device according to claim 51, comprising at least one motor
adapted to move said joint.
67. A device according to claim 66, wherein said motor is a
pneumatic motor.
68. A device according to claim 66, wherein said motor is adapted
to apply at least 1 Kg of force at said point.
69. A device according to claim 66, wherein said motor is
continuously controlled by said controller.
70. A device according to claim 66, wherein said motor cannot be
back-driven by said extension.
71. A device according to claim 51, comprising at least one
resilient element adapted to provide resilient compliance when said
person moves said point in a trajectory other than a trajectory for
which motion is controlled to move by said controller.
72. A device according to claim 71, wherein said controller sets a
degree of said resilient compliance.
73. A device according to claim 51, wherein said element is
extendible.
74. A device according to claim 73, wherein said element is
balanced during extension.
75. A device according to claim 51, wherein element includes a
conduit for electrical power.
76. A device according to claim 51, including at least one position
sensor which reports on an angular position of said joint.
77. A device according to claim 51, including at least one force
sensor which reports on a force applied to said joint.
78. A device according to claim 51, wherein said controller is
configured to control said motion and provide at least one of
assisting motion by said patient limb, resisting motion by said
patient limb, guiding motion by said patient limb, nudging said
patient limb to move and moving said patient limb.
79. A device according to claim 78, wherein said controller stores
thereon a plurality of different rehabilitation exercises.
Description
RELATED APPLICATIONS
[0001] This application claims the benefit under 119(e) of U.S.
Provisional Application No. 60/542,022 filed on Feb. 5, 2004, U.S.
Provisional Application No. 60/566,078 filed on Apr. 29, 2004, U.S.
Provisional Application No. 60/566,079 filed on Apr. 29, 2004, U.S.
Provisional Application No. 60/604,615 filed on Aug. 25, 2004, U.S.
Provisional Application No. 60/633,428 filed on Dec. 7, 2004, U.S.
Provisional Application No. 60/633,429 filed on Dec. 7, 2004 and
U.S. Provisional Application No. 60/633,442 filed on Dec. 7, 2004
the disclosures of which are incorporated herein by reference.
[0002] This application is also related to PCT applications, being
filed on same date and by the same applicant as the present
application, entitled "Gait Rehabilitation Methods and
Apparatuses"; "Rehabilitation with Music"; "Neuromuscular
Stimulation"; "Fine Motor Control Rehabilitation"; "Methods and
Apparatuses for Rehabilitation Exercise and Training"; "Methods and
Apparatus for Rehabilitation and Training"; "Methods and Apparatus
for Rehabilitation and Training"; and having attorney docket
numbers, 414/04391; 414/04396; 414/04400; 414/04401; 414/04388;
414/04404; and 414/04405 respectively. The disclosures of all these
applications are incorporated herein by reference.
FIELD OF THE INVENTION
[0003] The present invention relates to manipulation of a body, for
example for physical rehabilitation and/or training.
BACKGROUND OF THE INVENTION
[0004] After accidents or strokes, persons often need a prolonged
rehabilitation process in an attempt to recapture some or all of
the body function damaged in the accident or stroke. Such
rehabilitation may include one or both of two elements, a physical
rehabilitation portion, in which damaged or unused muscles, nerves
and/or joints are brought back to full functioning (to the extent
possible) and a cognitive rehabilitation portion, in which the
cognitive ability to control the body is restored. In some cases,
the damage to the body and/or brain is such that a patient needs to
be trained in modified functionality (e.g., when one limb is made
short) or even new functionality, for example, in the use of an
artificial limb.
[0005] Physical therapy is currently provided mainly by personal
attention of a physical therapist who monitors and instructs a
patient in the performance of certain exercises. Thus, costs for
rehabilitation are high and compliance after a patient leaves a
treatment center is relatively low.
[0006] Some home physical therapy devices are known, for example a
product called "backlife" provides CPM (Continuous Passive Motion)
of the spine.
[0007] U.S. Pat. No. 5,836,304, the disclosure of which is
incorporated herein by reference, describes a cognitive
rehabilitation utilizing a remote therapist.
[0008] U.S. Pat. No. 5,466,213, the disclosure of which is
incorporated herein by reference, describes a rehabilitation system
using a robotic arm.
[0009] An article in Journal of Rehabilitation Research and
Development, Vol. 37 No. 6, November/December 2000, titled
"Development of robots for rehabilitation therapy: The Palo Alto
VA/Stanford experience", by Charles G. Burgar, MD; Peter S. Lum,
PhD; Peggy C. Shor, OTR; H. F. Machiel Van der Loos, PhD, the
disclosure of which is incorporated herein by reference, describes
usage of robots for rehabilitation.
SUMMARY OF THE INVENTION
[0010] A broad aspect of some embodiments of the invention relates
to rehabilitation methods and apparatus suitable for a wide range
of situations, including, temporal, mental, cognitive, motor,
location and/or other situations.
[0011] An aspect of some embodiments of the invention relates to a
rehabilitation device which guides a patient to perform a motion
with a correct spatial trajectory, by the device applying one or
more pushing, assisting, reminding, responding and/or resisting
forces during a motion (or intent to move) by the patient. In an
exemplary embodiment of the invention, the forces are applied by an
actuator, for example, a robotic articulated arm or a spherically
jointed lever. In some embodiments, the applied forces act as a
force field, optionally continuous, which impedes and/or guides a
patient. Alternatively or additionally to spatial trajectories,
orientation trajectories and/or speed trajectories are guided,
supported and/or measured.
[0012] In an exemplary embodiment of the invention, the device
supports, for a given volume of space and a range of force
strengths, substantially any 3D trajectory within that volume. In
an exemplary embodiment of the invention, a device is provided
which supports the range of motion of a healthy arm or leg in one,
two or three dimensions. In some cases, a partial volume is
sufficient, for example, 50% or 30% of such a volume.
[0013] Optionally, the device is programmable with various
trajectories (paths and/or velocities) and/or forces. Optionally,
the forces at one point in the trajectory can vary responsive to an
actual trajectory by the patient, possibly a same trajectory (e.g.,
at an earlier point thereof) and/or responsive to a rehabilitation
plan and/or improvement of the patient. Optionally, the device
learns the patient motion and repeats it with a correction (e.g. a
smoothing of trajectory and or speed). Alternatively or
additionally, the device can learn a motion entered by a
physiotherapist and replay it for the patient, with an optional
adjustment (e.g. a limb size adjustment).
[0014] In an exemplary embodiment of the invention, the
trajectories and/or forces are defined for one or more points on
the body, on same and/or different limb or body part. Optionally, a
point is controlled (and/or measured) with 3, 4, 5 or 6 degrees of
freedom.
[0015] In an exemplary embodiment of the invention, the programming
comprises programming an electronic controller. In an exemplary
embodiment of the invention, the programming comprises mechanical
programming.
[0016] An aspect of some embodiments of the invention relates to a
rehabilitation device adapted for home use. In an exemplary
embodiment of the invention, the device is portable in a home, for
example, not permanently attached to any surface and/or including
wheels. In an exemplary embodiment of the invention, the device is
collapsible on a regular basis. In an exemplary embodiment of the
invention, the device is light enough to avoid structural
overloading of residential floors, for example the device can weigh
less than 100 kg, less than 50 Kg or less than 25 Kg. Optionally,
the device can be folded down to fit in a trunk of a standard
sedan-type car, for example having a maximum dimension of less than
120 cm. Optionally, the device breaks down into parts which are
light enough to be carried by a non-handicapped person.
[0017] In an exemplary embodiment of the invention, the device
ensures that a patient is correctly positioned. Optionally, the
patient is notified to correct his position. In an alternative
embodiment of the invention, the device recalibrates itself to take
the patient position into account.
[0018] In an exemplary embodiment of the invention, a device is
usable (e.g., by programming, attachments and/or setting) for a
plurality of different treatments, for example, a plurality of
different body sizes, a plurality of different ages, a plurality of
different joints and/or a plurality of different appendages.
[0019] In an exemplary embodiment of the invention, a
rehabilitation device is provided which is portable for various
activities, for example, indoors and/or outdoors, such as, cooking,
barbequing and eating at a table.
[0020] An aspect of some embodiments of the invention relates to
rehabilitation of daily activities, for example, eating, pouring
tea, knocking nails and cooking. In an exemplary embodiment of the
invention, a kit including position sensors and/or other sensors is
provided to attach to daily objects and track their use and provide
feedback and/or instructions for rehabilitation. Optionally, such
feedback and/or guidance are provided mechanically by a
rehabilitation robot. In an exemplary embodiment of the invention,
a daily activities training pedestal includes one or more
adjustable work spaces on which daily activities is carried out,
for example one surface emulating a table and another emulating a
saucer (e.g., for training of tea pouring.
[0021] An aspect of some embodiments of the invention relates to
long term rehabilitation and/or training. In an exemplary
embodiment of the invention, a rehabilitation device is used for a
long period of time, for example, months or years. Optionally, a
same device is used both for rehabilitation and for training of a
patient in correct motions. In an exemplary embodiment of the
invention, a rehabilitation device is used for preventive training,
for example, ensuring that a patient with developing arthritis does
not start favoring a diseased joint. Optionally, a rehabilitation
device is used to achieve a specific rehabilitation goal, such as
rehabilitation of a particular limb. Optionally, the device is used
for non-medical training, for example as a universal gym
machine.
[0022] An aspect of some embodiments of the invention relates to
support and/or measurement of various mental states of a patient,
for example, motivation, depression, endurance, ability to train in
pain, ability and/or desire to communicate and/or work and/or
interact with others. These states often overlap. For example,
depression is often expressed as lack of motivation. In an
exemplary embodiment of the invention, motivation is estimated by
comparing performance in diagnosis, game and/or therapy situations.
Such comparing optionally includes analyzing if a person achieved a
same performance under different motivational states and/or how
often did the person strain his limits. In an exemplary embodiment
of the invention, the motivational state is used for one or more of
estimating progress, suggesting psychological treatment,
controlling difficulty of exercise and/or providing motivational
incentives automatically.
[0023] An aspect of some embodiments of the invention relates to
support and/or overcoming of cognitive problems while performing
physical rehabilitation. In an exemplary embodiment of the
invention, cognitive and/or perceptive limitations are overcome by
providing one or more of instructions, feedback and guidance in a
plurality of modalities, in less damaged modalities (e.g.,
selecting from various possibilities), and/or with a degree of
enhancement congruent with the limitation (e.g., larger letters for
weak eyesight). In an exemplary embodiment of the invention, the
degree of enhancement is changed over time, as part of a
rehabilitation of the limited function.
[0024] An aspect of some embodiments of the invention relates to
multi-modal rehabilitation. In an exemplary embodiment of the
invention, multiple body systems (e.g., motor, visual, auditory,
visual-motor), skills and/or senses are rehabilitated using a same
system, for example, motor control, motor propreception, visual
perception and sound generation. In an exemplary embodiment of the
invention, coordination between such systems is trained. In one
example, hand-eye coordination is rehabilitated. In another
example, hand-leg coordination is rehabilitated. In an exemplary
embodiment of the invention, paths of coordination which are
damaged are targeted for rehabilitation.
[0025] An aspect of some embodiments of the invention relates to
feedback for rehabilitation. In an exemplary embodiment of the
invention, the feedback includes feedback on carrying out of daily
activities. Alternatively or additionally, the feedback includes
feedback from a remote therapist or automatic feedback, during an
activity. Alternatively or additionally, the feedback includes on a
quality of the motion carried out by the patient.
[0026] An aspect of some embodiments of the invention relates to
rehabilitation treatment methods. In an exemplary embodiment of the
invention, training specifically in daily activities is carried out
with the assistance of a rehabilitation device. Alternatively or
additionally, training to prevent deterioration is provided, for
example, to prevent deterioration of Parkinson's disease caused by
neglecting of arm/function. Alternatively or additionally, training
to provide long term improvement is carried out, for example, to
provide improvement in cerebral palsy. Alternatively or
additionally, treatment to prevent disease is carried out, for
example, training a patient to not neglect a joint just because it
hurts.
[0027] An aspect of some embodiments of the invention relates to
using a rehabilitation device for both rehabilitation and testing,
diagnosing and/or monitoring. In an exemplary embodiment of the
invention, the device is used to assess the abilities of a patient
and then to rehabilitate that patient. Alternatively or
additionally, the device is used to measure the patient and
calibrate future rehabilitation to those measurements. Exemplary
measurements include size, strength, range of motion and motion
quality, mental state and/or cognitive and/or perceptive
abilities.
[0028] An aspect of some embodiments of the invention relates to a
rehabilitation method related to motion quality. In an exemplary
embodiment of the invention, a quality of a motion is defined.
Optionally, when a patient is being rehabilitated, automated
feedback is provided to the patient regarding the quality of his
motion. Alternatively or additionally, part of rehabilitation
and/or training is teaching a patient the quality value for various
motions.
[0029] An aspect of some embodiments of the invention relates to
correctness of motion. In an exemplary embodiment of the invention,
a rehabilitation device is programmed with a correct movement. In
an exemplary embodiment of the invention, a correct motion is
programmed into the device by performing the correct motion and
then storing the motion in a device-associated memory. Optionally,
the motion is programmed in during a dedicated teaching mode or
when the device is off-line. Alternatively, the device learns
during usage by a patient.
[0030] Optionally, the device is used to teach a patient what
correct motion is, for example using template and/or using rules
(e.g., a 2/3 power rule for motor control). In an exemplary
embodiment of the invention, correctness of motion is evaluated as
a parameter of rehabilitation and feedback is provided thereon.
[0031] An aspect of some embodiments of the invention relates to a
rehabilitation device for daily activities, in which the
rehabilitation device is configured to train and/or test patients
in the carrying out of daily activities. In an exemplary embodiment
of the invention, the rehabilitation device can be used in
proximity to real-life settings, such as a table or a counter.
[0032] An aspect of some embodiments of the invention relates to
positioning of a rehabilitation device including a motion
mechanism. In an exemplary embodiment of the invention, a motion
mechanism has a limited range of motion and/or accuracy. The
rehabilitation device is optionally positioned to make maximum
usage of this range of motion, e.g., by matching to a specific
exercise. In an exemplary embodiment of the invention, the
rehabilitation device includes a positioning element, for example a
rail and/or one or more joints that can be used to fix the motion
mechanism at a desired position and/or orientation. Optionally, the
positioning element is motorized, for example, to allow automatic
or non-manual motion of the motion mechanism.
[0033] An aspect of some embodiments of the invention relates to a
rehabilitation method in which a healthy body part is used for
rehabilitating a diseased body part. In an exemplary embodiment of
the invention, a rehabilitation device allows simultaneous or
parallel motion of two limbs, one damaged and one not, and uses the
correct motion of an undamaged limb as a basis for force field
definition for the damaged limb. Alternatively or additionally,
sequential motion by undamaged and then damaged limbs is provided.
Optionally, the undamaged motion is modified, for example reduced
in force, speed or range of motion. Optionally, the motion is
mirror motion or synchronized motion (e.g., arm and leg during
swimming). In an exemplary embodiment of the invention, a device
which can hold two limbs is used. In some embodiments the motion of
the two limbs is linked. In other embodiments, there is some or
complete de-coupling between the limbs, at least in real time.
[0034] An aspect of some embodiments of the invention relates to a
multi-point rehabilitation device in which the rehabilitation
device is attached to a human body at multiple points which can
move relative to each other, which motion is part of
rehabilitation.
[0035] In an exemplary embodiment of the invention, the
rehabilitation device attaches to two limbs, for example an arm and
a leg or two arms.
[0036] In an exemplary embodiment of the invention, the
rehabilitation device separately allows motion in 3D space of two
bones on either side of a joint.
[0037] In an exemplary embodiment of the invention, the device
mechanically limits motion for one or more of the points.
Optionally, one or more of the points are tracked (in one or more
dimensions) but their motion is not mechanically limited in some or
any directions.
[0038] In an exemplary embodiment of the invention, the
rehabilitation device supports complex motion in which different
parts of the body are called upon to carry out certain motions, for
example, shoulder motion and wrist motion.
[0039] An aspect of some embodiments of the invention relates to a
mechanical structure for a rehabilitation device. In an exemplary
embodiment of the invention, the device comprises an arm mounted on
a joint, with a body attachment point, for attachment to or holding
by a patient, mounted on the arm. The joint acts as a spherical
joint, allowing movement of the arm along substantially any path on
the surface of a sphere, within a range of angles, for example,
.+-.90 degrees relative to the center of the joint, in either of
phi and theta directions (e.g., in spherical coordinates).
Optionally, the center of rotation for such motions is
substantially a same center of rotation for all the paths. In an
exemplary embodiment of the invention, the joint and/or the arm as
a whole lack singularity points in the range of motion. Optionally,
the resistance to motion of the joint (the device may add
resistance) is substantially uniform, substantially independently
of the spherical motion.
[0040] In an exemplary embodiment of the invention, the spherical
joint comprises a ball in socket joint, with the arm attached to
the ball or to the socket. The other one of the ball or socket is
optionally attached to a base, for example, a base which stands on
a floor or is attached to a wall or a ceiling.
[0041] In an exemplary embodiment of the invention, balancing is
provided. In one example, the device includes a weight attached to
said ball opposite of said arm and serving to balance the motion of
said arm. Optionally, the motion of the arm is substantially
balanced over the entire range of motion thereof. In an exemplary
embodiment of the invention, the balancing includes prevention of a
resting torque. Alternatively or additionally, balancing includes
correction for an existing moment of inertia or an expected moment
of inertia during use. Optionally, the device is configured to
include a resting force which tends to stabilize or destabilize the
device, depending on the embodiment.
[0042] Optionally, one or more guiding plates are provided. In an
exemplary embodiment of the invention, a pin attached to the ball,
optionally part of the weight, is constrained to travel within a
slot (e.g., a rectangle or other shape) defined in a guide plate.
Optionally, the slot is elastic.
[0043] Optionally, one or more motors are provided to rotate the
ball and/or apply force in a desired direction.
[0044] Optionally, one or more directional brakes are provided to
selectively stop motion of the ball in a desired direction.
[0045] Optionally, one or more uni-directional brakes are provided
to selectively stop motion of the ball in any direction.
[0046] In an alternatively embodiment of the invention, two or more
joints having a shared center of rotation, are provided instead of
a ball, for example a universal joint.
[0047] In an exemplary embodiment of the invention, the arm is
extendible along its axis. Optionally, a motor is provided for
selectively moving or apply force to resist motion of the extension
along the axis. Optionally, one or more brakes are provided to
selectively resist motion of said extension along said axis.
[0048] In an exemplary embodiment of the invention, the extension
is balanced, so that it has no self motion. Alternatively or
additionally, the extension, even when extended to various extents
does not affect a balance of said arm.
[0049] Optionally, a rehabilitation device is positionable at
various orientations. Optionally, the device includes a joint
between its base and an articulating portion thereof.
[0050] An aspect of some embodiments of the invention relates to a
ball joint with selective locking. In an exemplary embodiment of
the invention, a chuck is provided to selectively lock rotation of
the ball joint. Optionally, a plurality of directional brakes are
provided. Optionally, one or more sensors generates an indication
of a direction of force application and a controller selects which
directional and/or uni-directional brakes to release responsive to
the force direction.
[0051] An aspect of some embodiments of the invention relates to a
telescoping element, optionally used as part of a rehabilitation
device. In an exemplary embodiment of the invention, at least three
portions are provided, two ends and a center, with extension or
retraction forces being applied to the central portion. The central
portion is attached to the two end portions using a rack and pinion
(one rack on each end portion and the two pinions at either end of
the central portion. A belt interconnects the two pinions so that
they move in concert.
[0052] An aspect of some embodiments of the invention relates to a
force-feedback control mechanism including a spring. Changes in
compliance are provided by changing an effective length of the
spring. In an exemplary embodiment of the invention, the spring is
a flat spiral spring and the compliance is in a direction
perpendicular to the plane of the spring.
[0053] An aspect of some embodiments of the invention relates to a
force control mechanism for a human-movable element. In an
exemplary embodiment of the invention, a spring is provided to
counteract force applied by a human. Optionally, the degree of
force is adjustable, optionally by preloading the spring (or other
resilient element). Optionally, the human movable element is also
moved by a motor and said compliance is optionally provided to said
human motion. Optionally a damping element, for example viscous
cushioning, is provided.
[0054] In an exemplary embodiment of the invention, the resilient
element is configurable, optionally on the fly, to provide a
desired degree of resistance to the movement. Optionally, the
resilient means is re-adjusted to follow actual motion of the
element.
[0055] In an exemplary embodiment of the invention, the motor moves
the handle using one joint and a second joint is used for the force
compliance.
[0056] In an exemplary embodiment of the invention, the force
compliance is provided by one resilient element to a plurality of
axes simultaneously, substantially without coupling between the
axes.
[0057] In an exemplary embodiment of the invention, movement of the
element in spherical rotation axially compresses a resilient
element which then provides compliance.
[0058] In an exemplary embodiment of the invention, power is
provided to the element using a gear system which cannot be
back-driven. When back-driving is detected, it is mechanically
shunted to a resilient element, which provides compliance.
[0059] In an exemplary embodiment of the invention, a mechanical
diode design is provided in which a motion is imparted to a lever
using a gear and in which the lever cannot move the gear. In an
exemplary embodiment of the invention, the diode comprises a gear
or lever engaging a worm gear with a low enough lead angle (i.e.,
not back driven) a motor turns the worm gear, thereby moving the
gear and/or a lever attached thereto. Due to the low lead angle,
when the gear rotates, the worm gear moves axially rather than
rotates. Optionally, the worm gear sits on springs or another
elastic element which provide a degree of resiliency to motion of
the gear. Optionally, the springs are pre-stressed to a desired
amount. Optionally, the worm gear is rotated to follow motion of
the lever and maintain a desired tension and/or symmetry in the
elastic element(s).
[0060] An aspect of some embodiments of the invention relates to a
manual manipulator which moves or controls movement of a human body
using at least one wire and optionally one or more robotic
elements, so that motion in 3D of at least one point of the body is
constrained by the manipulator. In an exemplary embodiment of the
invention, the manipulator is configured for use as a
rehabilitation device. Optionally, one or more motors are provided
to move the at least one point. Optionally, one or more resilient
elements are provided to allow some slack with resiliency to be
provided in one or more wires. Optionally, three wires are provided
to constrain 3D motion.
[0061] An aspect of some embodiments of the invention relates to
patient positioning in a rehabilitation system. In an exemplary
embodiment of the invention, the system determines patient position
using an imaging system. In an exemplary embodiment of the
invention, alternatively or additionally, a location of a chair or
other support for the patient, relative to the system, is
determined. Optionally, a spring-loaded wire system is used to
measure the relative positions. Optionally, a pressure sensitive
mat is used.
[0062] In an exemplary embodiment of the invention, the patient is
instructed to perform one or more motions and the relative
positions are determined from the trajectories of the motions.
Optionally, position is determined in 2D, rather than in 3D.
Alternatively, 3D position and/or orientation information is
determined.
[0063] In an exemplary embodiment of the invention, a moving part
of the system itself or a light pointer portion of the system are
used to mark and/or note a correct positioning.
[0064] In an exemplary embodiment of the invention, once the
relative position is determined, one or more exercises are modified
to take into account the relative positions.
[0065] An aspect of some embodiments of the invention relates to
safety of a rehabilitation device. In an exemplary embodiment of
the invention, the rehabilitation device includes one or more
mechanical fuses which selectively tear when shear, strain and/or
torque on a replaceable element (such as a pin) increase above a
threshold. Alternatively to a mechanical pin, an adjustable
magnetic pin may be used, in which two parts of a pin attach to
each other based on magnetic attraction. The attraction level is
optionally set by moving a magnet inside one of the parts of the
pin. Torque is optionally detected by providing a serrated
connection between the pin parts which links relative rotation of
the pin parts and separation of the parts. Optionally, a wire is
provided in the pin so that tearing of the wire can be detected by
the device electrically.
[0066] In an exemplary embodiment of the invention, a dead-man
switch is provided for a patient in which if a patient lets go of
the switch, the device stops or goes into a predefined or
dynamically determined safe mode and/or position. Optionally, the
dead-man switch is on a wireless element held by a good limb or
body part, for example, being stepped on, held by hand or held in a
mouth.
[0067] In an exemplary embodiment of the invention, a voice
activated shut-off is provided, for example to allow a patient to
stop the rehabilitation by shouting.
[0068] In an exemplary embodiment of the invention, the
rehabilitation device analyses motions and/or forces applied by the
patient, to detect problems. For example, any gross irregularities
will cause the rehabilitation device to stop.
[0069] In an exemplary embodiment of the invention, the device
includes at least one moving element which includes resiliency when
moving so that there is slack, with increasing resistance as amount
of slack used increases. Optionally, the slack serves to allow a
user to not perform a motion according to the movement of the
element, while providing sufficient time to detect that the motion
is incorrect and that applied forces are reaching a safety
limit.
[0070] Examples of types of situations where embodiments of the
invention may be useful, follow. In some exemplary embodiments of
the invention, a range of treatment lengths are supported,
including for example, goal oriented treatment, short term
treatment, long term treatment and/or preventive activities. In
some exemplary embodiments of the invention, treatment over
multiple stages in rehabilitation, possibly an entire
rehabilitation process, are supported, in some cases with a same
device. In some exemplary embodiments of the invention, multiple
body parts may be rehabilitated, either simultaneously or
separately, in some cases, with a same device. In some embodiments
of the invention, multiple modalities are rehabilitated, either
together or using a same device, for example, motor control, motor
feedback, vision, audio ability and/or speech. A range of
complexities and hierarchies of motion are supported by some
embodiments, for example, simple motion of one joint and complex
planning of multi-limb motion. Multiple treatment locations are
supported by some embodiments of the invention, for example, ICU,
bed, clinic, home and/or outdoor. Multiple activity types are
supported in some embodiments of the invention, for example,
dedicated rehabilitation exercises, training exercises, daily
activities, outdoor activities and/or diagnosis activities. In some
embodiments of the invention, multiple body positions are
supported, for example, lying down, standing and/or sitting. In
some embodiments of the invention, a range of mental, cognitive
and/or motor ability states are supported. It should be noted that
not all the embodiments of the invention support all the various
ranges and the extents of the ranges described above.
[0071] There is thus provided in accordance with an exemplary
embodiment of the invention a method of rehabilitation using an
actuator type that includes a movement mechanism capable of
applying a force that interacts with a motion of a patient's limb
in a volume of at least 30 cm in diameter, in at least three
degrees of freedom of motion of the actuator and capable of
preventing substantial motion in any point in any direction in said
volume, comprising:
[0072] exercising a patient at a first place of rehabilitation
selected from a bed, a wheel-chair, a clinic and a home, using an
actuator of said actuator type which interacts with a motion of
said patient; and
[0073] second exercising said patient at a second place of
rehabilitation selected from a bed, a wheel-chair, a clinic and a
home using a second actuator of said actuator type which interacts
with a motion of said patient;
[0074] wherein said first exercising and said second exercising
utilize a same movement mechanism design for moving the
actuators.
[0075] Optionally, said first and said second exercising are
performed using a same rehabilitation apparatus.
[0076] In an exemplary embodiment of the invention, said motion
mechanism is motorized. Optionally, said motion and said force are
controlled by a controller. Alternatively or additionally, said
motion mechanism is capable of applying a force of at least 10 Kg
to a tip of said actuator. Alternatively or additionally, said
motion mechanism is capable of applying a force of different
magnitudes in different directions of motion said actuator.
[0077] In an exemplary embodiment of the invention, said motion
mechanism is adapted to apply selective resistance to motion of
said actuator.
[0078] In an exemplary embodiment of the invention, said actuator
is adapted to interact with said motion in a plurality of modes
including at least causing said motion, guiding said motion and
recoding said motion. Optionally, said first and said second
exercising use different motion interaction modes.
[0079] In an exemplary embodiment of the invention, at least one of
said first and said second exercising are performed in water.
[0080] In an exemplary embodiment of the invention, said first and
said second exercising are performed on a same limb.
[0081] In an exemplary embodiment of the invention, said first and
said second exercising are different exercises.
[0082] In an exemplary embodiment of the invention, the method
comprises keeping track of progress of said patient including said
first and said second exercising, in a same controller coupled with
said second actuator.
[0083] Optionally, said actuator is rigid.
[0084] There is also provided in accordance with an exemplary
embodiment of the invention a method of rehabilitation using an
actuator that includes a movement mechanism capable of applying a
force that interacts with a motion of a patient's limb in a volume
of at least 30 cm in diameter, in at least three degrees of freedom
of motion of the actuator and capable of preventing substantial
motion in any point in any direction in said volume,
comprising:
[0085] exercising a first organ type of a patient using said
actuator; and
[0086] exercising a second organ type of the patient using said
actuator.
[0087] In an exemplary embodiment of the invention, the method
comprises replacing an attachment to said patient of said
rehabilitation device between said exercising.
[0088] In an exemplary embodiment of the invention, the actuator
comprises a controller which controls said interaction. Optionally,
said controller is programmed with a plurality of different
exercises for different limbs
[0089] In an exemplary embodiment of the invention, the method
comprises adjusting at least one of a spatial position and
orientation of said actuator relative to said patient, between said
exercises.
[0090] There is also provided in accordance with an exemplary
embodiment of the invention a rehabilitation kit, comprising:
[0091] an actuator that includes a movement mechanism capable of
applying a force that interacts with a motion of a patient's limb
in a volume of at least 30 cm in diameter, in at least three
degrees of freedom of motion of the actuator and capable of
preventing substantial motion in any point in any direction in said
volume;
[0092] a tip on said actuator; and
[0093] a plurality of attachments modularly exchangeable for said
tip, at least two of which are adapted to fit different organs.
[0094] Optionally, at least one of said attachments is powered via
said actuator. Alternatively or additionally, at least one of said
attachments is capable of rotation in three axes of rotations.
[0095] There is also provided in accordance with an exemplary
embodiment of the invention a device for rehabilitation,
comprising:
[0096] a motorized actuator adapted to support a movement by a
person by at least one of resisting motion, guiding motion and
causing motion; and
[0097] a controller configured to control said actuator,
[0098] wherein, said controller is programmed to provide
rehabilitation exercising for patient's switchable between a
plurality of modes in which one or more or motivation, cognitive
ability and motor ability is either high or low.
[0099] Optionally, said controller is configured to provide
instructions in a selectable one of at least three information
presentation modes and complexity levels.
[0100] Alternatively or additionally, said controller is configured
to provide support for motor activity of said patient in a
selectable one of at least three levels of assistance.
[0101] Alternatively or additionally, said controller is configured
to provide incentive feedback to said patient in a selectable one
of at least three levels of incentive.
[0102] There is also provided in accordance with an exemplary
embodiment of the invention a method of rehabilitation using an
actuator that includes a movement mechanism capable of applying a
force that interacts with a motion of a patient's limb in a volume
of at least 30 cm in diameter, in at least three degrees of freedom
of motion of the actuator and capable of preventing substantial
motion in any point in any direction in said volume,
comprising:
[0103] coupling said actuator to a person in a home setting;
[0104] performing a daily activity by said person, wherein said
actuator interacts with said activity to enhance
rehabilitation.
[0105] Optionally, said daily activity is outdoors
[0106] Alternatively or additionally, said actuator interacts using
a stored rehabilitation plan.
[0107] Alternatively or additionally, said actuator reports to a
remote location on a progress of rehabilitation.
[0108] Alternatively or additionally, said actuator prevents unsafe
motions by said patient.
[0109] Alternatively or additionally, the method comprises first
practicing said daily activity at a rehabilitation clinic.
[0110] There is also provided in accordance with an exemplary
embodiment of the invention a method of rehabilitation,
comprising:
[0111] rehabilitating a first patient on a first rehabilitation
device;
[0112] rehabilitating a second patient on a second rehabilitation
device; and
[0113] passing information regarding rehabilitation between said
two devices, said information including at least one of a score,
current progress, spatial position of a portion of the patient and
a game play.
[0114] Optionally, said patients play a game together using said
devices for input and output. Optionally, said patients play
against each other. Alternatively or additionally, said first
rehabilitation device provides a different support from said first
patient than said second device supplies for said second patient,
to compensate for differences in ability between the two
patients.
[0115] In an exemplary embodiment of the invention, said
information is passed in real-time.
[0116] In an exemplary embodiment of the invention, said
information is passed using a wireless connection.
[0117] In an exemplary embodiment of the invention, the method
comprises monitoring said first and said second patients by a
remote therapist.
[0118] In an exemplary embodiment of the invention, the method
comprises remotely connecting into a therapy group by said
patients.
[0119] In an exemplary embodiment of the invention, said two
devices are in a same room.
[0120] There is also provided in accordance with an exemplary
embodiment of the invention a rehabilitation system configuration,
comprising:
[0121] A first rehabilitation device; and
[0122] A second rehabilitation device linked by a wireless data
link with said first rehabilitation device such that the two
rehabilitation devices can act in synchrony.
[0123] There is also provided in accordance with an exemplary
embodiment of the invention a method of cooperative rehabilitation,
comprising:
[0124] providing a first actuator that includes a movement
mechanism capable of applying a force that interacts with a motion
of a patient's limb in a volume of at least 30 cm in diameter, in
at least three degrees of freedom of motion of the actuator and
capable of preventing substantial motion in any point in any
direction in said volume;
[0125] providing a second actuator that includes a movement
mechanism capable of applying a force that interacts with a motion
of a patient's limb in a volume of at least 30 cm in diameter, in
at least three degrees of freedom of motion of the actuator and
capable of preventing substantial motion in any point in any
direction in said volume;
[0126] engaging said first and said second actuators by a patient
and by a non-therapist,
[0127] respectively; and
[0128] rehabilitating said patient using said first actuator and
said non-therapist.
[0129] Optionally, said non-therapist is a blood relative.
[0130] In an exemplary embodiment of the invention, the method
comprises guiding said non-therapist and said patient by
instructions by a controller.
[0131] In an exemplary embodiment of the invention, said
non-therapist is under an age of 18.
[0132] In an exemplary embodiment of the invention, said
non-therapist is under an age of 10.
[0133] In an exemplary embodiment of the invention, said providing
is at a home of said non-therapist.
[0134] In an exemplary embodiment of the invention, said
non-therapist has fewer than 50 hours experience in physical
therapy.
[0135] In an exemplary embodiment of the invention, said
non-therapist has fewer than 10 hours experience in physical
therapy.
[0136] There is also provided in accordance with an exemplary
embodiment of the invention a rehabilitation device comprising:
[0137] a frame;
[0138] an actuator that includes a movement mechanism capable of
applying a force that interacts with a motion of a patient's limb
in a volume of at least 30 cm in diameter, in at least three
degrees of freedom of motion of the actuator and capable of
preventing substantial motion in any point in any direction in said
volume;
[0139] a joint interconnecting said frame and said actuator and
allowing multiple different relative placements of said movement
mechanism on said frame, such that said volume moves relative to
said frame.
[0140] Optionally, said motion mechanism has different motion
limitations in different spatial direction and wherein said
multiple relative placements include changing an orientation of
said mechanism.
[0141] In an exemplary embodiment of the invention, said joint
comprises a linear joint.
[0142] In an exemplary embodiment of the invention, said joint
comprises a swiveling joint.
[0143] In an exemplary embodiment of the invention, said frame is
curved.
[0144] In an exemplary embodiment of the invention, said joint is
motorized.
[0145] In an exemplary embodiment of the invention, the device
comprises a controller that controls said joint according to an
exercise stored in said controller to be performed.
[0146] In an exemplary embodiment of the invention, the device
comprises at least one sensor that reports a position of said
joint.
[0147] There is also provided in accordance with an exemplary
embodiment of the invention a method of setting up a rehabilitation
system including an actuator that includes a movement mechanism
capable of applying a force that interacts with a motion of a
patient's limb in a volume of at least 30 cm in diameter, in at
least three degrees of freedom of motion of the actuator and
capable of preventing substantial motion in any point in any
direction in said volume, comprising:
[0148] determining a rehabilitation exercise to be performed;
[0149] selecting a desired position for said motion control
mechanism for said exercise; and
[0150] adjusting a position of the mechanism on a frame according
to said desired position.
[0151] In an exemplary embodiment of the invention, the method
comprises automatically adjusting said position.
[0152] In an exemplary embodiment of the invention, the method
comprises automatically reporting to a user said desired
position.
[0153] There is also provided in accordance with an exemplary
embodiment of the invention a rehabilitation device,
comprising:
[0154] a joint having freedom of motion in Phi (rotation) and Theta
(elevation) spherical angles, said freedom allowing positioning of
said joint in substantially any angular position within a range of
at least 30 degrees in each angular direction.
[0155] a substantially rigid radial extension attached to said
joint and adapted for movement with a limb of a person at least one
point thereof; and
[0156] a controller adapted to control motion of said joint and
thereby motion of said radial extension.
[0157] In an exemplary embodiment of the invention, said radial
extension is balanced such that said point remains stable if no
force is applied and moves if force is applied by said person.
Optionally, said balancing can be varied to match a weight of an
attachment selectively attached to said extension. Alternatively or
additionally, said balancing can be varied by said controller along
a path of motion to match a change in moment on said point.
Alternatively or additionally, said balancing can be set to provide
a neutral buoyancy to said limb.
[0158] In an exemplary embodiment of the invention, said joint is a
ball joint.
[0159] In an exemplary embodiment of the invention, said joint
comprises two orthogonal hinges with a common center of
rotation.
[0160] In an exemplary embodiment of the invention, said controller
comprises a mechanical controller.
[0161] In an exemplary embodiment of the invention, said controller
comprises an electrical controller.
[0162] In an exemplary embodiment of the invention, the device
comprises at least one brake adapted to selectively resist said
freedom motion. Optionally, said brake is continuously controlled
by said controller. Alternatively or additionally, said brake is
uni-directional in only one of said Phi and Theta directions.
Alternatively or additionally, said brake is operative in both said
Phi and said Theta directions.
[0163] In an exemplary embodiment of the invention, the device
comprises at least one motor adapted to move said joint.
Optionally, said motor is adapted to apply at least 10 Kg of force
at said point. Alternatively or additionally, said motor is
continuously controlled by said controller. Alternatively or
additionally, said motor cannot be back-driven by said
extension.
[0164] In an exemplary embodiment of the invention, the device
comprises at least one resilient element adapted to provide
resilient compliance when said person moves said point in a
trajectory other than a trajectory for which motion is controlled
to move by said controller. Optionally, said controller sets a
degree of said resilient compliance.
[0165] In an exemplary embodiment of the invention, said element is
extendible.
[0166] In an exemplary embodiment of the invention, element
includes a conduit for electrical power.
[0167] In an exemplary embodiment of the invention, the device
comprises at least one position sensor which reports on a angular
position of said joint.
[0168] In an exemplary embodiment of the invention, the device
comprises at least one force sensor which reports on a force
applied to said joint.
[0169] In an exemplary embodiment of the invention, said controller
is configured to control said motion and provide at least one of
assisting motion by said patient limb, resisting motion by said
patient limb, guiding motion by said patient limb, nudging said
patient limb to move and moving said patient limb.
[0170] In an exemplary embodiment of the invention, said
controllers stores thereon a plurality of different rehabilitation
exercises.
[0171] There is also provided in accordance with an exemplary
embodiment of the invention a balanced rehabilitation device,
comprising
[0172] an actuator that includes a movement mechanism capable of
applying a force that interacts with a motion of a patient's limb
in a volume of at least 30 cm in diameter, in at least three
degrees of freedom of motion of the actuator and capable of
preventing substantial motion in any point in any direction in said
volume; and
[0173] at least one weight that balances said actuator such that no
force is required to maintain said actuator in space.
[0174] There is also provided in accordance with an exemplary
embodiment of the invention a method of rehabilitation,
comprising:
[0175] assisting motion in space of a patient along a trajectory,
using an actuator;
[0176] providing resistance to motion by said patient away from
said trajectory, said resistance including compliance in a
direction away from said trajectory,
[0177] wherein said compliance is achieved mechanically without an
electro-mechanical feedback loop.
[0178] In an exemplary embodiment of the invention, said compliance
is provided by braking.
[0179] In an exemplary embodiment of the invention, said compliance
is provided by at least one resilient element.
[0180] In an exemplary embodiment of the invention, the method
comprises tracking said motion of the patient with said
compliance.
[0181] In an exemplary embodiment of the invention, a different
force of resistance is provided at different points in space along
the motion.
[0182] In an exemplary embodiment of the invention, a different
force of resistance is provided at different direction at a same
point in space.
[0183] In an exemplary embodiment of the invention, said compliance
is at least 1 cm.
[0184] There is also provided in accordance with an exemplary
embodiment of the invention a rehabilitation device comprising:
[0185] a lever adapted to move together with a portion of a
patient's body;
[0186] a motor, operatively connected to said lever in a manner
which prevents back-driving of the motor by said lever, said motor
being operative to move the lever; and
[0187] a spring coupled to said lever and providing resilience to
said motion.
[0188] In an exemplary embodiment of the invention, said spring
provides said resilience only when said lever is moved different
from motion caused by the motor.
[0189] In an exemplary embodiment of the invention, attempted
back-driving of said motor applies force to said spring.
[0190] In an exemplary embodiment of the invention, said spring has
a controllable pre-load.
[0191] In an exemplary embodiment of the invention, the device
comprises a damping element in parallel with said spring.
[0192] There is also provided in accordance with an exemplary
embodiment of the invention a rehabilitation device comprising:
[0193] a lever adapted to move together with a portion of a
patient's body;
[0194] a motor, operatively connected to said lever to move the
lever;
[0195] a slot guiding motion of said lever; and
[0196] a spring coupled to said lever and providing resilience to
said motion.
[0197] In an exemplary embodiment of the invention, said spring is
mounted on said slot.
[0198] There is also provided in accordance with an exemplary
embodiment of the invention a multi-axis resilient element for
rehabilitation, comprising:
[0199] a first set of at least one joint adapted to allow motion in
spherical coordinates of a radially extending lever;
[0200] a second set of at least one joint adapted to allow motion
in spherical coordinates of said first set;
[0201] a resilient element having a compression associated with
motion of said lever thereby compliance to motion in said second
set.
[0202] In an exemplary embodiment of the invention, said resilient
element has a settable pre-load.
[0203] There is also provided in accordance with an exemplary
embodiment of the invention a rehabilitation device comprising:
[0204] a lever adapted to move together with a portion of a
patient's body;
[0205] a motor, operatively connected to said lever to move the
lever; and
[0206] a spring coupled to said lever and providing resilience to
said motion,
[0207] wherein said spring has a settable compliance.
[0208] In an exemplary embodiment of the invention, said compliance
is set by a controller. Optionally, said setting is continuous.
[0209] In an exemplary embodiment of the invention, said spring is
a flat spring having a settable effective length.
[0210] There is also provided in accordance with an exemplary
embodiment of the invention a telescoping mechanism comprising:
[0211] at least three telescoping sections, including a central
section and two end sections;
[0212] an actuating mechanism that extends said central
section;
[0213] a first rack and pinion mechanism that couples motion of one
of said ends and of said central portion;
[0214] a second rack and pinion mechanism that couples motion of
the other one of said ends and of said central portion; and
[0215] a belt operatively linking the two rack and pinion
mechanisms.
[0216] There is also provided in accordance with an exemplary
embodiment of the invention a portable rehabilitation device
comprising:
[0217] a base for stabilization of the device to a surface or
object; and
[0218] an actuator that includes a movement mechanism capable of
applying a force that interacts with a motion of a patient's limb
in a volume of at least 30 cm in diameter, in at least three
degrees of freedom of motion of the actuator and capable of
preventing substantial motion in any point in any direction in said
volume,
[0219] wherein said device has two configurations: [0220] a first
configuration suitable for practicing rehabilitation; and [0221] a
second configuration suitable for storage, and wherein
[0222] said device is adapted to pass between said configurations
manually, by a layman.
[0223] In an exemplary embodiment of the invention, said device is
taken apart for said second configuration.
[0224] In an exemplary embodiment of the invention, said device
comprises at least one quick-connection.
[0225] In an exemplary embodiment of the invention, said device
folds down.
[0226] In an exemplary embodiment of the invention, said device
folds flat to fit in a car trunk.
[0227] In an exemplary embodiment of the invention, said device
weighs less than 30 Kg.
[0228] In an exemplary embodiment of the invention, said device is
wheeled
[0229] There is also provided in accordance with an exemplary
embodiment of the invention a rehabilitation device,
comprising:
[0230] a lever adapted to move together with a portion of a
patient's body;
[0231] at least one motor coupled to said lever adapted to interact
with a motion of said lever; and
[0232] at least one separable element interconnecting said motor
and said lever and adapted to decouple at least a portion of said
lever from said motor is a predetermined force on the element is
exceeded.
[0233] In an exemplary embodiment of the invention, said element
comprises a tearing pin.
[0234] In an exemplary embodiment of the invention, said element
comprises a separable joint.
[0235] In an exemplary embodiment of the invention, said element is
connected between a body of said lever and an attachment mounted on
said lever.
[0236] There is also provided in accordance with an exemplary
embodiment of the invention a rehabilitation device,
comprising:
[0237] a lever adapted to move together with a portion of a
patient's body;
[0238] at least one motor coupled to said lever adapted to interact
with a motion of said lever;
[0239] at least one resilient element interconnecting said motor
and said portion; and
[0240] a controller adapted to identify a safety problem and stop
said motor upon said identifying, said resilient element preventing
such stopping from being immediate.
[0241] In an exemplary embodiment of the invention, said device
comprises an actuator that includes a movement mechanism capable of
applying a force to said lever which lever interacts with a motion
of a patient's limb in a volume of at least 30 cm in diameter, in
at least three degrees of freedom of motion of the lever.
[0242] In an exemplary embodiment of the invention, said controller
identifies said safety problem by detecting a shout by said
patient.
[0243] In an exemplary embodiment of the invention, said controller
identifies said safety problem by calculating at least one position
of a point of the body of said patient and comparing the result of
the calculation to one or more allowed value.
[0244] There is also provided in accordance with an exemplary
embodiment of the invention a rehabilitation docking station
comprising:
[0245] an actuator that includes a movement mechanism capable of
applying a force that interacts with a motion of a patient's limb
in a volume of at least 30 cm in diameter, in at least three
degrees of freedom of motion of the actuator and capable of
preventing substantial motion in any point in any direction in said
volume;
[0246] at least one actuator adapted to assist in rehabilitation
by; and
[0247] a docking port adapted for locking to a patient carrier.
[0248] In an exemplary embodiment of the invention, said port is
adapted to engage a wheelchair.
[0249] In an exemplary embodiment of the invention, said port is
adapted to engage a bed.
[0250] In an exemplary embodiment of the invention, said station is
mobile.
[0251] In an exemplary embodiment of the invention, said station
includes at least one port for attachment of a second actuator
thereto.
[0252] There is also provided in accordance with an exemplary
embodiment of the invention a method of rehabilitation
comprising:
[0253] providing an actuator that includes a movement mechanism
capable of applying a force that interacts with a motion of a
patient's limb in a volume of at least 30 cm in diameter, in at
least three degrees of freedom of motion of the actuator and
capable of preventing substantial motion in any point in any
direction in said volume;
[0254] coupling said actuator to a point on a human body;
[0255] applying a force vector to said point by said actuator, said
force including a rotation.
[0256] In an exemplary embodiment of the invention, said force
vector includes at least two rotations directions relative to the
force vector.
[0257] In an exemplary embodiment of the invention, the method
comprises applying a second force to at least a second point on
said body, simultaneously with said force.
[0258] There is also provided in accordance with an exemplary
embodiment of the invention a method of rehabilitation
comprising:
[0259] providing a first actuator that includes a movement
mechanism capable of applying a force that interacts with a motion
of a patient's limb in a volume of at least 30 cm in diameter, in
at least three degrees of freedom of motion of the actuator and
capable of preventing substantial motion in any point in any
direction in said volume;
[0260] coupling said first actuator to a first point on a human
body;
[0261] providing a second actuator that includes a movement
mechanism capable of applying a force that interacts with a motion
of a patient's limb in a volume of at least 30 cm in diameter, in
at least three degrees of freedom of motion of the actuator and
capable of preventing substantial motion in any point in any
direction in said volume;
[0262] coupling said second actuator to a second point on a human
body; and
[0263] applying different forces to said points using said
actuators.
[0264] In an exemplary embodiment of the invention, said first
actuator applies a rotation.
[0265] In an exemplary embodiment of the invention, said different
points are on a same limb.
[0266] In an exemplary embodiment of the invention, said different
points are on different limbs. In an exemplary embodiment of the
invention, the method comprises exercising the two limbs in
concert. Alternatively or additionally, the method comprises
copying motion from one limb to the other limb.
[0267] There is also provided in accordance with an exemplary
embodiment of the invention a method of reverse kinematics,
comprising:
[0268] controlling motion of at least one point on an organ using
an actuator that includes a movement mechanism capable of applying
a force that interacts with a motion of a patient's limb in a
volume of at least 30 cm in diameter, in at least three degrees of
freedom of motion of the actuator and capable of preventing
substantial motion in any point in any direction in said
volume;
[0269] controlling a position of at least a second point on the
organ; and
[0270] reconstructing by a computer of a value of a bending of at
least one joint of said organ from said motion and said
position.
[0271] There is also provided in accordance with an exemplary
embodiment of the invention a rehabilitation device,
comprising:
[0272] an actuator that includes a movement mechanism capable of
applying a force that interacts with a motion of a patient's limb
in a volume of at least 30 cm in diameter;
[0273] a support for a patient; and
[0274] a controller adapted to adjust a rehabilitation exercise
according to the relative positions of said actuator and at least
one of said patient and said support.
[0275] In an exemplary embodiment of the invention, the device
comprises a distance sensor for determining said relative
positions.
[0276] In an exemplary embodiment of the invention, the device
comprises an imaging sensor for determining said relative
positions.
[0277] In an exemplary embodiment of the invention, said controller
relates to the relative placement of said patient and said
actuator.
[0278] In an exemplary embodiment of the invention, said controller
assumes the relative positions differ only in two dimensions.
[0279] In an exemplary embodiment of the invention, the device
comprises a pointer which indicates a desired patient
placement.
[0280] In an exemplary embodiment of the invention, said controller
is configured to use said actuator to determine said relative
placement.
[0281] In an exemplary embodiment of the invention, said controller
is configured to use said actuator to indicate a desired relative
placement.
[0282] In an exemplary embodiment of the invention, said controller
is configured to adjust said exercise on the fly, during an
exercise session and in response to patient movement.
[0283] There is also provided in accordance with an exemplary
embodiment of the invention a rehabilitation device,
comprising:
[0284] a memory storing therein a correspondence between exercises
and payment codes;
[0285] a controller adapted to control a rehabilitating exercise
and generate a report including a code from said memory
corresponding to said exercise.
[0286] There is also provided in accordance with an exemplary
embodiment of the invention a rehabilitation device,
comprising:
[0287] at least one actuator adapted to support motion of a body
part;
[0288] at lest one sensor associated with the actuator and
measuring said motion; and
[0289] a controller which analyses said measured motion and
generates a measure of quality of motion and which modifies a
rehabilitation plan responsive to said quality of motion
measure.
[0290] In an exemplary embodiment of the invention, the controller
modifies a selection of future exercises according to a measured
quality of motion.
[0291] In an exemplary embodiment of the invention, the controller
modifies a selection of parameters for future exercises according
to a measured quality of motion.
[0292] In an exemplary embodiment of the invention, the quality of
motion measure used is defined as the degree of matching to a 2/3
power law.
[0293] There is also provided in accordance with an exemplary
embodiment of the invention a method of rehabilitation,
comprising:
[0294] causing a person to carry out at least one exercise;
[0295] estimating a mental state of said person from a result of
said at least one exercise; and
[0296] automatically selecting at least one second exercise
according to said estimation.
[0297] In an exemplary embodiment of the invention, estimating a
mental step comprises comparing performance between two exercises,
one or which is expected to elicit a higher compliance.
[0298] In an exemplary embodiment of the invention, estimating a
mental step comprises comparing performance within an exercise,
using the maximum ability of the patient as a base line against
which variation can be determined.
[0299] In an exemplary embodiment of the invention, said estimating
is automatic.
[0300] There is also provided in accordance with an exemplary
embodiment of the invention a method of rehabilitation,
comprising:
[0301] determining a patient's ability to perform a motor task;
[0302] determining a patient's ability to perform a non-motor task;
and
[0303] automatically selecting an exercise or parameters of an
exercise for the patient according to said determinations.
[0304] In an exemplary embodiment of the invention, said selecting
comprises matching an instruction or feedback modality to a
perceptive ability.
[0305] In an exemplary embodiment of the invention, said selecting
comprises matching an instruction or feedback modality to a
cognitive ability.
[0306] In an exemplary embodiment of the invention, said selecting
comprises an exercise or series of exercises designed to
rehabilitate both of said motor and said non-motor abilities.
[0307] In an exemplary embodiment of the invention, said exercise
rehabilitates visual-motor coordination.
[0308] There is also provided in accordance with an exemplary
embodiment of the invention a method of rehabilitation
comprising;
[0309] moving a motorized actuator having a tip to a spatial
position within a volume having a diameter of at least 30 cm;
and
[0310] instructing a patient to apply force against said tip,
wherein said actuator provides a compliant resistance to said
force. Optionally, the method comprises selecting the resistance
according to the spatial location.
BRIEF DESCRIPTION OF THE FIGURES
[0311] Non-limiting embodiments of the invention will be described
with reference to the following description of exemplary
embodiments, in conjunction with the figures. The figures are
generally not shown to scale and any sizes are only meant to be
exemplary and not necessarily limiting. In the figures, identical
structures, elements or parts that appear in more than one figure
are preferably labeled with a same or similar number in all the
figures in which they appear, in which:
[0312] FIG. 1 is a schematic showing of an articulated-arm based
rehabilitation device, in accordance with an exemplary embodiment
of the invention;
[0313] FIG. 2 is a schematic block diagram of a remote
rehabilitation system, in accordance with an exemplary embodiment
of the invention;
[0314] FIG. 3A illustrates a force field generated by a
rehabilitation device in accordance with an exemplary embodiment of
the invention;
[0315] FIG. 3B shows an exemplary profile of a force of
resistance;
[0316] FIG. 4A is a flowchart of a method of using a rehabilitation
device, in accordance with an exemplary embodiment of the
invention;
[0317] FIG. 4B is a flowchart of a long term use of a
rehabilitation device, in accordance with an exemplary embodiment
of the invention;
[0318] FIG. 5 illustrates a system including limb position sensing,
in accordance with an exemplary embodiment of the invention;
[0319] FIG. 6 illustrates an elbow holding attachment, in
accordance with an exemplary embodiment of the invention;
[0320] FIGS. 7 and 8 illustrate two hand rehabilitation devices, in
accordance with exemplary embodiments of the invention;
[0321] FIGS. 9A and 9B illustrate devices for controlled motion of
more than one point in a body, in accordance with exemplary
embodiments of the invention;
[0322] FIG. 10 shows a ball-based rehabilitation device, in
accordance with an exemplary embodiment of the invention;
[0323] FIG. 11 shows a balancing of the rehabilitation device of
FIG. 10, in accordance with an exemplary embodiment of the
invention;
[0324] FIG. 12 illustrates a drive system for a plate-based
rehabilitation device, in accordance with an exemplary embodiment
of the invention;
[0325] FIG. 13A illustrates a coupling device for a plate drive
system, in accordance with an exemplary embodiment of the
invention;
[0326] FIG. 13B illustrates a plate with a flexible slot, in
accordance with an exemplary embodiment of the invention;
[0327] FIG. 14A illustrates a two plate rehabilitation device, in
accordance with an exemplary embodiment of the invention;
[0328] FIGS. 14B and 14C illustrate guide plates in accordance with
exemplary embodiments of the invention;
[0329] FIG. 15A shows a wrist attachment, which provides control
and/or feedback for one or more degrees of motion of a hand, in
accordance with an exemplary embodiment of the invention;
[0330] FIGS. 15B-15F show various attachments according to
exemplary embodiments of the invention;
[0331] FIGS. 16A-16D illustrate various methods of elbow support in
accordance with exemplary embodiments of the invention;
[0332] FIG. 17A illustrates a rehabilitation device with varying
orientation, in accordance with an exemplary embodiment of the
invention;
[0333] FIGS. 17B and 17C show an alternative rehabilitation device
with varying orientation, in accordance with an exemplary
embodiment of the invention;
[0334] FIG. 17D shows an alternative rehabilitation device with
varying orientation, in accordance with an exemplary embodiment of
the invention;
[0335] FIG. 18 shows a rehabilitation device for an arm and a leg,
in accordance with an exemplary embodiment of the invention;
[0336] FIG. 19A shows a rehabilitation device for two sides of a
body, in accordance with an exemplary embodiment of the
invention;
[0337] FIG. 19B shows a docking station, in accordance with an
exemplary embodiment of the invention;
[0338] FIG. 19C shows an occupied docking station of the type shown
in FIG. 19B;
[0339] FIG. 19D shows mobile rehabilitation devices positioned near
a bed, in accordance with an exemplary embodiment of the
invention;
[0340] FIG. 19E shows an alternative mobile rehabilitation device,
coupled to a bed, in accordance with an exemplary embodiment of the
invention;
[0341] FIG. 19F exemplifies the use of mobile rehabilitation
devices in a bathtub, in accordance with an exemplary embodiment of
the invention;
[0342] FIG. 19G shows a rehabilitation device configured for use
for daily activities, in accordance with an exemplary embodiment of
the invention;
[0343] FIG. 19H shows a device for assisting in training for
activities of daily living, in accordance with an exemplary
embodiment of the invention;
[0344] FIG. 20 shows a chuck mechanism in accordance with an
exemplary embodiment of the invention;
[0345] FIG. 21 shows an alternative non-ball, balanced,
rehabilitation device, in accordance with an exemplary embodiment
of the invention;
[0346] FIG. 22A shows another alternative non-ball rehabilitation
device mechanism, in accordance with an exemplary embodiment of the
invention;
[0347] FIG. 22B shows force control mechanisms and brakes attached
to the device of FIG. 22A;
[0348] FIG. 23 shows a cantilevered rehabilitation device
mechanism, in accordance with an exemplary embodiment of the
invention;
[0349] FIG. 24A is a side cross-sectional view of a force control
mechanism as used in FIG. 22B, in accordance with an exemplary
embodiment of the invention;
[0350] FIG. 24B is a flowchart of the operation of the mechanism of
FIG. 24A, in accordance with an exemplary embodiment of the
invention;
[0351] FIG. 25 shows a force control mechanism in accordance with
an alternative embodiment of the invention;
[0352] FIG. 26A shows a Z-axis extension mechanism in accordance
with an exemplary embodiment of the invention; and
[0353] FIG. 26B shows a force control mechanism for an attachment,
exemplified as part of FIG. 26A, in accordance with an exemplary
embodiment of the invention.
DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS
General
[0354] The methods and apparatus of some embodiments of the
invention provide for controlled, partially controlled or directed
motion of portions of the body. The following sections describe
this equipment by first describing the design of an exemplary
device (an articulated arm), followed by various rehabilitation
methods and then additional rehabilitation device designs and uses.
The invention should not be considered as being limited to
particular devices used to illustrate particular methods. Rather,
many of the methods can be practiced with a variety of devices and
many of the devices can be used to practice a variety of
methods.
Articulated Arm Design
[0355] FIG. 1 is a schematic showing of an articulated-arm based
rehabilitation device 100, in accordance with an exemplary
embodiment of the invention. In some of the description device 100
is referred to even though other devices described herein would
suit just as well. The term "system" is used in some places instead
of referring directly to device 100 and may also include multiple
devices and monitors.
[0356] Device 100 comprises an articulated arm 102 that projects
upwards out of a table or other pedestal 104. A tip 108 of arm 102
serves as a controlled point which can travel various 3D
trajectories. Optionally, pedestal 104 is not attached to a floor
but is instead weighted by an optionally weighted base 106 (which
may be located elsewhere than shown), to prevent tipping or
capsizing of device 100 during use. Optionally, base 106 includes
electronics used to power the arm. Alternatively or additionally,
weight 106 is a temporary weight, for example a water-filled
bladder. Other exemplary general layouts are shown below.
[0357] In an exemplary embodiment of the invention, arm 102 is an
articulated arm, which supports movement in 3D space. Alternative
designs, for example based on a single joint and an extending arm,
are described below.
[0358] In an exemplary embodiment of the invention, arm 102
comprises a plurality of sections 110 interconnected by a plurality
of joints 112. In an exemplary embodiment of the invention, each
joint is motorized, for example as known in the art of robotic
arms. Alternatively or additionally, each joint is selectively
lockable, for example as described below. Optionally, angular
position sensors are provided at each joint and/or a position
sensor at tip 108, so the position in space of arm 102 and/or of
tip 108 can be determined. The joints may be joints with one, two,
three or more degrees of freedom.
[0359] In an exemplary embodiment of the invention, arm 102 (e.g.,
its locking and/or force application and/or movement) is controlled
by a controller 114, for example a personal computer or a dedicated
embedded computer. Optionally, a display 116 and/or a user input
device 118 are used for interaction with a user. Optionally,
display 116 comprises (or is limited to) an audio display, for
example for providing audible and/or speech instruction and/or
feedback.
[0360] An external connection 120 for connection to a remote
computer and/or other units, is optionally provided, for example
for use as described in FIG. 2 below.
[0361] It should be noted that some implementations of device 100
include no computer. Some implementations require no electrical
power. In one example, a mechanical computer is used to control the
device parameters. In some embodiments of the invention, resistance
to motion (optionally variable) is provided using a brake
system.
Arm Specification
[0362] As will be described below in greater detail, various
rehabilitation methods in accordance with exemplary embodiments of
the invention require different types of motion and/or
responsiveness from arm 102 or other devices as described below. In
some embodiments of the invention the use of device 100 for
rehabilitation places certain constraints on device 100, with
respect to, for example, smoothness of motion, responsiveness,
coupling between axes, balancing and/or supported range of
motion.
[0363] For example, some types of rehabilitation in accordance with
exemplary embodiments of the invention require a patient to move
tip 108 along a trajectory. Resistance may be predefined along the
trajectory or possibly no resistance at all is provided. In any
case, it may be desirable that device 100 not adversely affect
motions by the patient, at least if they are correct. In a
particular example, tip 108 provides no resistance to motion along
a certain trajectory and strongly resists motion not along the
certain trajectory. Such a tip is termed a neutral directed motion
tip.
[0364] In order to support generalized 3D trajectories in a neutral
manner (e.g., not providing resistance at least along the
trajectory of motion), arm 102 is optionally required to not have
singularity points in a predefined and useful range of motion, for
example a sphere of radius of 0.8 meters or less, for example, 0.5
meters or less. The term "singularity" is used to define a point
and arm position where moving to an adjacent point passes the
limits of one or more joints and requires a relatively large change
in joints position, which is generally time consuming and is
exhibited to a patient as a sudden resistance or delay. In
addition, providing neutral motion means that a uniform (and
desirably zero) resistance can be provided at any point in a
desired range of motion. Possibly more important in some
embodiments of the invention is that any changes in resistance be
smoothly varying. In some embodiments, arm 102 provides a
counter-force or even provides motion. Uniformity and
controllability of such force is required in some embodiments of
the invention. In some embodiments, tip 108 is configured to
support a limb of a patient, so that the limb feels buoyant.
[0365] The magnitude of force that arm 102 can apply and/or resist
depend on the rehabilitation methods with which it is to be used.
For example, one rehabilitation type will require arm 102 to resist
absolutely an incorrect motion, up to a force of, for example, 100
Kg applied at tip 108. In another example, it is sufficient that
arm 102 resists motion up to a force level at which it is certain
that the patient feels the resistance, for example, 1 Kg. A
reminding force may be useful in some embodiments, for example, 10
Kg, which may ensure that a patient does not inadvertently move tip
108 against the force.
[0366] In an exemplary embodiment of the invention, the range of
motion of tip 108 covers a volume of 50.times.50.times.50 cm. In
other embodiments, a smaller or larger volume is provided. The
volume need not be rectangular. Optionally, the volume also
includes rotation of tip 108 around one, two or three axes. In some
embodiments, the volume of movement of the tip is one or two
dimensional (i.e., in a plane or along a line).
[0367] In some embodiments of the invention arm 102 is expected to
respond to a patient's activity in a manner which will seem natural
or at least not interfere with the rehabilitation motion. In an
exemplary embodiment of the invention, the responsiveness of arm
102 is faster than 10 ms or better than 5 ms.
[0368] A general property of many mechanical systems is that due to
manufacturing tolerances, sensing tolerances, design and/or
non-optimality of the construction some uncontrollable freedom of
motion is available. In an exemplary embodiment of the invention,
the amount of uncontrolled motion in device 100 is less than 5 mm
or less than 2 mm. In some embodiments of the invention, a
spring-loaded mechanism is used to prevent unrestrained backlash
motion.
[0369] Robotic technology for achieving such ranges of motion and
responsiveness and forces are well known, albeit possibly at a high
cost. Various additional suitable technologies are described below.
Optionally, controller 114 controls arm 102 in a passive, active or
a responsive manner to achieve these objectives. In an exemplary
embodiment of the invention, such active control of arm 102 results
in compensation for at least 80% or more of the moment of inertia
of arm 102. It should be noted that different values may be
required for different situations, for example a greater or lesser
responsiveness or a greater or lesser uncontrollable freedom.
[0370] Arm 102 is, for example, 1 meter, 0.8 meters, 0.5 meters,
0.3 meters or any greater smaller or intermediate length.
Motion Types
[0371] In device 100 as illustrated, the motion which is controlled
is that of a single point, i.e., tip 108. By providing various
attachments for tip 108, tip 108 may be connected, for example to a
bone, to a joint or to a different part of the body. The attachment
may be rigid, for example using a strap or it may depend on
cooperation of or action by the patient, for example, as a handle
or a rest. Specific attachment devices, for example for a hand,
arm, elbow, knee, ankle and/or shoulder may be provided. Further,
as described below, multiple tips 108 (optionally with individual
arms 102) may be provided for attachment at different points of the
body, on a same or different body part.
[0372] When providing rehabilitation various types of motion may be
supported, for example, one or more of:
[0373] a) Passive motion. Tip 108 is moved (by device 100) and the
patient moves with it.
[0374] b) Resisted motion. The patient moves tip 108 and encounters
resistance. The resistance may be of various magnitudes and may be
uniform in all direction or be directional.
[0375] c) Assisted motion. When a patient moves tip 108, a positive
feedback on arm 102 increases the force of motion in the direction
moved by the patient.
[0376] d) Force field motion. The patient moves tip 108. Along a
certain trajectory one level of resistance (or none) is
encountered. Deviation from the trajectory is not allowed or meets
with resistance. FIG. 3A shows an example of such a force field.
Motion along a "correct" trajectory 302 can be without resistance,
or possibly assisted. An increased resistance is exhibited in a
volume 304 surrounding trajectory 302. An even greater resistance
is exhibited in a surrounding volume 306. A prevention of motion
may be provided in an outside volume 308. In an exemplary
embodiment of the invention, a corrective force vector 310 is
applied when not on trajectory 302, pointing towards trajectory
302. Optionally, instead of a corrective force, resistance varies
as a function of distance from trajectory 302, thus, motion of tip
108 is naturally urged back to trajectory 302. FIG. 3B is a graph
showing an exemplary relationship between divergence from a path
and applied force. Optionally, the force is applied in the
direction of the path. Alternatively, the force maybe a
unidirectional force of resistance.
[0377] This type of motion may be used to help train the patient in
a desired motion.
[0378] e) Mirrored motion. Motion of tip 108 is required to mirror
the trajectory of motion of a different element, for example for
dual limb rehabilitation as described below.
[0379] f) Free motion. Patient moves tip 108 in any way he desires,
possibly receiving feedback. As the patient (or therapist or
helper) moves tip 108, device 100, may record it for future
playback. In a playback mode the prerecorded motion (or path) is
optionally reconstructed using other modes. Optionally, the
recorded path is modified (e.g., smoothed or otherwise edited), for
example automatically or manually.
[0380] g) General Force Field. A force field and/or an assistance
field is defined which is not related to any particular trajectory.
For example, a range of trajectories may be allowed to be practiced
by a user, or a real or virtual situation simulated (e.g., water,
areas with obstacles).
[0381] h) Local force field. A force field which is applied to only
a small locality and/or only in one or two dimensions.
[0382] i) Restricted motion. One or more points of the body of a
subject are supported or prevented from moving. Optionally, the
angles between such points and the moving points on the patient are
measured. In one example the elbow is locked with a dedicated
harness allowing only a shoulder motion. In some embodiments, the
restriction is partial and/or is provided by a movable element
(e.g., an arm 102).
[0383] j) Initiated Motion. The patient initiates the motion (e.g.,
a 1 cm motion or 100 gram force) and device 100 completes or helps
the patient complete the motion in space. The completion may be of
a whole trajectory or of part of a trajectory.
[0384] k) Implied motion. Device 100 begins the motion and the
patient completes it. Device 100 may assist the rest of the motion
in various manners (e.g., by changing to one of the modes described
herein after the motion starts). If the patient fails to pick up
the motion, device 100 may generate a cue, for example an audio
reminder. Different parts of a single motion trajectory may each
have a machine initiation definition. Optionally, if a patient is
too slow in moving, device 100 begins the motion.
[0385] l) Cued motion. The patient receives a cue from the system
before motion according to a different mode starts. The cue can be,
for example, vibration of tip 108, stimulation pads on the skin,
audio or visual cue. In some embodiments of the invention, the
strength of the cue and/or its timing and/or other ongoing
activities (e.g., a visual display and game) are used to help train
the coordination between different modalities, for example,
hand-eye coordination. A motion cue can be used to train a
kinesthetic sense.
[0386] m) Teach Mode. Device 100 is taught a motion. In one
example, a therapist performs a motion and motion parameters at
each point are recorded and can then be used for an exercise.
Another way of teaching the system is to use a path that the
therapist uses. The therapist may use a control to indicate a point
to be taught or a continuous mode may be defined by which an entire
trajectory is learned. Optionally the path and points are edited
before replay. Optionally, the paths are abstracted, for example,
by smoothing or identifying motion points, before playback.
[0387] Thus, in some embodiments of the invention, rehabilitation
device 100 can provide one or more of Isokinetic, Isotonic and
Isostatic exercises.
[0388] It should be appreciated that a definition of a trajectory
which tip 108 is to follow can include speed parameters (e.g.,
trajectory of path, trajectory of velocity, trajectory of force).
For example, a user may be assisted, or urged, or expected, to move
tip 108 at a certain speed. The speed may be, for example,
absolute, or relative (e.g., requiring a uniform speed or the speed
to match a non-uniform profile).
[0389] Optionally, an angular trajectory is defined, which places
constraints on an angular orientation of tip 108. In some
embodiments, the constraint is one dimensional. In others it is two
or three dimensional.
[0390] Speed, angles and spatial trajectories in a particular
rehabilitation scenario may each belong to a different one of the
above motion types. For example, spatial trajectory may be of a
force field type, while speed trajectory is free or assisted. The
type of trajectory and/or its parameters may also vary along the
trajectory, as a function of time and/or as a function of previous
performance. For example, a smaller assistance at a later part of a
trajectory may be provided for a type of motion which was properly
(or better than expected) executed in an earlier part of the
trajectory.
[0391] Trajectories may be absolute, for example, defined as a
function of a resting point or a different point on device 100. In
other embodiments, the trajectories are purely relative, for
example, requiring a patient to move an arm in a straight line,
regardless of starting point. In other embodiments, a trajectory is
partially relative, in that once motion starts, this determines the
shape of the rest of the trajectory, for example, a start of a
trajectory indicating if a patient is standing or sitting, and thus
what type of hand motion is expected.
[0392] In some embodiments, such as described below, where multiple
points 108 are defined, the motion types of each point may be of
different types. In some embodiments, what is defined is a
trajectory as a function of two or more points in space. For
example, if two points are used to define an elbow configuration
(e.g., angle between bones), the trajectory constraints may be
defined on the motion of the elbow. Such motion may be relative in
space (e.g., a comparison of the two points) and not absolute
(e.g., compared to a device reference point). In another example,
different limitations are provided for different points, for
example, angular limitations at one point and velocity limitations
of another.
[0393] It should be noted that in some embodiments of the invention
a tensor or tensor field is provided, as each point in space can
have associated with it a speed, a force and/or a rotation, all of
which can be scalar or a vector.
[0394] In some embodiments of the invention, different modes are
defined for different parts of a trajectory or for different parts
of space (e.g., for a particular arm). Optionally, a mode may be
triggered based on the actual performance. For example, if motion
velocity is below a certain threshold, a more assistive mode is
provided. Similarly, a pause of over a threshold may imply a more
assistive mode. An exact motion may imply a less assistive
mode.
[0395] In an exemplary embodiment of the invention, modes may be
changed automatically, for example, when nearing a patient motor
limit (e.g., range of motion) or when nearing a cognitive limit
(e.g., spatial neglecting zone or time neglect zone such as for
long motions).
Exemplary Usage
[0396] FIG. 4A is a flowchart 400 of a method of using device 100,
in accordance with an exemplary embodiment of the invention.
[0397] At 402, device 100 is powered on (for electrical devices).
Optionally, device 100 turns on when arm 102 is touched or moved a
certain amount. Alternatively, motion of arm 102 may provide power
for device 100.
[0398] At 404, if remote connection 120 is used, device 100
optionally downloads instructions, for example what activities to
suggest and/or what progress was expected and/or results from
physical therapy at other locations. Optionally, a patient
identifies himself to device 100, for example, using a code,
selecting a name form a list or using a smart card or a magnetic
card with user input 1118. Optionally, rehabilitation information
of a patient is stored or indexed on such a magnetic card or smart
card or on a portable flash memory device or portable hard
disk.
[0399] At 406, an activity to be performed is selected. In a more
automated device, the selection may be, for example automatic or by
a patient from a displayed list of options. In a less automated
device, for example, a patient may follow a chart provided to him
by a rehabilitation center or by a guiding therapist.
[0400] At 408, arm 102 is optionally moved to a start position
thereof, for example by device 100 or by the patient (e.g.,
directly or by permitting device 100 to do so). It should be noted
that in some trajectories no start position is predefined. Instead,
the actual starting position is used to define the rest of the
trajectory.
[0401] In some embodiments of the invention, the position of the
patient relative to the system is indicated or measured (e.g. by
vision system, by mechanical attachments) and the program is
adjusted accordingly.
[0402] In some cases, device 100 is adjusted in another manner. For
example, a particular handle may be attached at tip 108, or legs of
the device may be raised or lowered. In a collapsible device (e.g.,
folding legs), the device may be set up. Optionally, such setting
up is carried out before activating device 100.
[0403] At 410, an optional warm-up session is carried out on the
patient, to ensure that he is ready for the activity. Optionally,
one or more physiological sensors, for example a muscle temperature
sensor (e.g., skin surface) are used to ensure (e.g., as a safety
feature) that the patient is sufficiently warmed up.
[0404] At 412, the patient is optionally tested to confirm an
expected current ability.
[0405] At 414, the results of the test are optionally used to
modify one or more parameters of the selected activity or to select
a different activity, for example, due to an under- or
over-achievement of the patient during testing. Exemplary
modifications include: slowing down expected speed, reducing
expected or resistive force, reducing expected or allowed range of
motion and reducing number of repetitions.
[0406] At 416, the activity is carried out, for example, continuous
passive motion at 20 repetitions or motion (by patient) with
resistance of 0.5 Kg, along the entire trajectory. In another
example, the resistance grows as a function of speed, or if the
speed is higher or lower than a defined speed trajectory,
optionally using a mode or combination of modes as described
above.
[0407] At 418, various measurements which are optionally made
during the activity, are optionally logged. Such logging may also
be carried out concurrently with the activity.
[0408] At 420, feedback may be provided based on the activity, for
example, to the patient, a rehabilitation expert and/or to device
100. Optionally, feedback is provided on a patient physiological
condition as well, for example, determining fatigue based on
increased irregularities of motion and/or based on pulse rate or
other physiological parameters.
[0409] At 422, a decision is optionally made to repeat an activity
and/or to select a new activity. Such a decision may be made, for
example, based on patient progress and/or fatigue.
[0410] In an exemplary embodiment of the invention, device 100
automatically generates CPT codes or other reports used for
billing. Alternatively, a report is generated which a human
therapist approves and/or modifies. In some embodiments of the
invention the patient's progress is used to assess future expected
payments and/or exercises and/or suggested human guidance.
Optionally, such future factors, patient improvement, time elapsed
and/or motivation of the patient in using and improving using the
system, are used to decide on future financial support by a health
care provider.
[0411] In an exemplary embodiment of the invention, if after a
given time (e.g. several weeks) there is no improvement in function
or other measurements a decision can be made to stop the financial
support. In another example based on documented improvement in
certain areas (e.g. patient accuracy) the treatment support can be
extended. In another example, the therapy payer may insist on
minimum system usage (for example if a system was delivered to the
patient home). By reviewing an on going usage report (possibly on
line) the payer can decide to extend or stop usage.
[0412] In an exemplary embodiment of the invention, the system can
simply generate codes and/or reports, for example using a look-up
table (each exercise can have an associated code) using table and
also automatically generate reports regarding other factors, such
as motivation and completion of plan.
Planning and Long-Term Progress
[0413] FIG. 4B is a flowchart 430 of a long term use of device 100,
in accordance with an exemplary embodiment of the invention.
[0414] At 432, a new patient who is identified as needing
rehabilitation is tested, possibly using device 100. For example,
such tests may include range of motion tests, tests of maximum
applied force at different points in space, and/or tests of
fineness of force control and motion control. In an exemplary
embodiment of the invention, device 100 calculates limb size (or
detects them using a camera) and uses the limb size to adjust
pre-stored exercises, for example to adjust their trajectories
and/or starting point.
[0415] At 434, the results of the tests are analyzed to determine
the needs of the patient and to formulate objectives of the
rehabilitation. This act may be, for example, manual, automated or
manual with support from device 100.
[0416] At 436, a rehabilitation plan is drawn up, including, for
example one or more of an expected progress chart, various allowed
and/or required exercises and exercise parameters for different
parts of the plan, definitions of increased and decreased
difficulty levels for the exercises, allowed and/or required
exercise sequences, number of cycles for each exercise, warm-up
requirement, list of data to log, list of patient-modifiable
information, one or more safety parameters which should not be
passed and/or one or more parameter alert values at which an alert
should be provided to the patient and/or a rehabilitation expect
monitoring the patient's progress. It should be noted that while
generating a rehabilitation plan is a known activity, in an
exemplary embodiment of the invention, such a plan is special, for
example, taking into account one or more of the possibility of long
term rehabilitation, the possibilities involved in having a device
available at a home for multiple short sessions, the provision of
multiple activities with a single device, the needs of remote
monitors and/or the programmability and responsiveness of a device
in accordance with some embodiments of the invention. The plan may
be generated manually, automatically or manually with the
assistance of device 100, for example an initial plan generated
automatically and then annotated or approved by a human.
[0417] At 438, the plan is carried out, while being monitored. In
an exemplary embodiment of the invention, the monitoring is manual.
Alternatively, at least some of the monitoring is automatic.
[0418] At 440, the plan may be modified in response to the
monitoring, for example, if slow progress is detected, the plan
time frame may be changed.
[0419] In some cases, as rehabilitation progresses, new problems
may come up or become emphasized. In some cases, the plan may be
modified (440). In others, testing may be repeated (442), generally
to a lesser extent than when the patient was initially
evaluated.
[0420] In some plans, periodic testing (for example on device 100
at the patient's home) is part of the plan. Such evaluative testing
may also be used to determine when rehabilitation is complete.
[0421] At 444, rehabilitation is mostly completed and a training
plan is optionally made, for example to ensure maintenance of the
rehabilitation or for other reasons (such as prevention of
worsening or prevention of limb or joint neglecting).
[0422] At 446, long term monitoring of the patient may be
performed, for example, testing the patient's abilities once a week
or once a month.
[0423] At 448, new needs of the patient may be identified, for
example based on the monitoring or based on a periodic general
test. In one example, a patient being rehabilitated for stroke may
be determined after a time to need rehabilitation for a progressing
arthritic condition. In an exemplary embodiment of the invention, a
personal profile is created for a patient. For example, such a
profile may include a series of items to work on, for example
smoothness of motion, which can be tackled one by one over time or
if a certain threshold value is detected during testing (e.g.,
quality of motion went below a threshold).
[0424] As noted herein, a particular property of some embodiments
of the invention is that device 100 may be used over a wide range
of situations, including long range treatment and following a
patient from initial rehabilitation through follow-up
rehabilitation (e.g., to maintain an ability) and diagnosis.
Scoring and Time Estimation
[0425] In an exemplary embodiment of the invention, the ability
and/or progress of a patient are scored. In an exemplary embodiment
of the invention, such scoring is used as an aid in deciding on the
need and/or type of future rehabilitation. Alternatively or
additionally, scoring is used to monitor the effect of
rehabilitation exercises and/or help select between exercises.
Alternatively or additionally, scoring is used to ensure that a
patient's needs (e.g., personal rehabilitation needs or need for
balanced rehabilitation) are met. In an exemplary embodiment of the
invention, scoring is used to identify areas where progress was
made and areas where additional therapy or modified therapy may be
needed, due to lack of progress.
[0426] In an exemplary embodiment of the invention, one or more of
the following measures are used to score a patient's ability and/or
progress.
[0427] a) Motor scores may include one or more of Range of motion,
time of motion, force, smoothness, lack of tremor, degree of
tremor, spasticity, muscle tone, accuracy, quality of motion and/or
force finesse (control of force, e.g. not breaking an egg). These
may be defined for a single joint or for a complex motion, for
example for pinching between fingers, holding in a hand, moving of
an arm. In addition some functional scores may be used to e.g.--the
speed at which the patient can move a filled glass, and the ability
to pick and place an object.
[0428] b) Cognitive scores may include one or more of coordination
between motion (motor skills) and senses (e.g., visual, auditory),
speed of reaction, % of successful task completion, quality of
completion, mistakes, planning ability, level of instruction
complexity used (e.g level 1 is a simple visual & auditory
instruction such as a forward arrow on screen & audio verbal
instruction, while level 5 is a complex screen to motion
interaction, such as following a 3D path as shown on screen).
[0429] c) Mental stores may include one or more of: successful task
completed at patient capabilities and/or pain envelope, measure of
self work, amount of nudging required from the system, consistency
of use (e.g., at home).
[0430] In an exemplary embodiment of the invention, scoring of the
patient is calibrated to other patients, for example, using a
database of similar injuries, or using scores of patients that are
being rehabilitated at a same time. Alternatively or additionally,
scoring is carried out between a healthy and a non-healthy
limb.
[0431] In an exemplary embodiment of the invention, scoring is used
as an aid in diagnosis. In an exemplary embodiment of the
invention, when diagnosing a patient, scores are generated (e.g.,
by providing suitable exercises) for individual body part abilities
and for general abilities. In an exemplary embodiment of the
invention, device 100 can analyze a patient's abilities by
generating experiments and then analyzing the results. In one
example, device 100 tests whether a patient will respond better to
one type of exercise or to another by generating a series of
exercises including both types of exercises. The results of the
patient's performance are then analyzed to extract trends which
indicate which of a controlled variable had a better or a desired
effect on the patient. Optionally, a human therapist selects the
initial possible exercises. Alternatively or additionally, a human
therapist determines what percentage of time may be spent on such
exercises. The scoring method or resolution may be adjusted by the
therapist per the patient condition for example, adjusting the
accuracy of measurement or the dynamic range of the score or the
expected results (e.g., for qualitative measures).
[0432] In an exemplary embodiment of the invention, a patient may
show an increase in a muscle strength score but not show a
corresponding increase in accuracy (correspondence may be, for
example according to a table or according to a previous trend of
the same patient, possibly with a same limb). In such a case, the
exercise plan for the patient may be modified to include more
accuracy-focused exercises and fewer muscle building exercises. It
is noted that not all rehabilitation plans aim for concurrent
improvement in multiple measures. In some plans, one measure is
focused on and once a desired improvement in that measure is
achieved, a different measure is focused on.
[0433] In an exemplary embodiment of the invention, a score in
progress is used to estimate a time to reach a goal. Optionally,
such estimation is based on one or more of the following variables:
motivation, innate ability and current disability. Optionally,
innate ability is estimated by tracking the progress. Optionally, a
set of results and estimated times for different situations are
stored in a database and used to generate an estimate. Optionally,
a neural network is used. Motivation is optionally estimated using
methods as described below. Alternatively, manual estimation may be
provided. Optionally, a time estimation also includes thresholds of
different scores which must be met. For example, an estimate may be
conditioned on a certain motivation being maintained. Detection of
a reduction in motivation may be used to prompt an update in
expected progress or suggest certain treatment.
Home Use
[0434] In an exemplary embodiment of the invention, device 100 is
adapted for home use. Such adaptation may include one or more of
the following features:
[0435] a) Small size. For example, device 100 may take up less than
1 square meter of floor space. Optionally, device 100 is sized to
fit through standard door ways (e.g., of width of 60 cm, 70 cm or
80 cm).
[0436] b) Simple interface. In an exemplary embodiment of the
invention, device 100 has a simple interface to a user, for example
including a small number of options to choose from, graphical
and/or speech instructions of use and/or feedback designed to be
understand by a typical adult. In an exemplary embodiment of the
invention, a wired or wireless pendant or wrist-worn controller is
used. For example, such a controller can have a limited set of
commands, including, an exercise selector dial, a button for
selecting a dry-run or a slow version of the exercise, an
activation button to start or stop an exercise, a scale or a pair
of buttons to increase or decrease exercise difficulty level, and a
LED or LCD display for feedback (e.g., red LED for bad and green
LED for good). In an alternative embodiment, device 100 is voice
activated and controlled, for example using an IVR (interactive
voice response) type menu system.
[0437] c) Flexibility. In an exemplary embodiment of the invention,
device 100 is designed to be used by a range of different sized
patients (or persons living in a home) and for a range of different
treatments, for a plurality of different body parts and/or
appendages, for example, 1, 2, 3 or 4 limbs or body parts or more.
In some cases, various attachments may be provided. Optionally,
device 100 is adapted for positioning at various orientations
and/or in proximity to home activities, such as at a table for
rehabilitation of feeding and or activity of daily living.
[0438] d) Lack of fixation. In some embodiments of the invention,
device 100 is either simply fixed to a surface or not fixed at all,
simplifying installation and de-installation.
[0439] e) Mobility, detailed below.
[0440] f) Other home settings are optionally supported as well, for
example, when the patient is in bed, in the living room and/or in a
backyard.
[0441] In an exemplary embodiment of the invention, device 100 is
connected to home appliances such as a TV or HiFi system. In an
exemplary embodiment of the invention, the patient can be
instructed from the TV or the user can play with the system using
the TV as feedback. In another example, a set-top box is used as a
local processor and/or a communication port to a remote
station.
[0442] In an exemplary embodiment of the invention, use is made of
the fact that device 100 is at home and conveniently located for
the patient to use many times a day. In one example, rehabilitation
activities are designed to cover a larger part of the day than is
possible at an institute, for example, half or all of a day, while
still allowing a patient to have a life with non-rehabilitation
activities. For example, a rehabilitation plan can call for ten
5-minute sessions spread over an entire day, spaced by an hour.
[0443] In another example, device 100 interacts with real-life
activities and/or using real-life objects, as described in more
detail below. In particular, this allows a rehabilitation plan to
show (and achieve) a real progress in the patient's ability to deal
with real life situations, such as eating and getting dressed.
[0444] In an exemplary embodiment of the invention, devices in
separate houses are interconnected, for example, within a family or
between friends. Optionally, one of the participants may interact
using a computer, rather than a device 100 (e.g., using mouse
motions to emulate device manipulation, or as a player in a game
using standard computer interfaces).
[0445] In an exemplary embodiment of the invention, device 100
communicates with an outpatient clinic so that home activities and
clinic activities are synchronized. Optionally, the patient carries
a memory unit (e.g., a USB memory card) that includes his personal
data.
[0446] In an exemplary embodiment of the invention, the home system
generates reminders to the patient to exercise, for example, audio
reminders or e-mail or SMS reminders.
Remote Use
[0447] As noted above, device 100 is optionally used as part of a
distributed system. FIG. 2 shows an exemplary distributed
rehabilitation system 200.
[0448] One or more homes with rehabilitation devices 100 are shown.
A network 202, for example an Internet, a cable network, a cellular
network or a telephone network, connect device 100 to a remote
site. In an exemplary embodiment of the invention, a remote site is
a rehabilitation center including a computer station 204 with a
display 206 and a user input 208. A single station 204 can monitor
multiple devices 100, optionally in real time. A plurality of
stations 204 may be provided, at a same or different sites.
Optionally, a plurality of stations 204 are used to monitor a
single device 100. For example, each device 100 may have a low
level monitoring by a semi-skilled person, who shows difficult
problems to a skilled monitor who is in charge of or associated
with many unskilled monitored.
[0449] Also shown is an optional portable connection 212, for
example using a laptop computer.
[0450] Also shown is an optional remote database 210, which may
store data for one or more patients, for example, 100 or 1000
patients or more. While the database may be at the rehabilitation
site, this is not required. In some cases the database is
distributed, for example, among rehabilitation sites and/or user
devices 100.
[0451] In an exemplary embodiment of the invention, a group of
patients are collected into a network based on them having similar
(or overlapping) aliments, treatment and/or prognosis and/or
according to personal matching. In an exemplary embodiment of the
invention, the progress of members of the group are presented to
other members, possibly spurring competition. For patients with a
lower motivation, a support group may be provided, for example, one
in which the patient is more advanced than other members or one in
which a group effort is being carried out instead of a
competition.
[0452] In one example of a group activity, each of a plurality of
patients has a role in a role playing game. The difficulty of each
patient/role may be set according to the patient's ability. A group
leader may be selected. In another example, each player is required
to copy the movements and/or instructions of the group leader.
Optionally, each player is protected from over-reaching his
abilities by his device 100.
[0453] Other types of users may be supported in addition to
monitors, for example, a patient's general practitioner physician,
or a family member or caregiver may be able to log on and review a
patient's progress.
[0454] Remote rehabilitation can follow several paths, for example,
one or more of:
[0455] a) Real-time monitoring. Optionally, a camera 214 is
provided adjacent device 100 to allow a therapist to detect
problems and/or give advice to a patient. Optionally, the data is
analyzed by the therapist in real time. Optionally, a real time
reconstruction with animation software or VR (virtual reality) is
used. Alternatively, off-line analysis is provided. Different pay
schedules may be provided for different types of monitoring. In
addition, different rehabilitation needs may indicate the level of
interaction between a remote therapist and a patient. Optionally,
camera 214 is controllable by the therapist, for example to zoom
and/or pan to certain parts of the patient. Optionally, the path of
the camera is pre-planned to track planned or actual motion by the
patient and/or of various points on a body of the patient.
Alternatively or additionally to camera 214, real-time monitoring
may be provided by various position and orientation sensors
associated with device 100. This may also require only a reduced
bandwidth as compared to visual monitoring.
[0456] In an exemplary embodiment of the invention, a therapist can
provide real-time feedback, for example using audio-visual methods
and/or by commanding device 100 to respond in a certain way, for
example, to increase force, to change a trajectory or to prevent a
patient going past a safety limit.
[0457] b) Live start. A rehabilitation session is started live
(e.g., on camera) and once the therapist is convinced the patient
can work on his own, monitoring is stopped. Optionally, a patient
can request help, for example during an activity or between
activities.
[0458] c) Planning. Plans including exercises and/or programming
for device 100 are provided by the remote site, for example,
weekly, or at the start of each session. In some embodiments,
planning is automatic and optionally performed with or without
patient input at device 100.
[0459] d) Monitoring. A remote site can specialize in analyzing
data uploaded to it from device 100 or another location and suggest
changes. Other types of monitoring can also be practiced, for
example, checking to see how regularly a patient uses the system
and/or for following complaints. A rehabilitation center may
perform, for example, weekly checkups- and possibly require
periodic testing. Optionally, a patient may be called to come to
the rehabilitation center, for example, for testing, teaching
and/or additional therapy.
[0460] e) Testing. In an exemplary embodiment of the invention, a
remote site uses device 100 to administer tests to a patient and
assess his condition and/or progress. In an exemplary embodiment of
the invention, such testing is used to assess the efficacy of drugs
and/or other treatment prescribed for the patient. Optionally,
periodic testing is used to select a most useful drug, for example,
for a patient with Parkinson's disease or for a spastic
patient.
[0461] f) Home therapist. In some embodiments of the invention, a
therapist will come to the patient's home for a rehabilitation
session. For example, the therapist can set up device 100, mark
correct starting positions, calibrate device 100 for the particular
patient (e.g., size) and/or teach the patient the use of device
100. Optionally, the therapist can access and/or be in contact with
a remote site, for example, for advice and/or monitoring of his
work. When a therapist comes for later sessions, the remote site
may assist with comparing current and past performance, for
example. Optionally, a therapist brings device 100 with him.
Optionally, a therapist brings two devices. Optionally, a device
brought by the therapist is used to control a rehabilitation device
already at the patient's home.
[0462] g) Remote maintenance. In an exemplary embodiment of the
invention, device 100 can be maintained from a remote location, for
example, including one or more of reporting by device 100 of
technical problems; remote testing of mechanical abilities of
device 100, with or without patient assistance; remote testing of
sensing abilities of device 100, with or without patient
assistance; downloading and uploading logs; and/or downloading and
uploading software. Optionally, device 100 collects billing
information which is remotely accessed. Optionally, device 100
collects usage information which may be used, for example, by an
insurance company. In some embodiments, remote access to device 100
is designed to maintain a patient's privacy, for example by hiding
patient identifying information, by limiting access to various logs
and records and/or using password and other authentication
schemes.
[0463] h) Remote motivation session. In an exemplary embodiment of
the invention, device 100 is used to detect a reduced motivation
level and a live therapist (optionally provided at need) can
provide live encouragement and/or instruction. Live remote sessions
in general may be provided.
[0464] In an exemplary embodiment of the invention, virtual reality
methods, for example goggle mounted displays are provided at the
remote location, to help the remote operator feel in better
control. Alternatively or additionally, the operator can manipulate
his viewpoint. In an exemplary embodiment of the invention, various
sensors (for example as described below) are used to move a model
of the patient, for remote and/or local feedback.
Other Usage Scenarios
[0465] Device 100, in some embodiments thereof may be used in other
ways than described above. For example, in one embodiment of the
invention a supervised group is provided, in which one or more
therapists watch/monitor/support a plurality of patients, each on a
different device. In such a supervised group, one or more of the
following scenarios may be acted out:
[0466] a) Bring along--a therapist brings a plurality of devices
100 to a civic center or old age home or the like, and teaches a
session to a group of users.
[0467] b) Game--each patient plays a part in a game and a score is
kept. In the example of an adventure game (e.g., a role acting
game), patients can earn life points, weapons, abilities and other
items by improving their abilities using rehabilitation exercises.
The game may be personally adapted to one or more patients, for
example by providing assistance to those patients who require it.
In an exemplary embodiment of the invention, the games require a
patient to carry out certain physical activities. The activity may
vary between patients according to their needs for rehabilitation.
VR or simpler display technologies, such as screens may be used to
help patients become immersed in the game and focus less on the
other players. Such games can be played also when the patients are
distributed and interconnected by a network, such as the
internet.
[0468] c) Call-in group--the patients can join an existing group or
game or session, to form a virtual "therapy room". Optionally, a
chat line is provided concurrent with the rehabilitation exercises.
Optionally, a rehabilitation server is provided for devices 100 to
connect up to and register requirements, obtain connections to
other devices and/or control access to a therapist.
[0469] In an exemplary embodiment of the invention, a group is
supervised by a therapist and the therapist can monitor the group
using a web cam, for example. Alternatively or additionally,
patient's exercises can be reconstructed on the therapists system
using VR or simulation. Alternatively or additionally, the
therapist can review data generated by the system, such as scores.
Optionally, different levels of interaction between the therapist
and patients can be provided, for example, based on payment plan.
In one example, a live connection is available to only higher
paying patients. In another example, a web-cam interface is
available only to higher paying patients. Similarly, the payment
plan may dictate other parameters of treatment, for example,
complexity of exercises, level of review, interaction between
patients and quality of audio visual effects and/or games.
Optionally, the amount of rehabilitation actually provided by the
system also depends on the payer. Alternatively or additionally,
the payer is billed according to the rehabilitation performed.
[0470] d) Test and/or train--In an exemplary embodiment of the
invention, the group is used by the therapist to try out new
therapy ideas and receive feedback form the patients, in real-time
on the relative benefits and problems with different methods.
Optionally, such a group is used for training purposes, for example
to allow a therapist to view multiple patients at same and/or
different conditions, substantially simultaneously. Optionally, if
differences are identified, the therapist can be trained to detect
such differences and/or be shown how to differentially rehabilitate
for them.
[0471] In an exemplary embodiment of the invention, a linked-system
scenario is carried out. In one example, two devices are connected
using a master-slave relationship for example using a wired or
wireless (e.g., BlueTooth, Cellular or WiFi) connection between
them, or using a network connection between them. A master can be,
for example, a son (or daughter) and the slave is an aged parent
whom the son is assisting in rehabilitation. This allows a paretic
parent to use the rehabilitation exercises as a means for
maintaining contact with the family. Alternatively or additionally,
the paretic parent may receive support from family members. Such
support may also include advice on how to use the system and/or on
what exercises to try.
[0472] Another exemplary usage of linked devices 100 (or a single
device with multiple arms 102) is for child play. In an exemplary
embodiment of the invention, a paretic child plays with a healthy
child, each child manipulating a separate arm or device.
Optionally, the motor abilities of the paretic child are
compensated for by device 100, for example, providing speed
enhancement or providing periodic automated action. If the children
play a role-playing game or a sport simulation (e.g., tennis),
device 100 can supplement the abilities of the paretic child, while
still allowing the child some control over the game, for example,
allowing the paretic child to actually perform 20% of the moves.
Device 100 can control the level of support for the paretic child
to ensure a level playing field.
Feedback and Patient User Interface
[0473] Various types of feedback are envisioned for use with
exemplary embodiments of the invention, for example, one or more
of:
[0474] a) Feedback from a patient. Optionally, a patient can
provide feedback to a therapist, for example, using voice
annotations or text annotations. In one example, such feedback is
provided during an activity. In another example, a patient reviews
a recording of the activity and then adds comments. In some
activities supported by exemplary embodiments of the invention, a
patient is requested to manipulate a control, when a certain
situation is reached, for example, a maximum force. Feedback may
also be provided by the patient for a plan or progress, not only
for individual activities.
[0475] In some embodiments of the invention, patient feedback is
processed by device 100 to modify and/or decide on current or
future activities and/or their parameters. For example, if a
patient marks that a certain force is a maximum force, later
activities will not pass that force. In some embodiments of the
invention, no explicit user feedback is required, instead, the
system can implicitly determine when a maximum force is approached,
for example based on difficulty in control, and model future
activities on the thus determined force.
[0476] b) Feedback to patient. In an exemplary embodiment of the
invention, feedback is presented to a patient, for example, during
an activity, in rest breaks and/or after an activity. For example,
such feedback can include an indication to the user that he is
performing an activity incorrectly, that future cycles should be
done differently and/or a comparison between current and past
performance and/or other statistics. It should be noted that in
many cases positive feedback is as important or even more important
than negative feedback. This may depend on the rehabilitation
method used. A positive feedback can be, for example, an auditory
encouragement, a sound of clapping hands, a visual pleasing screen
and/or a score increase.
[0477] Various feedback modalities may be provided, for example,
speech and audio feedback, a display containing text or graphics, a
marked up video image, force or vibration feedback on device 100
(e.g., by tip 108), using a separate element (such as the above
pendant) and/or using virtual reality devices, such as goggle
mounted displays, in which the type, position and/or other
parameters of a mistake (or correct action) are shown overlaid on a
real or virtual image of the activity.
[0478] As described, for example, in U.S. Provisional Application
60/633,429 filed on Dec. 7, 2004, also being filed as PCT
application on same date as the present application and by the same
applicant, entitled "Rehabilitation with Music" and having attorney
docket number 414/04396, the disclosures of both applications are
incorporated herein by reference, the disclosure of which is
incorporated herein by reference, music may be used as a feedback
modality, especially for patients with limited cognitive speech
and/or visual ability. For example, music can be used to indicate a
quality of motion, be generated by the motion or be used by device
100 as instructions or cues to the patient.
[0479] c) Feedback to therapist. In an exemplary embodiment of the
invention, a local or remote therapist is provided with feedback.
Such feedback can include, for example, one or more of extent of
use (e.g., including whether patient is exercising when therapist
is not paying attention), force levels, an indication of mistakes,
a notification of missing, exceeding or meeting certain parameters,
a predefined alert, a motion quality (described below) a safety
situation and/or a statistical analysis of a current and/or a past
activity.
[0480] d) Feedback from remote therapist. In an exemplary
embodiment of the invention, feedback is provided by a remote
therapist, for example as indicated above of feedback that a
patient may receive. Optionally, such feedback includes instruction
to device 100 whether to repeat a certain exercise and/or modify
parameters. In an exemplary embodiment of the invention, an
exercise is defined with, or a therapist can add, break points, at
which the therapist, patient and/or device 100 (depending for
example on implementation) can decide, for example, if to modify
future parameters, impose a rest and/or repeat an activity if a
desired result was not achieved. Such a breakpoint need not be
notice by a patient, if no decision is made by him and a decision
is made fast enough or during a short, pre-defined, break.
[0481] e) Feedback from device 100. Depending on the automation
level of device 100, feedback can be provided by the device, for
example indicating a threshold was past or indicating a safety
problem.
[0482] f) Feedback from sensor patches attached to or image based
analysis of the patient and/or device 100. Exemplary such patches
are described below with reference to FIG. 5.
[0483] g) Feedback from one device to another, for example, in a
master-slave mode of operation.
[0484] In an exemplary embodiment of the invention, speech is part
of the rehabilitation process. In one example, device 100 responds
to or expects voice commands. In another example, device 100
generates voice instructions.
[0485] Simple interfaces may be required for some users. In one
example, instructions to a user (patient) are simple red/green
lights, to indicate go and stop.
[0486] A plurality of different types of cues may be provided to
indicate a need to act by the patient, for example, audio, tactile,
vibration (of device 100 or of a patch), motion of opposite limb,
visual (e.g., flashing screen) and/or change of speed. In an
exemplary embodiment of the invention, a jolt, for example an audio
blast (or shout) is used to alert an otherwise non responding
patient, for example.
[0487] In an exemplary embodiment of the invention, a dummy body is
used to show the patient the effect of the motion of device 100
(e.g., arm 102) on the patient.
[0488] Optionally, the complexity of the interface used increases
as the patient rehabilitation progress and the patient's cognitive
abilities improve and/or the patient has more attention to spare.
Optionally, for example as described below, the user interface is
used for performing concurrent cognitive, perceptive and motor
rehabilitation, for example, by selecting the interface used to
match an ability of the patient and/or train the patient in certain
non-motor activities.
Mental State
[0489] As noted above, the progress of rehabilitation of any
particular patient typically depends on one or more of the
following: cognitive ability (if the patient cannot think clearly,
motor planning is difficult or impossible), mental ability (if the
patient has no motivation, rehabilitation is difficult) and motor
capabilities.
[0490] In an exemplary embodiment of the invention, one or more of
these may be measured and/or supported by device 100. Optionally,
changes in the degree and/or type of support are determined by
system 100. Alternatively or additionally, changes in support are
determined by a user, or a plan of how to change support according
to scores, is set by a user.
[0491] Support of cognitive abilities is, for example, by providing
a simple display, multiple modes of presentation of information,
reminders and/or multiple cues. Cognitive abilities may be tested,
for example, by providing tests or by assessing performance in
games where cognitive ability is required. In some cases a
distinction is made between cognitive abilities and perceptive
abilities.
[0492] In an exemplary embodiment of the invention, the patient is
required to execute a motor task (e.g. move forward) his ability to
understand the task depends on the cognitive capabilities. The
ability to see a target on the screen or actually receive the
instructions (e.g., visual or verbal) depends on his perceptive
abilities.
[0493] Support of motor capabilities is, for example, by the
various modes of motion described above. Measurement of motor
capabilities is, for example, by providing exercises having a
standard range of results and placing the results on a known
scale.
[0494] In support of the mental state, various methods are provided
herewith in some embodiments of the invention:
[0495] (a) Device 100 (or a remote controller) can supply the
initiative instead of the patient, for example, initiating motions
and initiating exercise repeats.
[0496] (b) Device 100 can provide incentive, for example, scores,
special feedback elements, such as images, jokes, funny icons,
laughter and/or rest periods.
[0497] (c) Device 100 can support groups, where members of the
group provide motivation for each other, for example, via
cooperation and/or competition.
[0498] (d) Device 100 can provide games.
[0499] (e) Device 100 can indicate a lack of motivation which
suggests a need to provide consoling.
[0500] (f) Device 100 can increase patient motivation and reduce
fear by presenting safety features and/or features design to reduce
pain (e.g., a user indicating a pain range and device 100 ensuring
that the pain range is exceeded only when the patient is
forewarned). In an exemplary embodiment of the invention, a user
indicates a pain range to device 100 by pressing a control when a
pain point is reached or by a therapist doing so. Specialized pain
sensors may be used as well, for example, detecting nerve activity
or detecting physiological changes such as sweating or increased
pulse.
[0501] (g) Device 100 can selectively provide positive feedback or
negative feedback.
[0502] (h) Device 100 can be set to more or be less forgiving of
errors.
[0503] (i) Device 100 can track which exercises seem to inspire
more motivation and/or cooperation from a patient.
[0504] (j) Device 100 can provide attention instead of a patient,
for example, continuing attention to ensure that a motion once
started is carried out. If a mistake occurs, instead of the patient
being required to notice it, device 100 can detect the mistake and
provide a cue to correct the motion--thereby reducing the mental
and cognitive load on the patient.
[0505] While motivation and other mental states such as depression
and withdrawal may be estimated by a human, in an exemplary
embodiment of the invention, they are measured or estimated by
device 100 by detecting their effect on performance. In an
exemplary embodiment of the invention, device 100 assesses, for
example, one or more of: how hard a patient works, how well the
patient carries out his task, progress within and between sessions,
expected responses to stimuli and/or variability between different
tasks and/or along a task.
[0506] In one measurement method, a patient's performance on a task
is compared to the patient's performance (e.g., range of motion,
speed accuracy) in a game. Under the assumption that playing a game
increases motivation, differences in performance between a game and
an exercise, may indicate the degree of motivation difference
between desired and undesired tasks.
[0507] In another measurement method, device 100 is used to measure
the range of a patient's abilities, for example, ROM (range of
motion), pain limit and the like. It is assumed that a diagnosis
session can be trusted to provide relatively accurate information
about the patient's ability, at least for the reason that the
patient knows the diagnosis session is limited in scope.
Thereafter, exercises at the edge of the patient's ability are
provided to the patient and a determination is made of the number
and success of attempts to reach the edge of the range. This
determination may be used as an indication of motivation (e.g.,
willingness to achieve what is known the patient can achieve). In
an exemplary embodiment of the invention, the exercise comprises
providing performance targets to the patient and the patient is
expected to reach for the targets.
[0508] In another measurement method, a self-calibrating method, a
patient plays a game in which some of the targets are at the range
of the patient's ability. As this ability might not be known in
advance, a variety of targets of different levels of difficulty,
are provided. In an exemplary embodiment of the invention,
motivation is assessed by analyzing the game to determine, first,
what the patient's abilities are and, second, how often the patient
tries to reach the edge of his abilities.
[0509] Another method of measurement is tracking how hard a patient
works (e.g., how long are rest periods). Another method is
determining the hardest a patient works in any particular exercise.
Another method is determining if a patient provides attention,
involvement and/or activity in a free-play session, where a patient
can exercise if he wants to, to any degree of difficulty the
patient wants. Attention is optionally determined by comparing
trajectories of motion at different times, for example to see the
range of variability (e.g., does a patient suddenly slow
down--maybe his attention wandered). Involvement is optionally
determined by tracking modifications requested by the patient, for
example in exercises where a patient can select one of several
trajectories.
[0510] In an exemplary embodiment of the invention, mental state is
estimated by analyzing handwriting or gross motor movements, for
example, detecting unusual tremors, ticks or other signs of tension
and/or lack of control (e.g., as compared to other times). It
should be noted that mental states, in some cases, may be provided
as a relative state rarer than absolute values.
Exercises
[0511] In an exemplary embodiment of the invention, existing
physical rehabilitation exercises are used for device 100. However,
various measures can be provided not currently available. In some
cases, the exercise is modified to take into account limitations of
device 100 or abilities of device 100. Optionally, correct motions
are determined with exactitude and/or with a degree of control not
possible manually. In addition, some exercises are described herein
which are not possible without robot support (or other techniques
described herein).
[0512] In an exemplary embodiment of the invention, exercises are
modified manually. In an exemplary embodiment of the invention,
exercises are recorded by a therapist and then annotated (e.g., to
mark desired measurements). In another example, exercises are
directly programmed into device 100. Optionally, device 100
suggests limitations or additions to exercises, for example, safety
limitations or device limitations and/or suggest where a less
supportive or more supportive motion mode may be appropriate (for
example at an end of a motion a more supportive mode may be
advisable).
[0513] In an exemplary embodiment of the invention, a reaching
exercise is performed by the patient. In such an exercise, various
muscle groups can be trained and various levels of difficulty can
be provided.
[0514] In an exemplary embodiment of the invention, reaching
movements are defined by one or more of the following exemplary
parameters:
[0515] Reach Distance: [0516] Close--touching the body or several
inches from the body [0517] Mid--in the mid range from full to
close [0518] Far--almost at full arm extension
[0519] Reach Direction: [0520] Up/Down--from a lower/higher reach
location to a higher/lower location [0521] Out/In--moving away/to
the body [0522] Lateral/Proximal--moving out from the body
laterally/moving toward the body
[0523] Reach height: [0524] Abovehead [0525] Eye level [0526]
Shoulder level [0527] Torso level
[0528] Reach target: [0529] Free reach--movement to general
location in space with no target [0530] Target reach--movement to a
physical target [0531] Simulated target--movement to a target
presented on a computer screen
[0532] A particular "Reach" is defined by the starting location and
the ending location of the hand as defined by its distance,
direction, and height. Any reach may also be further understood in
terms of the involvement of the arm joints and the ability of the
patient to individuate the joints to achieve the reach.
[0533] In an exemplary embodiment of the invention, one or more of
the following measures is defined:
[0534] Ability of the patient to perform the reach;
[0535] Smoothness of motion;
[0536] Time to achieve the reach end point;
[0537] Accuracy of the reach;
[0538] Work or power performed;
[0539] Comparison of motion trajectory to normal trajectory
patterns for reach movements;
[0540] Number of repetitions of the reach the patient can
perform;
[0541] The stability of the performance with subsequent
repetitions.
[0542] In an exemplary embodiment of the invention, a reach
training comprises the following general steps:
[0543] 5 to 10 repetitions to reach under guided motion. Patient
will be instructed to attempt to move with the device 100.
[0544] 5 to 10 repetitions initiate mode. The magnitude and
direction of force of the patient will be measured by device 100.
When the threshold for correct intention is exceeded, device 100
will guide the patient to accomplish the reach.
[0545] 5 to 10 repetitions assisted mode. The patient will attempt
to perform the reach independently. Device 100 will measure the
intention and assist the patient to move. Over time, the amount of
assistance will be reduced as the patient is able to move more
independently.
[0546] 5 to 10 repetitions of free motion. Patient will attempt to
perform the reach free of assistance from device 100.
[0547] Another exemplary exercise is mimicking of daily activities,
such as moving a full cup between points and lifting a book.
Programming
[0548] In an exemplary embodiment of the invention, various aspects
of a rehabilitation process can be planned and inputted as
instructions to a computer (e.g., device 100), including, one or
more of:
[0549] a) designing a new exercise;
[0550] b) modifying an exercise for a particular situation and/or
patient;
[0551] c) designing and modifying a rehabilitation plan; and
[0552] d) designing and modifying decision logic (e.g.,
breakpoints, thresholds and repetitions).
[0553] Permissions may be different for different users of system
200 and/or device 100, for example, different permissions may be
allowed for one or more of adding new, copy, modify, delete and/or
edit. These activities may apply, for example, to one or more of
patient data, activity, plan, statistics and/or data logs.
Particular activity parameters which may be created and/or modified
in accordance with exemplary embodiments of the invention include:
trajectories, locations and ranges (e.g., minimum and maximum speed
and angles); force parameters, number of repetition cycles, stop
decision(s) and/or rest periods length and frequency.
[0554] In some embodiments of the invention, one or more libraries
are provided as a basis for modification and for storing programs,
for example, a plan library, a per-patient library and/or an
activity library.
[0555] In an exemplary embodiment of the invention, entering a new
trajectory is by physically manipulating tip 108 (e.g., by a
patient with a good hand or by a therapist). Optionally, the
resulting trajectory(s) are then edited on a computer.
Alternatively or additionally, a 3D CAD/CAM program may be used,
optionally one in which a human body is modeled and various
constraints can be placed on movement of points on the body and/or
a desired or allowed range of motion for such points defined.
Optionally, a graphic design program is used, for example, with a
user indicating a few points of a trajectory and the program
completing them with a line or a curve. Alternatively or
additionally, a user may define various geometrical shapes, such as
a circle, for example by providing points and/or a formula.
Alternatively or additionally, a user may make a drawing and scan
it into system 200 (e.g., at a station 204 or at device 100).
[0556] In an exemplary embodiment of the invention, an exercise is
calibrated for a particular patient and/or situation. Such
calibration may include, for example, one or more of:
[0557] a) calibration to patient abilities, such as angular range
of motion of a joint or ability to apply force or maintaining fine
positional control;
[0558] b) calibration to a size of a patient, for example, the
length of a limb or a bone;
[0559] c) calibration to progress, for example, a plan may have its
time span and/or its step size changed based on exhibited or
expected progress.
[0560] As noted above, a path carried out by a patient or by a
therapist may be edited and used for an exercise. In an exemplary
embodiment of the invention, editing includes one or more of
smoothing, adding points and/or path sections, converting the
motion into primitive motions elements,
Exemplary Programming Language
[0561] Table I, below, describes an exemplary high-level
programming language which is optionally used to program device
100, in lieu of learning a robotic programming language. In an
exemplary embodiment of the invention, this language is used by the
therapist and/or other user. Optionally, existing exercises are
storable and modifiable.
[0562] This high-level language is based on library of Icons (each
representing a command) that can be dragged into a program area in
order to build (or edit) a program.
[0563] Each icon represents a command; with 3 types of command
defined (more may be added):
a. Motion command--basic motions, such as line and circle. Each
command has start point (P1) and stop point (P2), for every motion
command the speed, force acceleration/deceleration time can be set.
Setting the points (P1, P2) can be done by pressing the enter key
while tip 108 is at the desired point. b. General command--such as
start/stop program, delay and record. c. Accessories command--a set
of command that handle the external devices and accessories that
can be attached to device.
[0564] Every command has a set of parameters that may be entered
(if not, a default parameter value may be used). An operator can
add comments to each command. Device 100 generates a description
for each command, to every command the operator can add comments,
and every command has a description. Not shown are commands for
instructing users and parameters which define what behavior device
100 should carry out under certain conditions. Optionally, each
path section may include one or more triggers, which, upon
activation, execute short sections of code. One example is a
trigger activated when a user varies his speed more than 10%, in
which case a warning is provided or a more assistive motion mode is
provided.
TABLE-US-00001 TABLE I command types Motion Line Left p1, p2, F, S,
Text Press @ P1 & F- force S - commands press @ P2 Speed Curve
Left p1, p2, .sub.P3, F, S Use P1 to start P3 system as end &
P2 as interpolates Via point and curve Circle/ Left C, R1, R2, F,
S, Tex For ellipse use ellipse t or P1, P2, P3 R2 not 0 Teach Left
P1 . . . Pn, F, S, Text system points interpolates between points
Teach Path Left Path, F, S, Text System samples sample rate path
General Start Both Text first program commands command stop both
TXT- Text end of program Delay/Pause Left T-Time (second) can be
used for or B- (button waiting on name); TXT certain button press
Cycle both N; No. Of allow to disply repeated cycles; No. Of cycles
TXT Record right 3 level data Position, Indicate record accuracy:
Normal force, speed, mode on/off Fine coarse accelaration, , jerk,
I/O state, preload, brake setting analysis right use "eval"
command, for example read input both Read (string); use as input
logic may be TXT mechnism used with if input Accessories Handle
Handle 1 pinch pinch/grip commands pinch (on/Off, force handle
range(kg/Lb)) Handle grip right Handle 1 grip pinch/grip (on/Off,
force handle range(kg/Lb)) wrist Handle wrist wrist handle motion
3Xrange of force elbow
[0565] Table II is a sample program, using the language shown in
table I. A program structure has several columns; the first one is
the main command that are sequential, the second and third columns
are for commands which operate in parallel.
[0566] When a new program is started, the start and stop commands
optionally are provided automatically. Other commands are manually
inserted between the start and stop.
[0567] Table II is a sample program of a path having 3 straight
lines (can be rectangular), with a delay in between, and during the
second line an external device is operated (for example--waiting
for input from handle). All data during the second and third lines
is recorded and the entire program is repeated 5 times. Modifiers
for the repetition (e.g., increase speed, increase required
accuracy) are optionally provided as parameters. General program
parameters, such as type of scoring, expected quality of motion are
optionally provided as well.
TABLE-US-00002 TABLE II program sample Prog name description date
file name: trial1 glass grip auto date xxx.prg Com- optional
optional mands command command Parameters comments 1 start 2 line
P1(start PA (value) point) P2 patient active Force must exceed
(PA[VALUE]/ force value; PP) PP Patient passive - no force value 3
delay/ D(1 sec) pause 4 handle record 1 kg < display grip pinch
force < force during 5 kg run if not in range display warning
message 5 line handle record P1 P2 Force pinch (PA[VALUE]/PP) 6
delay/ handle record D(1 sec) pause pinch 7 line record P1, P2
(start point) 8 cycle record N = 5 9 stop
[0568] A particular type of control provided in accordance with
some embodiments of the invention is spatial programming control.
In this type of control, certain gestures or positions in space of
tip 108 are translated into commands for device 100. In one
example, such gestures may be used by a therapist or by a patient
to fast forward past an exercise section.
[0569] In another example of a shortcut, wrist movements of a
therapist will be translated into arm (or other limb) motions, thus
allowing the therapist to make smaller motions and only with his
hand, rather than the limb whose motion is being programmed.
Sensing and Control of Limb Position
[0570] In device 100, as illustrated, only one point of the patient
is controlled, the point in contact with tip 108. However, this
means that multiple different arm motions can result in a same
spatial trajectory. For some situations this is not a problem. For
example, for recovery from stroke, in some cases, any motion is
useful. In other rehabilitation scenarios, it is desirable to
better dictate or know the positions of all the moving body parts.
In some exemplary embodiments of the invention, the position of
other body parts is fixed. For example, a patient may be strapped
to a chair (e.g., the shoulder of the patient) and/or a rest may be
provided for an elbow. This restricts possible motions by a hand
holding tip 108.
[0571] FIG. 5 illustrates a system 500 including limb position
sensing and/or restricting, in accordance with an exemplary
embodiment of the invention. Correct motion of other parts of the
body than the hand that contacts tip 108 may be provided, for
example, by detecting the positions and providing feedback, for
example, audio or visual feedback, to the patient.
[0572] A patient 506 sits in a chair 514 and uses device 100 (or a
device as described below in which the arm is mounted on a ball).
One or more cameras 502 image the arm and/or other parts of patient
506 and determine the spatial position and/or velocity thereof.
Alternatively or additionally, one or more cameras 516 are mounted
on device 100 for such imaging. In some implementation of image
based reconstruction of body positions, it is useful to include one
or more fiduciary markers 504, for example strap-on patterns or
LEDs.
[0573] Alternatively to image based position sensing, magnetic,
electric, ultrasonic or other contact-less position sensing and
orientation sensing methods may be used. Many such position
determination methods and devices are known in the art and may be
used. In an exemplary embodiment of the invention, a reference
position is provided on device 100 and/or on tip 108. Optionally,
such position sensors are used for determining the state of device
100, instead of or in addition to mechanical sensors in device
100.
[0574] Alternatively or additionally to using contact-less position
sensing, mechanical based position sensing, for example using an
articulated arm, may be used.
[0575] It should be appreciated that in some embodiments of the
invention no arm 102 is provided, instead position sensors of some
type are used. Feedback is optionally provided via virtual reality
type displays and feedback (e.g., vibration to emulate force).
However, this may not allow direct force feedback and resistance to
be applied, as desired in other exemplary embodiments of the
invention.
[0576] In an exemplary embodiment of the invention, patches 504 are
used to provide feedback or cuing to a patient. In an exemplary
embodiment of the invention, a patch includes a wireless receiver,
an optional power source and a stimulator, for example a vibrator,
pin-prick, a pincher or a heating element. Upon command from device
100, patch 504 can provide a stimulation to the patient. Patch 504
may be wired instead of being wireless.
[0577] In an exemplary embodiment of the invention, sensed
positions of body points are used for one or more of:
[0578] a) determining if a body motion is correct;
[0579] b) determining what motions are possible (e.g., based on
angles of joints);
[0580] c) learning desired motions from an example;
[0581] d) monitoring a patient's ability (e.g., for testing or limb
measurements); and/or
[0582] e) determining if a body posture is correct during, before
and/or after exercise and when changes occurred.
[0583] Alternatively or additionally to position, orientation and
velocity sensors, physiological sensors may be provided, for
example one or more of pulse measurement sensors as known in
exercise machines and grip and/or pinch force sensors in tip 108.
Alternatively or additionally, one or more physiological sensors
may be provided on the patient, for example, breath rate
sensors.
[0584] Referring back to FIG. 5, alternatively or additionally to
position sensors, a body rest 508 may be provided for one or more
body parts. In the example shown, rest 508, attached to chair 514
by a (optionally adjustable) bar 510 prevents motion of the chest
and/or shoulder. In an alternative embodiment, one or more straps
are used to hold body parts.
[0585] In an exemplary embodiment of the invention, reverse
kinematics method are used to estimate the motion and/or dimension
of a patient's joints and/or bones. For example, if a limb is fixed
to rest 508, movement of tip 108 can be used to estimate the actual
motion of the joint. When harness 508 used to lock the elbow is in
a fully extended position, the distance from the shoulder to wrist
can be calculated as the patient moves the arm. If the handle of
FIG. 15F is used and patient is restricted by a shoulder harness
then the forearm length can be determined. Alternatively or
additionally, a force field can be used to restrict the motion in a
manner which will guarantee that limb dimension can be
determined.
[0586] In an exemplary embodiment of the invention, a model of the
patient is constructed for use in such reverse kinematics
calculation. Also, in safety calculations, such a model may be
used. For example, a motion may be prevented as being unsafe if a
patient can possibly reach a configuration of joints where the
motion is unsafe. The reach of each joint may be dependent, for
example, on fixation of the patient (e.g., harnesses), measured ROM
and assumed ROM.
[0587] Optionally, chair 514 is fixed to device 100, possibly in an
adjustable manner, for example, using a fixation bar 512.
Optionally, an initial calibration process is carried out, for
example when first doing a new activity or during device setup. In
one example, bar 512 includes graduations and during calibrations
the correct setting of the chair relative to the graduations is
determined.
[0588] In some embodiments of the invention, device 100 comes with
a built-in chair 514. Exemplary positioning of a movable chair is
described below.
[0589] In an exemplary embodiment of the invention, positioning
sensing is to better than 1 cm, 5 mm, 2 mm or 1 mm, over the entire
working volume of the device. In some embodiments, a lower absolute
positioning accuracy is tolerated if a relative accuracy, within an
exercise is maintained.
[0590] In an exemplary embodiment of the invention, accuracy of
force control is better then 100 gr, 50 gr, 10 gr or better.
Optionally, the balancing of the arm is within these values.
Similar accuracies may be provided for measurement. Optionally,
sampling rate of better than 10 Hz, 50 Hz, 100 Hz or more is
provided.
Patient Positioning
[0591] In some embodiments of the invention and/or exercises, the
patient position is not important. However, in many exercises,
correct targeting of a certain joint, tendon and/or muscle group
may require precision in motion of tip 108 relative to the patient
and/or in the posture of the patient and or other body part.
[0592] In an exemplary embodiment of the invention, straps, a
harness and/or rest 508 are provided to set the position of the
patient. Optionally, one or more bars 512 links chair 514 to device
100. Alternatively to a bar, reference 512 represents a
spring-loaded wire, which includes a position sensor to indicate
its retraction and thus the position of chair 514 relative to
device 100. Optionally, a plurality of retractable wires are used.
Optionally, each wire includes a ring into which a leg of chair 514
is placed. Optionally, if the chair moves during a session, the
exercises are corrected on the fly to account for the new relative
position of chair 514 and device 100. Alternatively or
additionally, if motion of the patient is detected during a
session, for example motion from one posture to another, the
exercises are adapted to reflect the new position. Optionally, a
plurality of typical static postures of the patient are learned and
the system uses these learned postures to distinguish ongoing
motion from semi-permanent postures. Optionally, change in posture
is detected by changes in pressure on various pressure sensors, or
using cameras which image the chair, device and/or patient.
Alternatively or additionally, changes are detected by detecting
changes in the actual trajectory followed by tip 108.
[0593] Optionally, a mat 518 is provided. In one option, mat 518 is
a pressure sensitive mat for detecting positions of chair legs or
patient legs. Optionally, calibration is performed for the chair
that the patient actually uses. Alternatively or additionally, the
mat is used to allow manual entry of relative position.
Alternatively or additionally, the mat includes markings that are
recognizable by a camera that images the mat.
[0594] In an exemplary embodiment of the invention, tip 108 is used
to determine the position of chair 514. In one example, once chair
514 is locked in place, tip 108 is used as a digitizer by
contacting points on chair 514 and/or the patient. In some cases an
adaptor tip may be placed at tip 108. Optionally, once a patient
position has been digitized once (e.g., under therapist guidance),
next time chair 514 is brought to device 100, tip 108 is moved by
device 100 to indicate a desired position of chair 514 or the
patient.
[0595] Optionally, a laser or light pointer is attached to tip 108
(or other part of arm 108 or device 100) and serves to generate a
light marking of a desired location for a chair and/or patient
part. Device 100 optionally converts between the coordinate systems
of the pointing device, arm 108 and/or chair.
[0596] In some embodiments of the invention, it is not tip 108
which has to be at a certain position, but the patient's hand or
finger. Optionally, a dummy hand is placed in device 100 and used
for such calibration.
[0597] It should be noted that positioning methods as described
herein may also be used for positioning other parts of the
rehabilitation system, for example, a table, a glass, a second
device 100 or a kit for daily living, for example as shown in FIG.
19H.
[0598] In an exemplary embodiment of the invention, patient
positioning is determined by patient kinematics. In an exemplary
embodiment of the invention, once a patient is positioned, the
patient performs one or more exercises and the patient position is
determined based on the actual trajectories followed. In some
cases, a previous ability of the patient, for example, joint range
of motion, needs to be known in order to determine the patient
position.
[0599] In an exemplary embodiment of the invention, the patient
performs swinging of the arm, without bending the elbow. The radius
of the motion indicates the position of the shoulder joint. If the
patient cannot straighten his elbow (or keep it straight) this
information is optionally used.
[0600] In an exemplary embodiment of the invention, it is assumed
that patient movement between sessions is mainly translational
motion in a 2D plane, so only one motion of the arm is sufficient
for position calibration. Optionally, two arms are moved, to assist
in detecting body twist.
[0601] Optionally, alternatively or additionally to determining
patient position, an initial set of patient movements are used to
extract basic information about the patient, such as range of
motion and freedom of motion. Optionally, device 100 first applies
or suggests a series of exercises meant to warm up muscles and
joints, before taking measurements.
Attachment to Body
[0602] In FIG. 1, tip 108 is held in a patient's hand. To attach to
other parts of the body, other means may be used. In one example, a
strap or elastic ring is provided at end 108 instead of a ball-like
handle. In another example, a rod-like handle is provided instead
of a ball-like handle.
[0603] FIG. 6 shows an elbow holder 600, in accordance with an
exemplary embodiment of the invention. Such an elbow holder can be
used, for example, when the motion required is of the shoulder, so
an elbow 616 is what moves along a trajectory. A base 602 is
adapted for attachment at tip 108. A hinge 604 allows relative
motion between a first part 606 and a second part 608 on which an
arm 614 rests. Optional straps 610 and 612 optionally attach arm
614 more firmly to holder 610. Optionally, joint 604 has a varying
resistance, for example settable by the patient and/or by device
100. Alternatively or additionally, joint 604 includes an actuator
for applying force to close or open elbow 616. Alternatively or
additionally, joint 604 includes an angle sensor. Optionally,
holder 600 can vibrate the elbow, for example as a therapeutic
effect or to help prevent freezing of the joint. Such vibration may
be applied to other joints and body parts as well, for example,
using suitable attachments.
[0604] In an exemplary embodiment of the invention, holder 600
functions as a spastic harness in one example, joint 604 is locked
(or is not a joint) and arm 614 is forced open and held by straps
610 and 612.
[0605] In an exemplary embodiment of the invention, parts 608 and
606 are raised so that joint 604 has a center of rotation which is
substantially the same as elbow 616, in one or more planes.
[0606] In other embodiments of the invention, attachment to other
points on the body is provided. In particular, it is noted that in
some embodiments of the invention, what is constrained is a joint,
while in other, what is constrained is a bone or a certain location
on a bone. As noted above, various types of constraints can be
provided, for example, constraints on angular and/or spatial
dimensions. Additional attachments are described with reference to
FIG. 16 below.
[0607] In an exemplary embodiment of the invention, the attachment
includes a coded circuit or other means so that when attached to
arm 102, device 100 is aware of the type of attachment.
[0608] In some embodiments, the attachment is fitted with a quick
connecting elements made out of two mechanical quick connect parts
(e.g., spring loaded pin and slot arrangement) and an electrical
quick connect (e.g., spring loaded small needle contacts), this
allows a fast change over from exercise to exercise or from patient
to patient. In an exemplary embodiment of the invention, each
attachment includes a chip and receives power form the connector
and sends data (if any) on a bus, for example a packet-type bus.
Alternatively, the electrical connector is used to directly
interface measurement means (e.g., a potentiometer) of the
attachment, to device 100.
Instructing of User
[0609] Device 100 can provide instructions to a user in many modes,
including, one or more of (for various embodiments of the
invention):
[0610] a) recorded speech.
[0611] b) computer animation display.
[0612] c) instruction videos.
[0613] d) motion of device 100, while patient is not attached.
[0614] e) motion of device 100 while patient is attached, possibly
at a slower speed and with commentary.
[0615] f) motion of device 100, with a dummy attached.
[0616] g) using musical notes, for example as cues or to set a
tempo of motion.
[0617] h) motion of a second device 100, for example as a
demonstration or in sequence with the patient's own motion.
Training Teaching and Quality of Motion (QoM)
[0618] While one part of a rehabilitation plan is often exercising
a body part to maintaining or increase strength or range of motion,
in an exemplary embodiment of the invention, rehabilitation
includes teaching a patient quality aspects of motions and/or what
motions are correct.
[0619] In an exemplary embodiment of the invention, one or more of
the following qualities of a motion are of interest:
[0620] a) degree of utilization of available joints and/or joint
range of motion;
[0621] b) usage of muscles where they can apply sufficient
force;
[0622] c) motion where joints and/or muscles can achieve a better
accuracy of control;
[0623] d) motion which does not approach thresholds of ability;
[0624] e) motion which does not approach danger areas (for example
for a patient with unstable joints);
[0625] f) smoothness in motion and/or rotation;
[0626] g) distance traveled;
[0627] h) maximum force required;
[0628] i) spatial and/or energy efficiency of motion, e.g., extra
motions; and/or
[0629] j) motion with minimum jerk
[0630] In an exemplary embodiment of the invention, quality of
motion is judged using a power law, which characterizes motions by
healthy individuals. Paretic individuals are optionally
characterized as to how closely they reach this law and for which
joints and/or motion types it is reached.
[0631] Optionally, `Healthy movement` is described by basic
kinematic characteristics that define quality of motion. For the
arm, one such characteristic is a smooth transition of the hand
from one point to another following roughly the shortest path
between the two points. A second characteristic is that the
velocity of the hand is constrained by the curvature of the path
(Viviani P, and Terzuolo C. Trajectory determines movement
dynamics. J Neurosci 7, 1982: 431-437, the disclosure of which is
incorporated herein by reference). The larger the curvature of the
path, the slower the movement of the hand is, at a constant ratio
of 2/3. These kinematic descriptions are defined mathematically,
and thus, they can be used for an objective quantification of the
quality of movement.
[0632] A "Minimum Jerk" can explain the smooth and shortest
movement characteristics often observed in healthy people, while
the "Two-thirds Power law" has been developed to validate the
relation between path curvature and hand speed. More recently, both
rules have been unified (Viviani P, and Flash F. Minimum-jerk,
two-thirds power law, and isochrony: converging approaches to
movement planning. J Exp Psychol: Hum Percept Perform 17: 32-53,
1995, the disclosure of which is incorporated herein by reference)
and mathematically defined as two aspects of the same intention
(Richardson MJE, and Flash T. Comparing smooth arm movements with
the Two-Thirds Power Law and the related segmented-control
hypothesis. J Neurosci 22: 8201-8211, 2002, the disclosure of which
is incorporated herein by reference). These two rules combined in
one single description can be adopted for testing quality of
movement before, during and/or after treatment with device 100.
Optionally, power law fitting is determined by providing the
patient with a range of motions, at different speeds and extracting
power-law information from the results. The law may be applied to
other joints and limbs, such as lower limbs.
[0633] Another law which may be applied relates to the relative
motion of each joint in a coordinated motion. In healthy persons
such motion takes into account the relative distances of the
various joints from the target of motion and the different
accuracies of such joints. Another law which may be applied is Fits
law which relates a size of target to a time to hit the target.
[0634] These qualities may be general for a motion or particular
for a patient with certain abilities and lacks.
[0635] In an exemplary embodiment of the invention, such qualities
of a motion are taught to a patient by example, for example,
leading an arm through correct and incorrect motions. Such motions
may be entered for example by the therapist or by the patient or be
pre-programmed. Alternatively or additionally, a patient motion is
recorded and corrected and then the patient is paced through the
incorrect and the corrected motions. In a pre-defined motion, the
motion may be calibrated for the particular user, for example for
the user's size.
[0636] Optionally, a threshold of correctness is defined, for a
patient to attempt to keep all his motions as being of a quality
(in one or more parameters) above the threshold.
[0637] Alternatively or additionally, such qualities are taught by
a commenting in real-time or off-line on a patient's motions.
[0638] Thus, in some embodiments of the invention, a substantial
part of rehabilitation comprises exercising a patient in motions
which are correct or teaching the patient how to know if a certain
motion he has performed is of a higher or of a lower quality.
[0639] Other types of training are not related to motion
correctness. For example, a patient may be trained to not ignore a
damaged limb. In a related aspect, however, a patient may be
trained to use a damaged joint as part of "correct" motion, so as
not to reduce a range of motion of the joint.
[0640] In one example, the relative motion expected between an
elbow and a wrist is known (e.g., or is inputted by a therapist,
such as by example) for certain motions, such as moving objects on
a table surface. If a patient deviates by a certain amount (e.g.,
defined by the therapist) feedback is provided.
Paired Motion
[0641] In an exemplary embodiment of the invention, motion with a
good arm limb is used to train a bad limb. For example, a good arm
can be used to trace a circle and then the bad arm is trained to
trace the circle. One advantage of such training is the intimate
feedback that a patient receives by better understanding exactly
which joints and muscles are used for each motion. In an
alternative application, the "good" motion is provided by a
therapist or other caregiver.
[0642] In a single arm device 100, the following process may be
used:
[0643] a) Device 100 optionally illustrates a correct motion, in
actuality or on a display.
[0644] b) A motion is executed with a "good" limb. Optionally, the
motion is corrected, using methods as described above for
editing.
[0645] c) The motion is repeated with a "bad" limb, for example
using passive motion, free motion or a force field. Optionally, the
"good" motion is corrected before being applied to the bad limb,
for example, an expected speed reduced, a range of motion reduced
or a force reduced.
[0646] d) Feedback is provided to the patient during and/or after
the motion (e.g., as a display).
[0647] e) The motion is optionally repeated.
[0648] FIG. 7 and FIG. 8 shows two handle devices 700 and 800
respectively, in which two arms can be moved simultaneously, with
optional coupling. In an exemplary embodiment of the invention,
this is used to have one arm passively move the other arm, for
example so the patient can sense with the good arm what a bad arm
is doing, or vice versa. Alternatively or additionally, one handle
is moved by the device, so the patient can see what is expected of
him. Optionally, two arm devices are used for children, for example
as a game between paretic children and healthy children or
grownups.
[0649] In device 700, two separate rehabilitation devices 702 and
704 are optionally attached by a base 706 and coupled by computer,
electrically and/or mechanically, so that an arm 708 of one mimics
the motion of an arm 710 of the other. The arm moving mechanism is
optionally a ball based mechanism as described below.
[0650] In device 800, a single joint links two arms 808 and 810. As
a result, the motions are reversed. Optionally, arms 808 and 810
are extendible (as described below, for example) and are linked
together so that they both lengthen and shorten together, for
example, the two arms including extensions that are engaged on
opposite sides of a gear with a fixed center of rotation (e.g., a
rack and pinion mechanism).
[0651] In an exemplary embodiment of the invention, mirrored motion
is provided using other devices. For example, in an application
using standard devices, mirrored motion is provided by a user
holding one mouse in either hand (or in a same hand sequentially)
and applying the above transfer of motion form one hand to the
other. In another embodiment, one or two force-feedback joysticks
are used. It should be noted that for this and other embodiments a
plurality of devices may be used. In particular, for specific
applications, relatively simple and/or standard hardware can be
used, for example force feedback joysticks or haptic displays.
Complex Motion
[0652] FIG. 9A illustrates a rehabilitation device 900 comprising
two sections, a first section 902 associated with motion of a wrist
and a second section 904 associated with motion of an elbow.
Sections 902 and 904 can be ball-based devices as described below.
A rigid and optionally adjustable connection 910 fixes the relative
position of sections 902 and 904. A connection 912 optionally
interconnects a wrist holder 906 and an elbow holder 908. Device
900 is used to exemplify control of multiple points on a limb
(e.g., arm or leg) during rehabilitation.
[0653] In use, each of holders 908 and 906 can be controlled in
three spatial dimensions and optionally in angular dimensions as
well, thus allowing more complex motions to be tested, trained
and/or provided. Optionally, the possibility of restricting certain
motions is useful from a safety point of view, for example,
preventing certain rotations of the joints. Optionally, a point is
controlled in 3, 4, 5, or 6 degrees of freedom of motion.
Optionally, the control in some of the degrees of freedom is
different than in others. For example, motion in one axis may have
resistance associated therewith, while an angular motion may be
assisted motion with device 900 supplying some of the force.
[0654] It should be noted that in device 900, trajectories may be
defined as relative trajectories in which the actual position of
the device 900 is less important than the relative positions and
movement in space of holders 906 and 908.
[0655] FIG. 9B illustrates a rehabilitation device 920, including a
single section 928 with an arm 932, on which is mounted an arm
holder 930. Holder 930 restrains both an elbow using an elbow
holder 924 and a wrist, using a wrist holder 922. An optional
rotation mechanism 926 is shown for rotating holder 930
perpendicular to arm 932 while an optional rotation mechanism 940
rotates holder 930 around arm 932. Alternatively or additionally, a
similar mechanism (not shown) is optionally provided for rotating
holder 930 around its axis.
[0656] As will be described below, another type of complex motion
which can be supported by a rehabilitation device in accordance
with an exemplary embodiment of the invention requires synchronized
motion of several body parts, for example, an arm and a leg.
Ball-Based Device
[0657] As noted above, designs other than an articulated arm may be
used for device 100. In particular, in an exemplary embodiment of
the invention, the device is based on a universal joint, from which
extends a rigid arm, which is optionally changeable in length.
[0658] In an exemplary embodiment of the invention, the universal
joint is implemented as a ball in socket joint. FIG. 10 shows an
exemplary rehabilitation device 1000, using a ball-in-socket joint.
This reference number is used in the general sense for several
ball-based devices as described herein, for conciseness.
[0659] Device 1000 comprises a base 1004, for example a table
containing a plate 1016, with an aperture 1017 defined therein and
enclosing a ball 1010. Ball 1010 optionally rests on a plurality of
rollers 1012. In an alternative embodiment shown in FIG. 11,
rollers 1012 are replaced by a bottom plate 1015 with an aperture
1013 defined therein which supports ball 1010.
[0660] An arm 1002 extends from ball 1010 and is optionally
balanced by a counter-weight 1018 attached by a rod 1022 to an
opposite side of ball 1010. Rod 1022 optionally passes through a
slot in an optional guide plate 1020, described in greater detail
below.
[0661] In use, ball 1010 turns and/or rotates, allowing a tip 1008
of arm 1002 to define various trajectories in space. Optionally,
arm 1002 is extendible, so that the trajectories fill a volume of
space. Optionally, arm 1002 includes a motor or brake 1024 (e.g.,
an oil brake), to actively move or passively resist such
extension.
[0662] In an exemplary embodiment of the invention, a brake 1014 is
provided for ball 1010. One potential benefit of using a relatively
large ball 1010 is that torque at the surface of the ball, for
example as required for braking or moving arm 1002 is generally
smaller than required for smaller joints, possibly allowing the use
of smaller or cheaper motors or other mechanical elements.
Alternatively or additionally, positional control of such motors
and/or sensitivity of position sensors can be smaller, while still
allowing for sufficiently precise control and feedback.
[0663] Device 1000 can be provided in various configurations. In a
simplest configuration, the device is completely passive and a user
can merely set plate settings (described below) and resistance
settings on the brakes. In a more advanced configuration,
resistance can be varied in real-time by a computer control. In
another advanced configuration, sensing of ball and/or arm position
is provided (e.g., using sensors, not shown). In another advanced
configuration, directional resistance can be varied (e.g., using a
directional brake, not shown). In another advanced configuration,
motive force, optionally directional can be set or varied, for
example using a plate and/or using multiple directional motors
(which can also be used to provide resistance).
[0664] In an exemplary embodiment of the invention, multiple motors
are used to control motion and/or force of arm 1002. The motors
optionally include optical position encoders, to determine an arm
position. Alternatively or additionally, stepper motors or servo
motors are used. Alternatively or additionally, a separate sensor,
for example, one which reads optical markings off of ball 1010, is
used. In an exemplary embodiment of the invention, rollers 1012 are
replaced by motors which rotate wheels. If one wheel is in a
direction (relative to the surface of ball 1010) perpendicular to
another such wheel, selective motion in one or both directions can
be achieved (e.g., if motion perpendicular to the wheel is
low-friction slipping motion). Alternatively, only one roller is
replaced by a motor with a turning wheel, wherein the wheel is
turned to a direction of motion desired and then rotated to achieve
the motion. Directional resistance is optionally achieved using the
motor. Alternatively, such resistance is achieved by a combination
of the motor applying force or resistance and a general resistance
applied by brake 1014. Optionally, one or more strain sensors are
provided or integrated in the motor(s), to assess a direction of
force being applied to arm 1002. Then, the motors can respond with
a counter-force, or an assisting force or a diverting force (e.g.,
with a component perpendicular to the applied force), as
required.
[0665] In an exemplary embodiment of the invention, brake 1014 is
operated by raising and lowering the brake towards the equator of
ball 1010, when the brake has an inner diameter of less than that
of the ball. Alternatively, the brake is inflated and deflated as
needed. Alternatively or additionally, a circumference of the brake
is modified, for example, by it being formed of shape memory alloys
which are heated to cause momentary expansion and/or shrinkage of
the brake. Alternatively or additionally, a perpendicular brake is
used which is pressed onto the surface of ball 1010 and towards the
center thereof.
[0666] Alternatively or additionally to a uni-directional brake,
directional brakes may be used, for example, rubber blades-like
pads which resist motion of the ball along the blade by bend with
relatively low friction to allow motion perpendicular to the
blade.
[0667] It should be noted that when arm 1002 is extendible, forces
applied to point 1008 generally include also a component along the
axis of arm 1002, to which brake or motor 1024 may respond and
which is optionally taken into account in the response of ball
1010.
Balance
[0668] FIG. 11 shows a balancing of device 1000, in accordance with
an exemplary embodiment of the invention. As noted above, FIG. 11
shows a variant of device 1000, in which ball 1010 is supported by
plate 1015. Weight 1018 is optionally designed to exactly cancel
the moment of arm 1002. Alternatively, it may be designed, or
modified (e.g., by changing its distance from ball 1010 or by
adding or removing a modular weight), to provide a force which
return arm 1002 to a resting position or a force which tends to
move it away from such a resting position. In some cases, balancing
may be adjusted to correct for a weight of an attachment, or of the
patient's limb.
[0669] Optionally, when arm 1002 is extendible, the extending part
includes a moving counter-weight that extends away from the center
of ball 1010 in a manner which maintains the center of gravity of
ball 1010. This motion may be solely inside of ball 1010.
[0670] Alternatively or additionally, balancing of ball 1010 is
provided by active balancing by the motors and/or brakes. Such
active balancing may also be used to effectively reduce or cancel
out the moment of inertia of ball 1010 and arm 1002.
[0671] When an attachment is added to tip 1008, this may change the
balancing. Optionally, a suitable weight is provided with each such
adjustment, for adding to balancing weight 1018. Alternatively,
handle 1008 includes one or more contacts and/or circuitry which
match one or more contacts or circuitry in a mating part of the
attachment. This allows device 1000 to detect which attachment is
being added and suitably move weight 1018 to compensate. Suitable
tables are optionally downloaded from a remote site. Alternatively,
the attachment includes a peg of suitable length which pushes into
tip 1008 and thereby moves an arm balancing weight inside of ball
1010. Movement of weight 1018 is optionally by a motor (not shown)
and may be, for example, along a rod 1022 and/or away from a line
connecting rod 1022 and arm 1002. Alternatively or additionally,
device 1000 self calibrates by detecting an applied torque moment
and moving weight 1018 (or other weights) to compensate.
[0672] Optionally, the balancing is designed relative to an
expected weight or force applied by a person during an
activity.
[0673] FIG. 11 also shows rod 1022 being constrained to travel in a
straight line by a slot 1030 in plate 1020.
Guide Plate
[0674] While, in general, computer controlled directional motors
and brakes can achieve any desired motion, in some embodiments of
the invention, a possibly more limited motion is supported by the
use of plate 1020 and its associated slots 1030. A potential
advantage of using guide plates is that movement perpendicular to
the slot is not generally possibly, and this does not required
suitable circuitry.
[0675] FIG. 12 illustrates a drive system for a plate-based
rehabilitation device, in accordance with an exemplary embodiment
of the invention. A first, optional, motor 1046 is attached to a
gear 1048 which rotates plate 1020 to allow motion of rod 1022 in
other than a straight line. A second, optional motor 1040 is
attached to a threaded rod 1042 on which a rod coupler 1044
travels. As coupler 1044 travels, it moves (or resists) rod 1022
along slot 1030. Other mechanisms can be used as well.
[0676] As noted in FIGS. 3A and 3B, it is sometimes desirable to
provide varying, rather than absolute resistance to motion
perpendicular to slot 1030. FIG. 13A illustrates an exemplary
coupling device 1300 for replacing coupler 1044, and which has this
property. Coupling device 1300 includes a body 1314 having an inner
threaded section 1302 for mounting on threaded rod 1042. Body 1314
further comprises an apertured element 1306 having an aperture 1304
which engages rod 1022. One or more spring elements 1308 couple
element 1304 to body 1314. Optionally, the tension in spring
element 1308 can be adjusted, for example by a screw 1310.
Optionally, a linear displacement sensor 1312 is provided to
measure the error in the position of rod 1022. Elements 1308 can be
provided, for example, in the direction of slot 1030 and/or
perpendicular to it. Other exemplary force control mechanisms are
described with reference to FIGS. 22-26.
[0677] FIG. 13B shows an elastic guide 1340, formed of two halves
1342 and 1344 coupled by one or more springs 1352 and 1354. Thus, a
slot 1346 formed between two edges 1348 and 1350 of the halves has
some elastic give. Alternatively or additionally, edges 1348 and
1350 are made at least partially elastic, for example, of
rubber.
[0678] FIG. 14A illustrates a variant device, in which two guide
plates are used in tandem, an upper guide plate 1020 and a lower
guide plate 1402. Separate motors are optionally provided for
rotating each guide plate.
[0679] FIG. 14B shows a guide plate with several slots. The solid
areas are provided to prevent the cut-outs from falling out. Other
methods, for example, out-of-plane bridges, may be used
instead.
[0680] FIG. 14C shows a guide plate with an "X" shaped slot. Other
shapes can be provided as well, for example a circle with a cross
inside, or curved slots.
[0681] In an exemplary embodiment of the invention, programming
device 1000 includes replacing slots and/or setting resistance.
Optionally, when a slot in inserted, it is recognized by device
1000, for example, using a contact based detection scheme as
described above or using a wireless or RF communication, for
example, by embedding a smart card circuitry in the plate.
Accessories & Wrist Attachment
[0682] FIG. 15A shows a wrist attachment 1500, which provides
control and/or feedback for one or more degrees of motion of a
hand, in accordance with an exemplary embodiment of the
invention.
[0683] A forearm is supposed to rest on a rest 1510, while a grip
1502 is grasped by the hand. Grip 1502 is gimbaled in one or more
axes relative to rest 1510. In the example shown, handle 1502 is
mounted on a base 1503 which includes a rod 1504. A joint section
1506 can optionally rotate around the axis of rod 1504 and/or
travel along it. In addition, an optional rod 1508 interconnects
rest 1510 and joint section 1506 and allow rotation around rod
1508. In addition, an optional rod 1512 meets joint section 1506 at
a direction perpendicular to the other two rods and allows rotation
around that third axis.
[0684] Optionally, wrist attachment 1500 is attached to tip 1508 at
rest 1510 or at a base section 1514 attached to rod 1508.
[0685] Optionally, one or more of the relative motions described is
supported by one or more motors and/or controllable brakes.
[0686] In some wrist attachments (or for other attachment devices),
one or more springs the handle to the rehabilitation device so as
to provide the varying resistance shown in FIGS. 3A and 3B, in one
or more dimensions.
[0687] FIG. 15B shows a wrist attachment 1520, according to an
exemplary embodiment of the invention and generally following the
form of device 1500. A handle 1522 is griped by a patient, while
the patient's arm rests on an arm rest 1524. Optionally, one or
more straps are provided (not shown) which can attach via one or
more strap slots 1526. A base 1542 affords attachment via a
connector 1528 to an arm 102 (not shown, but exemplified in FIG.
15C). In an exemplary embodiment of the invention, a universal
connector is used which is suitable for multiple attachments as
described herein, for example. In an exemplary embodiment of the
invention, the connector provides one or more of mechanical
fixation, power (e.g., electrical power) and data transfer.
Optionally, the connector also provides identifying information
about the attachment to device 100.
[0688] In the embodiments shown, three wrist rotations are
supported, by mechanical joints 1530, 1532 and 1534. Optionally,
the resistance at one or more of the joints is adjustable. In the
embodiment shown, the adjustment is manual, for example using one
or more of knobs 1536, 1538 and 1540. Alternatively an internal
adjustment, for example, using a small electric motor, is provided.
The resistance may be, for example, of a friction type or of a
resilient (e.g., spring) type. Optionally, rotation sensors are
provided for each joint, for example potentiometers.
[0689] Optionally, handle 1522 is replaceable, for example, using a
pull-pin 1544 to selectably unlock handle 1522 for removal.
[0690] FIG. 15C shows a different version, of a wrist attachment
1550, similar to wrist attachment 1520 (e.g., a knob 1552 is at a
different place from knob 1538) and shown from an opposite side.
Also shown is the mounting of the wrist attachment on an arm 102.
In an exemplary embodiment of the invention, the mounting comprises
a ball and socket joint, optionally with friction resistance.
Optionally, the socket joint is designed to disconnect if it
experiences torque above a certain level, for example as a safety
feature. Optionally, this safety level is settable. In an exemplary
embodiment of the invention, the joint comprises a ball held
between two plates, with the plates interconnected by springs with
a settable resistance. A wire interconnecting the plates is
optionally provided and may generate a signal is torn (e.g.,
springs over strained). Optionally, a safety tether is provided to
keep the parts of the joint together.
[0691] Another difference is that instead of a single arm rest
1524, two arm rests, 1558 and 1556 are shown. Optionally, straps
are provided only for the far arm rest (1558). Optional padding
1560 is also shown.
[0692] FIG. 15D shows a non-vertical handle attachment 1560. While
a 90 degree angle is shown in a bend 1562, other angles, for
example 45 degrees may be provided. Optionally, the angle allows
better control over which muscles will act and/or may make some
motions easier. Optionally, bend 1562 is adjustable, for example to
preset angles, such as 0, 45 and 90 degrees.
[0693] An optional universal attachment 1564 is shown.
[0694] FIG. 15E shows a grip 1570 in which optional finger
indentations 1572 are shown. An optional button 1574 for input form
the patient is shown. Additional buttons may be provided and
buttons may be provided in other embodiments as well.
[0695] Optionally, a body 1576 of handle 1570 is squeezable (as it
may be in other embodiments as well). One type of squeezable body
includes a gas-filled bladder. Optionally, the compression of the
gas can be varied to change the resistive force. In an alternative
embodiment, body 1576 is formed of two panels separated by one or
more springs.
[0696] An optional universal attachment 1578 is shown.
[0697] FIG. 15F shows a two handle embodiment 1580 including two
handles 1582 and 1586, which are optionally changeable via pins
1584 and 1588. This embodiment may be useful, for example, when it
is desired for one hand to assist the other hand in a motion. The
two handles actually used need not be identical.
[0698] An optional universal connector 1590 is shown.
[0699] Other attachments may be used as well. In one example, a cup
like attachment is used. A patient can hold the cup as a glass or
hold it using a pinching action by its handle. Various sensors to
measure pinching force and or grip force (as may be applied to the
glass) may be provided. Alternatively, attachments known in the art
can be used, optionally being modified to include a universal
connector and/or suitable sensors. Optionally, an attachment with a
strap to hold the hand is provided.
[0700] Optionally, the attachment used provides a sensation to the
patient, for example, vibration, pricking, pinching or a surface
texture. Electrical power may be provided to the attachment, as
well as data, to generate and control such sensation. Surface
texture may be varied, for example, by providing a smooth layer
with an underlay that is bumpy. Extending the bumps or the bumpy
layer, will vary the surface texture.
[0701] While the attachments are described for the arm, it should
be appreciated that such attachments can be provided to other limbs
and to the head and neck. In one example, a pedal is provided as an
attachment for a foot. The various rotations of the wrist
attachments may also be provided for the foot. Similarly, a head
and neck attachment may be designed to hold the support various
rotations and/or movements of the chin relative to the neck.
[0702] Another type of attachment is not mounted directly on arm
102, patches 504 for example (FIG. 5).
Elbow Support
[0703] FIGS. 16A-16D illustrate various methods of elbow support in
accordance with exemplary embodiments of the invention. As noted
above, for some rehabilitation methods it is useful to provide
support for and/or prevent motion of the elbow (or other body
parts). In an exemplary embodiment of the invention, device 100
supports the weight of the limb so that a patient can focus on
moving the limb and not on holding it in space. Conversely, device
100 may be set to prevent the patient from leaning on the device,
for example, with device 100 providing exactly the force expected
to be applied by the limb (optionally with some leeway).
Optionally, the degree of force changes along the trajectory, for
example, as the limb extends.
[0704] FIG. 16A shows an elbow support 1604 attached by wires to a
frame 1602, fixed to the rehabilitation device. Optionally, frame
1602 is collapsible. Optionally, frame 1602 is designed to allow
entry of a wheel chair so that a patient on a wheelchair is not
required to leave the chair for rehabilitation. One or more foot
pedals 1609 are provided for exercising and/or other rehabilitation
activities of the legs. Optionally, the pedals are used to support
coordinated exercises between arms and legs. Pedals that move in
more than one degree of freedom may be provided, as well as various
sensors as described herein. A perpendicular motion mechanism 1606
is shown, which may provide room for the knees of a patient sitting
in a wheelchair.
[0705] In a simplest embodiment, wires 1605 are set (e.g., their
length) to a desired elbow location. Optionally, three wires are
used so that elbow support 1604 can be fixed in space. Optionally,
more wires, for example, four wires are provided, so that even when
not occupied, support 1604 does not move. While wires may be used
to set an elbow support, such wires may also be used to support
other body parts. Optionally, multiple sets of wires are provided,
for supporting multiple body parts. Optionally, a wire based system
is used instead of an arm 102 or 1002 to control the position of a
tip (or attachment) or point on a body.
[0706] In an exemplary embodiment of the invention, a wire system
is used for measurement of a position in space. In one example, a
wire 1605 recoils and is attached to a measurement device such as
an encoder. Interpolation can be used to provide XYZ coordinates of
support 1604. In another example, described above as well, wires
are used to measure a relative position of a chair and a
rehabilitation device (e.g., frame 1602).
[0707] Optionally, a wire mechanism is attached between two limbs
and used to determine their relative distance. Multiple wires may
be used to determine more than just a distance value.
[0708] Optionally, a wire system is used for measuring additional
parameters, for example, force applied to a limb (optionally
including direction) and speed of motion. It should be noted that a
combined system including (for a same point or tip 108) both
robotic elements and wire elements, may be provided.
[0709] In an exemplary embodiment of the invention, a wire system
is controlled, for example using a motor, to maintain a certain
tension. Optionally, this is used to allow floating support of a
limb. Optionally, motors are used for controlling or assisting
motion, for example with a motor being used to shorten a wire or
allow a wire to play out at a certain speed or if a certain force
is sensed.
[0710] Optionally, a wire 1605 provides compliance against tension,
for example, by providing a spring attached to a wire 1605 (e.g.,
at a point 1608, where a motor may be provided as well).
Optionally, the tension in the spring may be varied, for example,
using an electric motor. Optionally, the spring is used to provide
cushioning in general.
[0711] FIG. 16B shows elbow support 1604 supported by an arm 1610
which extends from the rehabilitation device. Optionally, arm 1610
includes a linear extension measurement element and two rotary
measurement elements, to indicate the position of support 1604.
Other embodiments described herein may also include such sensors so
device 100 can calculate the position. Also, as noted, force
sensors may be provided, to assist in analyzing the forces applied
by the patient to support 1604.
[0712] FIG. 16C shows elbow support 1604 supported by a jointed arm
1620 which extends from the rehabilitation device.
[0713] FIG. 16D shows elbow support 1604 supported by a member 1630
which extends out of (and/or is mounted on) arm 1002.
[0714] Optionally, the extending arms and members are configurable.
Alternatively or additionally, the arms include motors and/or
variable resistance elements. Alternatively or additionally, the
arms and links include position, orientation, displacement and/or
force sensors. In an exemplary embodiment of the invention, the
actual position of various parts of the arm may be determined based
on the fact that one or more parts of the arm are fixed and the
length is known. If any joints are provided, the angle of the joint
may be measured.
[0715] An additional elbow support example is shown in FIG. 19,
below, in a docking station.
Varying Orientation
[0716] In some embodiments of the invention it is desirable that
arm 102 have a center resting position which is not vertical. FIG.
17A shows a rehabilitation device 1700, including a joint 1702
between a base 1704 thereof and a movement mechanism 1706 thereof,
which can assume multiple orientations.
[0717] Alternatively, one of the above described rehabilitation
devices may be mounted on a surface other than the floor or on legs
with uneven lengths. Optionally, when device 1000 is mounted on a
wall or upside down, rollers such as rollers 1012 are provided
above ball 1010 as well, so that they can support ball 1010, when
device 1000 is on its side or upside down. Mounting is achieved,
for example, by screws or using an adhesive.
[0718] One potential advantage of a varying orientation
rehabilitation device is the ability to rehabilitate a patient in
varying positions. For example, some exercises, for example those
including reaching and balance may be usefully practiced while
standing up. Some exercises, must be practiced while lying down, as
the patient is bed-ridden. Some exercises may be practiced sitting
and others while kneeling.
[0719] Another potential advantage is that a same system may be
used to rehabilitate different body parts with a same device.
[0720] Another potential advantage of a varying orientation
rehabilitation device is that many arm motion mechanisms are
limited in their range of motion, coupling between axes and/or
other mechanical considerations. Varying the orientation of the
device allows the motion mechanism to be placed at a more optimal
position. It should be noted that in some varying orientation
devices, the controlled tip 108 of the device can stay in a same
location even though the motion mechanism has moved. This allows,
for example, that a patient remain in a wheelchair during a change
in exercise.
[0721] While a manual change in orientation is shown, optionally
one or more motors are used to effect the change in orientation.
One or more angle sensors may be provided to detect the actual
rotation of joint 1702 (in one or two directions).
[0722] FIG. 17B and FIG. 17C show an alternative varying
orientation rehabilitation device 1710, in two orientations. In
FIG. 17B, an angled orientation is shown, a support slab 1724
positions a motion mechanism 1720 and an arm 1722 relative to a
base 1712. Optionally, one or more extendible legs 1714 are
provided for stability. Optionally, a wheelchair guide 1716,
optionally extendible, is provided. Optionally, guide 1716 is
slotted to allow a wheel to enter therein. Optionally, chucks are
added on either side of the wheel to lock the wheel in place. Not
shown is an optional bracket based locking mechanism in which one
or more pins or brackets engages the wheel from one or both sides
thereof, for example along the wheel axis. Such a mechanism may be
electrically actuated, for example, by the patient himself. This
wheelchair locking mechanism may be used in other embodiments of
the invention as well.
[0723] In an exemplary embodiment of the invention, slab 1724 can
be positioned at various angles. FIG. 17B shows an angle of about
45 degrees. FIG. 17C shows a 90 degree angle. Also shown in FIG.
17C, is a second support slab 1726 attached by a lockable hinge
1728 to support slab 1724. In FIG. 17B slab 1726 is flat against
base 1712. Additional possible modes are a 0 degree angle, in which
slabs 1724 and 1726 lay flat in a recess 1734 of base 1712. A hinge
1730 is used to rotate motion mechanism 1720 so that it faces
upwards. Optionally, motion mechanism 1720 is coupled to hinge 1730
via a rotatable base 1721. Another exemplary position is with slab
1724 lying flat in a recess 1732, so that rotatable base 1721 also
lies in recess 1732. This is a transport mode, in which arm 1722
may be detached and the whole of device 1710 may fit, for example,
in a trunk of a car. Slab 1726 is optionally attached to base 1712,
by another lockable hinge (not shown).
[0724] FIG. 17D shows an alternative rehabilitation device 1740
with an adjustable position of a motion mechanism 1748 thereof. In
this embodiment, a rail 1744 extends from a base 1742 and motion
mechanism 1748 is coupled to a traveler 1746 which rides on rail
1744. Optionally, motion mechanism 1748 is attached by a hinge to
traveler 1746, to better utilize the range of motion of mechanism
1748 (e.g., allowing an arm 1750 of device 1740 to be centered in a
center of a motion space using traveler 1746, rather than using
mechanism 1748).
[0725] Rail 1744 optionally folds for travel. Rail 1744 optionally
includes an in-built data and power bus for transferring at least
power to mechanism 1748. Alternatively, a flexible cable (not
shown) is used. Base 1742 (as other bases shown herein) may
optionally include wheels.
Multi-Limb Devices
[0726] In an exemplary embodiment of the invention, multiple limbs
can be trained together, for example, for rehabilitating
synchronized motion. In an exemplary embodiment of the invention,
multiple modules such as used in device 1000 are attached in
various configurations to achieve this effect. The attachment can
be, for example, structural (e.g., preventing undesired relative
motion, but possibly adjustable), mechanical, for example
transmitting motion from one module to another, and/or controlled,
for example, modifying the interaction at one module in response or
in synchrony with interaction at another module.
[0727] FIG. 18 shows a rehabilitation device 1800 for an arm and a
leg, in accordance with an exemplary embodiment of the invention.
Device 1800 includes a first section 1804 for exercising an arm,
for example using a mechanism of device 1000, and a second section
1802 for exercising a leg, for example also using the mechanism of
device 1000.
[0728] One exemplary use for this type of device is to rehabilitate
a stroke victim with one side paralysis. Another exemplary use is
to train synchronized motions, such as required for walking.
[0729] In some cases, two sided rehabilitation is desirable. FIG.
19A shows a rehabilitation device 1900 with four mechanism modules.
A pair of modules 1902 and 1904 is used to control the movements of
a right arm and a pair of mechanism modules 1906 and 1908 is used
to control the movements of a left arm. The two pairs of modules
can be synchronized and/or used for teaching, for example, as
described above.
[0730] Optionally, one or more modules are added for exercising
each leg. In the example shown, one or more pedals 1910, such as in
FIG. 16A are provided. However, as noted above, devices with a
greater degree of freedom can be used. Optionally, gait training
mechanisms, for example as described in U.S. provisional
application No. 60/633,428 filed on Dec. 7, 2004, also being filed
as PCT application on same date as the present application and by
the same applicant, entitled "Gait Rehabilitation Methods and
Apparatuses" and having attorney docket number 414/04391, the
disclosures of which are incorporated herein by reference, are
used. Optionally, such mechanism includes a support which attaches
to an ankle and can rotate and/or translate the ankle (e.g., foot)
in various (e.g., 2, 3, 4, or more) directions so as to
rehabilitate walking. Optionally, one or more mechanism modules are
provided for training hip motion, even while sitting. Optionally, a
tread-mill or training bicycle is provided for the patient to walk
on while exercising his upper body. Motion of the treadmill is
optionally synchronized to rehabilitation exercises and actual
performance by the patient. Optionally, gait training includes
individual training of different parts of the body and then
training them together for a complete (or partial) gait.
[0731] Optionally, device 1900 is used with a wheelchair and not a
standard chair.
Docking System
[0732] FIG. 19B shows a docking station 1920 and FIG. 19C shows
docking station 1920 occupied by a wheelchair 1922. By docking
station is meant a structure to which a patient can be brought and
locked into place and then rehabilitated. From a functional point
of view it is generally desirable that only a minimum of
manipulation of the patient be required for rehabilitation work to
start. Thus, for example, the patient can stay in the wheelchair
and optionally instead of adjusting the patient's position (e.g.,
initially and when exercises change) the rehabilitation device
moves, optionally autonomously, to ensure correct relative
positioning.
[0733] In the embodiment shown, two varying orientation modules
1924 and 1926 are provided on a track 1928. Optionally, the modules
are moved by hand. Alternatively, motors (not shown) change the
configuration of the modules and/or move them along track 1928.
Track 1928 optionally provides power and/or data to the modules.
Also non-varying orientation modules or other rehabilitation
devices may be attached.
[0734] An optional wheel-chair holding mechanism 1932 is shown
positioned on a track 1930. Optionally, the position is changed
manually. Alternatively, the position is changed using a motor (not
shown). Similarly, the wheelchair-engaging mechanism can be manual
or motorized.
[0735] A set of foot pedals 1934 is shown, but it could be replaced
by other foot-training devices.
[0736] An optional elbow support 1936 is shown, attached to a joint
1938. Optionally, elbow support 1936 is floating with respect to
the person, optionally adjusted to compensate for the weight of the
patient. Optionally, the floating is in a plane, for example in a
plane parallel to the floor. Optionally the location of the elbow
is measured by the support and can be used for various feedbacks
such as measurement of quality of motion. Support 1936 is
optionally on a telescoping and/or articulating arm, for example as
described in FIG. 16.
[0737] A display 1940 is optionally provided, for example for use
of a therapist and/or the patient. An input system 1942, for
example a keyboard and a joystick may be provided as well.
Optionally, the input and output devices 1940 and 1942 can be
swiveled to different positions, so that the therapist can access
them while docking station 1920 is occupied.
[0738] Display 1940, input 1942 and/or joint 1938 are optionally
mounted on a column, optionally a telescoping column. Optionally, a
display 1946 (audio and/or visual) dedicated to the patient is
provided.
[0739] A similar docking station may be provided for a gurney, for
example with four motion mechanisms, one for each limb.
Alternatively, as described below, the rehabilitation device is
made portable enough so that it may be brought to a bed-ridden
patient.
Mobility
[0740] A feature of some embodiments of the invention is that a
rehabilitation device is provided which is mobile. There are
various levels of mobility and various embodiments of the
invention, as described herein can achieve these levels.
[0741] In an exemplary embodiment of the invention, mobility of a
rehabilitation device is used to move the device within a ward or
between hospital wards.
[0742] FIG. 19D shows mobile rehabilitation devices 1950 positioned
near a bed 1951, in accordance with an exemplary embodiment of the
invention. In this embodiment of a mobile device, a motion
mechanism 1952 is mounted on a rail 1958, for example a curved rail
with a base 1960. Wheels, optionally lockable and/or extending legs
(not shown) may be provided on base 1960. Rail 1958 optionally
includes one or more tracks 1962 (slots shown) for adjusting the
position of mechanism 1952. Two different attachments are shown,
1954 for an arm and 1956, for a leg. Optionally, the wheels are
used to move device 1950 into storage. Collapsible devices were
described above, for example in FIG. 17B.
[0743] FIG. 19E shows an alternative mobile rehabilitation device
1964, coupled to bed 1951, in accordance with an exemplary
embodiment of the invention. One or more attachment mechanism 1972
lock device 1964 to bed 1951. Wheels are optionally provided.
Device 1952 may be used, for example for rehabilitation from above.
In an exemplary embodiment of the invention, device 1964 comprises
a frame 1970 on a top part 1966 of which a movement mechanism 1952
is mounted. Optionally, device 1952 can move along the frame. A
ball grip attachment 1968 is shown.
[0744] Mobility may also be useful in other settings, for example,
at home or in a small clinic. Also, as noted above, a mobile
rehabilitation device may be carried by a therapist on
home-calls.
[0745] In an exemplary embodiment of the invention, rehabilitation
is performed in water (or a steam bath), or with water supporting
the patient and/or providing heat and/or massage. FIG. 19F
exemplifies the use of mobile rehabilitation devices 1972 in a
bathtub 1976, in accordance with an exemplary embodiment of the
invention. A wheeled base 1978 is shown, but other base types,
including a fixed base, may be used. In the embodiment shown, two
arm attachments 1974 with extended connections are used and the
patient may be sitting or lying down.
[0746] Rehabilitation may also be carried out in a swimming pool,
with device 1972, for example, being attached to a ceiling above
the pool.
[0747] In an exemplary embodiment of the invention, the
rehabilitation device is kept outside the water, but attachments
are made waterproof. Optionally, the device itself is made
waterproof or at least splatter-proof. Optionally, the
rehabilitation device is made battery operated, to prevent
electric-shock hazard. Alternatively, pneumatic or hydraulic motors
are used instead of electric motors. Optionally, low-voltage (e.g.,
24, 12, 5 volts or less) are used to power the rehabilitation
device. Optionally a device without motors that includes brakes, is
used
[0748] In an exemplary embodiment of the invention, the mobility of
the rehabilitation device is used for rehabilitation in the
outdoors, for example in a person's garden (e.g., on grass) or in
nature. In one example, a rehabilitation device is used for a
recreational activity such as barbequing. The device can be used to
help guide, diagnoses and train a patient in flipping hamburgers,
for example. Optionally, large wheels are provided for better
traveling over soft surfaces. In another example, the
rehabilitation device is used to rehabilitate outdoor activities
such as golf or fishing. Optionally, special attachments are
provided for such activates, to match the range of motion of the
movement mechanism used to the activity. In a fishing example, the
rehabilitation device can assist for example in holding a fishing
rod, generating range of motion in the shoulder to through a fly
and in resisting the pull of a fish (which is a varying force).
Exemplary attachments are an attachment to a fishing rod and an
attachment to a tip of the rod (e.g., simulating a fish).
[0749] In an exemplary embodiment of the invention, a leveling
mechanism is provided for uneven surfaces. This mechanism, for
example, similar to that of FIG. 17A includes an inclination sensor
which detects the level plane and adjusts the motion mechanism to
be arranged suitably.
[0750] In an exemplary embodiment of the invention, a tip and or
tilt detection mechanism is provided. Optionally, when tipping is
detected (e.g., acceleration of the base of a rehabilitation unit),
the unit generates a warning signal. Optionally, any attachments to
the patient are released, to prevent damage to the patient.
Optionally, the base includes collapsible sections so that if
tipping is detected, the base can collapse one section thereof and
cause the device to fall away from the patient.
[0751] In an exemplary embodiment of the invention, a mobile
rehabilitation system for use out side of a sterile environment is
made easier to clean and/or proof against spills, dirt and some
weather conditions. Optionally, the electronics and motion
mechanisms are sealed. Optionally, joints are covered with flexible
rubber so that fewer bumps and cracks are present. Optionally, a
wipe-clean plastic covering is provided on the device.
[0752] In an exemplary embodiment of the invention, the
rehabilitation system is mounted on a wheelchair, for example on
its side or in back, or in a car, for example, in the seat near a
driver. Optionally, the device can be fitted in the back of a van
and the van is configured to be used as a mobile rehabilitation
unit, where a patient can enter (possibly in a wheel chair,
possibly using a lift) and exercise.
Modularity
[0753] In an exemplary embodiment of the invention, a
rehabilitation device optionally features modular design. Such
modular design may manifest itself in one or more of the following
manners:
[0754] (a) The device is capable of being broken down into modules.
This allows, for example, for maintenance by replacing a defective
module. Alternatively or additionally, the mobility of a device is
enhanced by the ability to take it apart into components which can
be quickly put together again by a layperson. In an exemplary
embodiment of the invention, no special tools are required for
taking apart or for putting together the device. Optionally, a
simple screwdriver or turn wrench is used. Optionally, the device
can be broken down/folded up or put back together in less than 1
hour. Optionally, the time required is less than 30 minutes, less
than 20 minutes or less than 10 minutes, 5 minutes or 2 minutes,
for example.
[0755] (b) The device itself is a module. As can be seen for
example in FIG. 19, a same motion mechanism module can be used for
multiple different rehabilitation configurations. Optionally the
unit as shown in FIG. 17 is used as an attachable/detachable module
for the docking station of FIG. 19B.
[0756] (c) Modular attachments. As shown for example in FIGS.
16-19, various types of attachments can be added to a same basic
device, thereby changing its usage. In a particular example, the
device is adapted for various patient sizes, for example children
with Cerebral Palsy, by replacing parts, for example an arm 102,
with suitably sized parts.
[0757] In some embodiments of the invention the hand attachment
includes mechanical and electrical quick connections. The
mechanical quick connect may include a pin that fits to a hole with
locking the electrical quick connect can includes spring loaded
needles on one side and surface pads on the others. A same set of
connectors may be used for multiple attachments.
[0758] (d) Modular software. Optionally, the software used by the
rehabilitation device is provided as modular software, for example,
separate modules for different attachments; modules which includes
sets of exercises; separate modules for different motion modes;
and/or separate modules for different uses of the device (e.g.,
group, home or clinic).
Daily Life
[0759] As noted above, in an exemplary embodiment of the invention,
a rehabilitation device is used to help specifically rehabilitate a
patient to achieve daily activities, such as opening doors, eating
at a table, reading a book, getting dressed, brushing teeth and
washing dishes.
[0760] FIG. 19G shows a rehabilitation device 1980 configured for
use for daily activities, in accordance with an exemplary
embodiment of the invention. A rehabilitation module 1952 is
mounted upside down over a table 1986 set with various eating
utensils. An elbow rest 1984 is optionally provided. In this
embodiment table 1986 is attached to a frame 1988 which supports
mechanism 1952. Alternatively, frame 1988 may be wide enough to
surround an existing table or other home element.
[0761] In use, a hand of the patient is strapped to a movable tip
1982 of device 1980 and the user attempts to or is guided through a
daily activity such as picking up a fork. Optionally, a glove with
force-feedback is used to selectively rehabilitate individual
fingers. Such gloves are known in the art.
[0762] In an exemplary embodiment of the invention, device 1980 is
used for one or more of training a patient to do activities related
to daily life, testing the patient's current ability to do such
activities and/or monitoring a patient's ability. Optionally, such
testing and/or monitoring are used by insurance companies to decide
on compensation or assistance required. Such testing can be
repeated over a period of time so that attempts to cheat may be
detected by sudden spikes in ability.
[0763] It is noted that a very important goal for rehabilitation is
quality of life, which is optionally addressed and/or determined by
training and testing the ability to perform various daily
activities.
[0764] In an exemplary embodiment of the invention, specific
attachments are provided for daily activities training. In one
example, a spillage indicating cup is provided, which includes an
inclination sensor. In another example, a whiteboard with ability
to detect a pen position is used in rehabilitation exercises
involving writing on a wall. The detected position and/or pressure
is reported to the rehabilitation device which optionally holds,
supports and/or guides the hand of a patient.
[0765] In an exemplary embodiment of the invention, an implement of
daily living is turned into an attachment by providing one or more
patches, for example stickers which include a sensors, for example
a position or a pressure sensors, and attaching the patch to a
daily use implement, such as hammer or a wall. The rehabilitation
device optionally includes a position determining means, for
example, a wireless unit which communicates with position sensors
on the patches or a camera which images the patches, so that the
rehabilitation device can determine relative positions and/or
orientations of the daily use objects. In some cases,
rehabilitation and/or diagnosis is carried out using the methods
described herein but without mechanical support or kinesthetic
feedback. Optionally, vibration or other feedback is provided to a
patient by attaching a vibrating patch (under control of the
rehabilitation device) to a limb which is being rehabilitated.
[0766] U.S. provisional application No. 60/566,079 filed on Apr.
29, 2004, also being filed as PCT application on same date as the
present application and by the same applicant, entitled "Fine Motor
Control Rehabilitation" and having attorney docket number
414/04401, the disclosures of which is incorporated herein by
reference describes various structures useful for rehabilitation of
fine motor control or the combination of fine and gross-motor
control.
[0767] FIG. 19H shows a device 1990 for assisting in training for
activities of daily living, in accordance with an exemplary
embodiment of the invention. Rather than provide an entire table,
device 1990 includes two settable points 1992 and 1993 connected to
a base 1994. A pair of adjustable arms, for example goose-neck arms
1996 can be used to adjust their position in space. In use, for
example for pouring tea, set points 1992 and 1993 are positioned to
emulate a situation, for example pouring tea. In an exemplary
exercise, a patient is required to move a cup (e.g., helped by a
rehabilitation device, not shown) from point 1992 to point 1993.
the trajectory is then evaluated. Set point 1993 is shown as a flat
surface, on which items may be placed. Other structures and
attachments, such as hooks, may be used. Optionally, set points
1992 and 1993 (more may be provided) include sensors, for example
proximity sensors (to detect human or rehabilitation robot),
contact sensors, pressure sensors and/or position sensors. The set
points may also provide feedback, for example, lights, sound or
vibration.
[0768] The relative positions of points 1992 and 1993 may be
determined, for example, using position sensors or cameras.
Alternatively, tip 108 is used to register their position to the
rehabilitation device, by contacting points 1992 and 1993 in turn
by tip 108. Optionally, a dummy arm is mounted on the
rehabilitation device to calibrate the relative expected position
of tip 108 and a set point, when the set point is actually being
touched by a part of the user, such as a finger.
Small Chuck
[0769] In an exemplary embodiment of the invention, a joint in an
articulated arm is configured to provide selective and/or
directional resistance.
[0770] FIG. 20 is a cross-sectional view of such a joint between a
rod 2004 and a rod 2002. A chuck 2006 fits into a flaring end 2008
of rod 2004 and engages a ball 2012 attached to rod 2002. If chuck
2006 is retracted towards rod 2004, it tightens around ball 2012
and increases the resistance thereof.
[0771] Optionally, one or more strain sensors and/or optical
sensors is provided between chuck 2006 and ball 2012, so that a
direction of force being applied to joint 2000, can be determined.
Optionally, one or more electrically activated brake elements are
provided, for example piezoelectric elements, which can selectively
modify a degree of resistance. This may be provided instead of or
additional to a retracting chuck mechanism.
Balanced Gimbal Device
[0772] FIG. 21 shows an alternative rehabilitation device 2100, in
which a ball joint is not used. An arm 2102, optionally extendible
is optionally balanced by an optional counter-weight 2110 around an
axle 2106. Counter-weight 2110 may include a motor or variable
brake for controlling extension of arm 2102.
[0773] A motor 2108 is optionally provided to rotate arm 2102
around axle 2106. A second hinge 2112 is provided to allow rotation
around an axis perpendicular to arm 2102 and axle 2106. Optionally,
motor 2108 includes a weight so that it balances arm 2102 relative
to hinge 2112. Optionally a slot 2114 is provided in a base section
2104 of device 2100, for functioning as plate 1020 and slot 1030
above. A similar structural arrangement may be used as well.
Optionally, a rotatable plate 2116 is provided for carrying slot
2114. A motor (not shown) is optionally provided for rotation
around joint 2112. Optionally, joint 2112 is raised to have an axis
crossing the axis of axle 2106.
Alternative Gimbaled Device
[0774] FIG. 22A shows an alternative gimbaled device 2200 for use
as a motion mechanism in accordance with an exemplary embodiment of
the invention. FIG. 22B, described below shows a configuration of
device 2200 including motors and/or brakes.
[0775] Device 2200 includes a gimbaled section 2202, an optionally
removable z-axis element 2204 and an optionally replaceable handle
2206 attached thereto. A modular connector 2208, for example as
shown in FIG. 15 may be used. Optionally, a release pin 2210 is
user to selectively take off z-axis element 2204, for example, for
replacement or for storage.
[0776] Gimbaled section 2202 optionally includes a frame 2212
including a first hinge 2214. Optionally, a guiding frame 2216 is
attached to hinge 2214 that provides a first stationary axis and
includes a guide pathway for guiding an extension (or cam follower
or pin) 2218 (described below).
[0777] A second stationary axis is provided by a hinge 2220 also on
frame 2212. In an exemplary embodiment of the invention, handle
2204 is optionally rigidly attached to a frame 2222 which includes
extension 2218. Thus, the spherical rotation motion of handle 2204
is translated to rotation of the two hinges around the stationary
axes. Optionally, extension 2218 includes a balancing weight (not
shown).
[0778] FIG. 22B shows device 2200 in an exemplary deployed
configuration, with two braking mechanisms 2232 and two force
control mechanism 2230 attached. As can be appreciated a practical
device can be constructed with only one of resistance and force
control. Force control mechanisms 2230 are described below in
greater detail.
[0779] Referring to braking mechanism 2232, in an exemplary
embodiment of the invention, a disc braking mechanism is used in
which a disc (or part of a disc) 2240 is selectively constrained by
a friction element (not shown). A motor 2250 selectively sets the
pressure applied by the friction element on the disc. Other
friction mechanisms may be provided as well. In an exemplary
embodiment of the invention, the following mechanism is used to
couple motor 2250 to disc 2240. A coupling 2248 converts rotational
motion of motor 2250 into axial motion of a rod 2247. Optionally,
rod 2247 is spring-loaded so that absent power to motor 2250, the
pin moves to a locked or an unlocked position, where the friction
on disc 2240 is maximal or minimal (depending on the
implementation). A rest 2246 is thereby selectively lifted or
pushed down by rod 2247. The friction element, while not shown, is
coupled to a rotatable element 2242 that converts rotation thereof
to motion of the friction element towards or away from disc 2240.
Optionally, element 2242 is a screw. Element 2242 includes an
trans-axial lever 2244 which is engaged by rest 2246 and thereby
rotates element 2242 when rest 2246 is moved. Rotatable element
2242 is optionally spring-loaded.
[0780] Other brake mechanisms can be used, for example as known in
the art of brakes, for example, electrical, fluid, magnetic and/or
mechanical brakes.
[0781] In an alternative embodiment of the invention, coupling
between motion in the various axis is reduced by providing a single
uni-directional brake. In an exemplary embodiment of the invention,
the brake comprises a spherical segment which is selectively
pressed against pin 2218.
[0782] Also shown in FIG. 22B are various optional sensors. A
sensor 2234 is coupled to the axis of hinge 2220 and report when
handle 2204 is rotated to its limit(s). A sensor 2236 reports when
the handle is in a reference (or home) position. A sensor 2238, for
example a rotary potentiometer or encoder reports on the angle of
rotation of hinge 2220. Similar sensors may be used for the hinge
2214.
[0783] In some embodiments of the invention, the brake mechanism is
used for one or more of providing safety by stopping motion,
providing programmable resistance (even in a system without active
motion of the device) and/or balancing (e.g., by providing friction
when needed to counteract external forces). Optionally, the braking
action in the two modules 2232 is coupled to provide for uniform
braking behavior independent of whether the motion of handle 2204
is along one of the stationary axes or not.
Cantilevered Gimbaled Mechanism
[0784] FIG. 23 shows a cantilevered gimbaled mechanism 2300 in
accordance with an exemplary embodiment of the invention. A frame
2302 is coupled (rigidly or not, as will be described in FIG. 25)
to a handle (not shown) which is optionally attachable to a drive
system 2304 (e.g., for selectable extension and resistance to axial
motion of the handle). Frame 2302 is rotatably coupled to a frame
2306. In an exemplary embodiment of the invention, relative
rotation between frames 2302 and 2306 is provided by a motor 2316.
In an exemplary embodiment of the invention, motor 2316 couples the
frames using a worm gear 2314 and pinion 2312. Other connections
methods may be provided. Optionally, the worm gear has a lead angle
small enough to prevent motion of the handle from back-driving the
motor. Possibly a worm gear is cheaper, quieter and/or allows a
lower cost motor to be used, as compared to using a precise motor
and/or gear-box.
[0785] Frame 2306 is optionally coupled to a base bracket 2307
using a similar mechanism, of which only pinion 2308 and worm 2310
are shown.
[0786] Optionally, braking is provided as described in the previous
embodiment.
Force Control Mechanism
[0787] FIG. 24A shows a force and drive control mechanism 2400, in
accordance with an exemplary embodiment of the invention. As shown,
mechanism 2400 includes a drive section and a force feedback
section. One or both of these sections may be omitted in some
embodiments.
[0788] Referring first to the drive section, an axle (not shown) of
hinge 2220 or 2214 is coupled to an inner pinion section 2402 of a
pinion 2404, for example via a gear section formed on the axle.
Optionally, other attachment methods, for example direct
attachment, are used. Pinion 2404 is rotated by a worm gear 2406
which turns on an axis 2407. In an exemplary embodiment of the
invention, power is provided by a motor 2414 via a set of two
pulleys 2408 and 2410 connected by a belt 2412. Other power trains
may be used as well.
[0789] Referring to the force feedback section, in an exemplary
embodiment of the invention, worm gear 2406 has a lead angle small
enough so that it cannot be back-driven by pinion 2404. Instead,
force (e.g., from the handle) which counteracts the force applied
by motor 2414 will cause worm gear 2406 to move axially along axis
2407. Optionally, one or both of a viscous braking mechanism and a
resilient resistance mechanism are provided to counteract this
force. Various combinations of settings may be provided, for
example resulting in what is shown in FIG. 3B.
[0790] Axial movement of worm gear 2406 results in displacement of
one of the two levers marked 2422 (the figure shows a mirror-imaged
mechanism). Viscous cushioning is optionally provided by a cushion
2440 resisting motion of lever 2422. Cushion 2440 is optionally
adjustable, for example by hand or by the rehabilitation device. A
linear potentiometer or other position sensor, are optionally used
to detect the offset of worm gear 2406.
[0791] In an exemplary embodiment of the invention, a spring 2420
resists the motion of lever 2422. Optionally, spring 2420 can be
selectably preloaded by a motor 2424. In the embodiment shown, a
set of pulleys 2426 and 2430 and a belt 2428 cause the rotation of
a threaded shaft 2432. In an exemplary embodiment of the invention,
a nut 2434 (or other mechanism) rides on the screw and converts its
rotation into preload of spring 2420. Optionally, shaft 2432 is
threaded in opposite directions on its two ends. It should be
appreciated that separate preloading for each of the two springs
2420 may be provided, for example if an asymmetric force resistance
is desired, or to counter-balance for gravity. Optionally, manual
adjustment of preloading is provided by a nut 2438, possibly used
for initial calibration and setting.
[0792] Optionally, a pin 2436 is provided to limit the axial extent
of motion of worm gear 2406. It should be noted that if the preload
is above zero, axial motion of worm gear 2406 will not occur until
this force is overcome. This corresponds to F.sub.min in FIG. 3B.
Optionally, the force mechanism is set up so that there is more
resistance to extending motion (away from the body) than to motion
towards the body.
[0793] Other mechanical structures can be provided as well, for
example, springs 2420 can sit on axis 2407. In another example,
instead of motor 2424 and the associated pre-load setting mechanism
can be replaced by a single spring coupled between the two levers
2422.
[0794] This structure can provide various modes of operation for
example:
[0795] a) User passive mode. In this mode, motor 2414 drives worm
gear 2406 and worm gear 2406 rotates pinion gear 2404 that is
connect to the handle.
[0796] b) Free user mode. In this mode, a user moves the handle in
any user determined direction and the system follows the user. In
this embodiment, mechanism 2400 acts as a mechanical diode is used
to decouple the user motion from the motor. As the user exerts
force on the robot arm, worm gear 2406 moves axially as described
above. This linear motion is measured and can be used as input to a
controller. The amount of force felt by the user is generally
determined by the preload of spring 2420. The preload can be set or
as in this case be controlled by the motorized preload motor.
[0797] In the free user mode the controller receives the input from
the linear potentiometer and instructs motor 2424 to follow in the
same direction. This causes the user to a predetermined force
counteracting his desired motion.
[0798] c) Restricted mode (force field). An additional use for the
spring motor combination is to create a track where the
counteracting force is minimal but any deviation from the track
will result in higher spring displacement and thus a force opposite
the deviation (e.g., as shown in FIG. 3A). Optionally, this mode is
activated for a particular speed, thereby setting up an isokinetic
exercise.
[0799] d) Initiated Mode. A user starts a motion in a certain
direction, which will be sensed as displacement of worm gear 2406.
This motion can then be carried to completion by the rehabilitation
device. Optionally, the motion will be completed only if the
initiated move was in a predetermined direction.
[0800] e) Assist mode. When a motion is in progress, spring 2420 is
preloaded in a fashion which pushes the handle in the direction of
the motion (e.g., positive feedback). This may be a continuous
force or it may be provided in pulses.
[0801] f) Static. Optionally, the force mechanism is used to
require a patient to apply a force at a point in space without
substantial movement of the handle. The force can be measured
and/or controlled on the fly. It should be noted that a spring
mechanism can generally provide more realistic small motions in
response to force than a friction mechanism or direct robotic
motion using motors.
[0802] A potential advantage of the spring-motor combination is
that velocity and/or range limitations on motion can be provided.
Another potential advantage is that gradual (e.g., resilient)
stopping can be provided, even in an emergency stop. Another
potential advantage is that the viscous damping can provide a
dynamic feeling.
[0803] FIG. 24B is a flowchart 2460 of the operation of mechanism
2400 when two such mechanisms are attached to the device of FIG.
22B, in a free-hand mode, in accordance with an exemplary
embodiment of the invention. A similar process may be used for
implementation with force control in three axes.
[0804] Flowchart 2460 describes how the magnitude and direction of
force applied by a user is measured and then used to guide the
motion of the handle. Acts 2462 through 2476 are described only for
Phi, but are carried out for all axes (e.g., Theta), as well.
[0805] At 2462, measurement of the Phi offset is acquired.
[0806] At 2464 optional filtering is applied, for example low pass
filtering which smoothes the signal and/or removes noise.
[0807] At 2466, a scaling operation is optionally performed, for
example to match calibration and control parameters.
[0808] At 2468, a noise gate is optionally applies where signals
below a threshold are converted to zero.
[0809] At 2470, the magnitude and/or direction of the change in
position are optionally extracted.
[0810] At 2472, a position command is optionally generated using a
gain factor.
[0811] At 2474, the position command is optionally clamped to be at
least a minimal value, for example, to overcome friction and/or
noise levels.
[0812] At 2476, an absolute position command is optionally
generated.
[0813] At 2478, the velocities of Phi and Theta axes are
calculated. Optionally, acceleration is calculated as well.
[0814] At 2480, a composite vector of correction is found.
Optionally, the composite vector is a maximum of phi and theta
rather than a vector combination, this may serve to stabilize the
system and/or prevent mechanical problems.
[0815] At 2482, a gain smaller than 1 is optionally applied,
possibly increasing the stability.
[0816] At 2484, the angle of the velocity vector is optionally
calculated.
[0817] At 2486, the components for Phi and Theta velocity are
calculated.
[0818] At 2488, a command for the motive source (e.g., motors) is
generated.
Coupled Force Control Mechanism
[0819] FIG. 25 shows an alternative force control mechanism 2500 in
which Phi and Theta axes are coupled using a single spring
mechanism. A handle 2502 is moved using axes not shown. In one
example, mechanism 2500 comprises an inner mechanism of the
embodiment described in FIG. 23 (where external Phi and Theta axes
are shown).
[0820] An axis 2504 (and a matching orthogonal axis, not shown)
comprise inner Phi and Theta axes which handle 2502 rotates around
a small amount when force control is applied. A bottom part 2506
contacts a plate 2508. The small amount of rotation causes plate
2508 to be depressed by part 2506 (other shapes may be provided,
but part 2506 is optionally rounded at its circumference). This
depression is resisted by one or more springs 2510, for example
four springs. The pre-load of the springs may be set using a motor
2522 which using a driver train comprising pulleys 2520 and 2516
and a belt 2518 can rotate a screw 2514 which compresses springs
2510 by lifting a base 2512. Alternatively or additionally, manual
pre-loading may be practiced
[0821] Optionally, linear motion of plate 2508 is ensured using a
bushing 2524 or other means as known in the art. A mechanical stop
may be provided to the relative motion of cap 2508 and base 2512,
so that sufficient preload of springs 2510 prevents any mechanical
motion.
[0822] The rounding of the edges of part 2506 may be calculated to
ensure a linear relationship between angle of rotation and
displacement.
[0823] The axes of inner rotation may be congruent with the axes of
external rotation, however, this is not required. For example, the
axes may not be co-planar and/or the axes may not be parallel.
[0824] Various measurement means may be provided, for example, a
linear potentiometer measuring spring displacement and/or rotary
potentiometers measuring Phi and Theta rotation. Measured values
may be used with the flowchart of FIG. 24B.
[0825] Optionally, spring 2510 is used to also provide compliance
in the Z-direction. In one example, when handle 2502 is depressed,
spring 2510 provides resistance. The hinge at axis 2504 is
optionally placed in a slot is that z-axial motion of the hinge is
possible.
Z-Axis Motion Mechanism
[0826] FIGS. 26A and 26B shows a z-axis motion and force response
mechanism 2600, in accordance with an exemplary embodiment of the
invention. The mechanism comprises a three part telescoping rod
comprising a central portion 2604, a top portion 2608 and a bottom
portion 2606. An external motor (e.g. 2304 from FIG. 23) couples to
a coupling 2602 and thereby rotates a rod 2609. The use of an
external motor optionally helps modularity as a z-axis mechanism
can be made lower cost and interchangeable with other z-axis
mechanisms. A coupling 2610, for example a nut converts the rotary
motion into axial motion of central portion 2604. The telescoping
of portions 2604, 2606 and 2608 is optionally guided by a pair of
linear bearings, 2614 for portion 2608 and 2612 for portion 2606.
The linear bearings lie in channels 2613 and 2611,
respectively.
[0827] In an exemplary embodiment of the invention, a combined rack
and pinion and timing belt mechanism is used to synchronize the
extension of portions 2606 and 2608, as follows. Each of the
channels 2611 and 2613 also includes a rack defined thereon and
portion 2604 includes two pinions 2616 and 2618, one on either end.
When portion 2604 extends, rack 2611 causes pinion 2616 to rotate.
A timing belt 2620 which is connected between pinions 2616 and 2618
(on co-axially coupled belt pulleys of same effective diameter)
causes pinion 2618 to rotate in synchronization. Pinion 2618 then
moves rack 2613, causing telescoping of portion 2608.
[0828] In an exemplary embodiment of the invention, telescoping
allows the z-axis mechanism to be compact and assist in
portability. Also, it allows motions near to the center of rotation
of the motion mechanism. In an exemplary embodiment of the
invention, telescoping allows a range of 2:1 or close to 3:1 of
z-axis length. Additional telescoping portions can be provided for
a greater extension ratio.
[0829] Referring to the upper part of the z-axis mechanism, an
exchangeable handle 2630 is shown. Axial motion of handle 2630 is
optionally shown by motion of a linear measurement potentiometer
2638. Optionally, handle 2630 is attached using a quick connect
mechanism.
[0830] In an exemplary embodiment of the invention, a spring 2632
provides resilient resistance to axial motion of handle 2630, for
example using the logic as described above in FIG. 24.
[0831] Referring to FIG. 26B, spring 2632 is a spiral spring, whose
resistance can be changed by changing its effective length, for
example by moving a sliding stop 2636 which determines a length of
the leaves of spring 2632. This sliding stop is optionally moved
manually, for example by rotating a housing 2634. Alternatively, an
internal motor may be provided. This change in leaf length is
generally comparable to a change in preload. Minimal force setting
may be provided by actually preloading spring 2636, for example by
axial motion thereof, or by providing another spring to resist
axial motion. Preload may also be achieved by rotating spring 2632
itself, thereby tensing the spring.
[0832] The range of motion of the force control mechanisms can be,
for example, 3 cm, 5 cm, 10 cm, 15 cm, 20 cm or intermediate,
smaller or greater ranges, depending on the implementation.
[0833] It should be noted that in some embodiments of the invention
the use of gear-reduction ratios allows lower power and/or lower
cost motors to be used.
[0834] It should be noted that force in the Z-axis can be
transferred using a flexible or a bent coupling. Thus, for example,
the z-axis element can be a 90 degree elbow in which only the far
portion extends. Alternatively or additionally, goose-neck like
mechanism is used to define shape in space for the z-axis
element.
Games
[0835] Various games have been mentioned. In an exemplary
embodiment of the invention, one or more of the following
game-types is provided: role playing games (adventure and D&D
games), kinetic games (shoot-em-up), board games and simulation
games (e.g., soccer and tennis).
[0836] Games may be played, for example, one-on-one, against a
human opponent or against a machine opponents.
[0837] In an exemplary embodiment of the invention, device 100
serves as an input device, for example replacing a joystick.
Alternatively or additionally, device 100 is used as a VR input
device, for example to read limb positions. Alternatively or
additionally, specialized input modes may be defined, for example,
spatial positions of arm 102 may be mapped to virtual positions on
the screen or in the game world, or to velocities and/or
accelerations thereof. Gestures may be defined for various
controls, for example, "fire", "lift" and "put" commands may each
have an associated gesture.
[0838] In an exemplary embodiment of the invention, child games are
provided, for example for encouraging paretic or CP children to
avoid neglecting body parts. Device 100 may also be used as a
social focal point for preventing the paretic child from becoming
an outcast.
[0839] In an exemplary embodiment of the invention, a game is
fitted to the ability of the patient, for example, limiting the ROM
required, providing enhancement of patient motion, changing the
game speed and changing the visual field which needs to be
attended.
[0840] In an exemplary embodiment of the invention, the game is
selected to match a motivation level of the patient, for example, a
simple game selected for low-motivation patients.
Safety
[0841] In an exemplary embodiment of the invention, one or more
safety features are provided to prevent injury to a patient. For
example, one or more of the following safety mechanism may be
used:
[0842] a) Dead man switch. If a patient releases this switch (or
touches a suitable button) movement of device 100 is frozen and/or
all forces and resistance brought to zero. Other "safe harbor"
configurations can be defined instead.
[0843] b) Tearing pin. A pin may be used to attach tip 1008 (or
other attachment) to arm 1002. If a certain threshold force is
exceeded, the pin tears and the attachment is released from the
arm. Different pins with different tearing thresholds may be
selected for different situations. Optionally a wire can be
attached to the pin for feedback. Optionally the pin comprises two
magnetically attracted materials, with the degree of attraction
optionally set by electrical current.
[0844] c) Locking. Arm 1002 may have an initial locking condition,
to allow a patient to lean on it.
[0845] d) Voice activation. Voice activation and/or deactivation
may be provided, to allow a patient to shout the system to a
stop.
[0846] e) Analysis. Optionally, the actual movements and/or forces
applied by a patient are analyzed to determine if a threshold is
being approached or if the patient is experiencing undue
stress.
[0847] f) Resiliency. The force control mechanism with a spring
prevents sudden stops from suddenly stopping the patient. Instead,
the spring allows some compliance and a more gradual stop.
[0848] g) Force-measured. If the force mechanism determines a force
and/or spatial divergence above a threshold, the motion can be
stopped and optionally moved opposite to the direction of force
application.
Balance Training
[0849] In an exemplary embodiment of the invention, a
rehabilitation module is used for balance training. In one example,
a seat is attached to tip 1008 and a patient sits on the seat. A
non-rotating plate 1020 with a slot sets the direction in which the
seat is allowed to roll and the resistance level sets the
difficulty. Optionally, a handle bar is provided. Alternatively or
additionally, a foot rest and/or pedals are provided for the feet.
Alternatively one or more rehabilitation modules for the arms are
provided. In this manner, various daily and sports activities can
be simulated and trained for. Optionally, a virtual reality type
display or a television display are provided to enhance the sense
of reality. Such a virtual reality display may be provided in other
embodiments of the invention, for example to show feedback, to show
instructions or to make the activity more interesting.
[0850] U.S. provisional application No. 60/633,442 filed on Dec. 7,
2004, also being filed as PCT application on same date as the
present application and by the same applicant, entitled "Methods
and Apparatuses for Rehabilitation Exercise and Training" and
having attorney docket number 414/04388, the disclosures of which
are incorporated herein by reference, describes training of
balance, for example, using such a chair. Optionally, a full body
system is used to train multiple body parts associated with balance
simultaneously, for example, torso, arms and/or legs.
[0851] In an exemplary embodiment of the invention, device 100 is
used to train balance while standing. For example, a patient
performing a reaching exercise to arm 102, when tip 108 is at
various spatial positions; some positions requiring only arm
extending and some positions requiring torso bending.
Multi-Modal Therapy and Coordination Training
[0852] In an exemplary embodiment of the invention, device 100 can
be used for providing rehabilitation in modes other than motor. In
one example, the displays (audio and/or visual) are used to perform
visual and/or auditory rehabilitation. Thus, a single device can be
used for multiple rehabilitation types (e.g., at home) and serve as
a single point of contact both for the patient and for the
therapist. If multiple therapists exist, the device can serve to
coordinate between the various therapies and/or track general
parameters, such as general progress, motivation and/or cognitive
level. In an exemplary embodiment of the invention, device 100
selectively applies an exercise in one of several modalities, for
example, for load balancing and/or for interest.
[0853] In an exemplary embodiment of the invention, device 100 is
used to rehabilitate the coordination between modalities and/or
using the rehabilitation of one modality to help rehabilitate other
modalities. One example is eye-hand coordination, where a patient
is shown a target on a screen and the aim is to move tip 108 to
tack it. Another example is timing where a patient needs to provide
a command at a certain timing, possibly in an auditory modality.
Another example is spatial planning, where a patient is provided
with verbal instructions of gradually increasing complexity with
regard to spatial motions.
[0854] In an exemplary embodiment of the invention, progressively
more complex visual instructions, motor acts and feedback (visual
or not) are provided to the patient. Similarly, progressively more
complex audio, kinesthetic, haptic, and smell (using scent release
attachments) feedback and/or instructions are provided.
[0855] In a particular example, speech recognition is rehabilitated
in concert with motion for example requiring speech to be
understood fast enough to perform the motion in time, or respond to
verbal instructions. A user may be required to provide speech
utterances which match his motions. A speech recognition module may
be provided.
[0856] In another example, visual stimuli is made more complex as
visual rehabilitation progresses, for example, starting with a
light, then a light at a position, then a speed of blinking, then
text which must be read, all of which are used to prompt motor
action or serve as feedback (e.g., for progressively complex motor
tasks: moving arm, moving to a direction, moving to a particular
area).
[0857] A particular advantage of some embodiments of device 100 is
mechanical feedback and support is provided to the patient. In some
embodiments, some of the methods described herein for motor
rehabilitation (and which may find special utility therefor) are
used for non-motor rehabilitation, for example, measuring
motivation, remote rehabilitation, group activities and support by
a computer of user activities (for example for group
participation).
Other Devices
[0858] Various designs for robots and positioning devices (e.g.,
hexapods) are known in the art. It should be appreciated that
various ones of the statements described herein may be adapted for
such robots and/or positioning devices, in accordance with
exemplary embodiments of the invention. Alternatively or
additionally, software may be provided for such robots and devices
for carrying out various ones of the methods described herein, all
in accordance with exemplary embodiments of the invention.
[0859] U.S. provisional application No. 60/604,615 filed on Aug.
25, 2004, the disclosure of which is incorporated herein by
reference, describes taking the effects of brain plasticity into
account. The methods described herein may use EEG or fMRI as an
input for deciding, for example, on feedback or type of device mode
to use.
[0860] U.S. Provisional Application 60/566,078 filed on Apr. 29,
2004, also being filed as PCT application on same date as the
present application and by the same applicant, entitled
"Neuromuscular Stimulation" and having attorney docket number
414/04400, the disclosures of both applications are incorporated
herein by reference, describe stimulating a paretic limb while
moving the limb or otherwise supporting the motion of the limb. EMG
measurements, for example of healthy limbs are optionally used as
part of the teaching of the present application for deciding on
stimulation and/or supported motion of a paretic limb.
[0861] It should be noted that the rehabilitation devices described
herein are optionally usable not only at a home but also at care
centers, such as old age homes, hospitals and rehabilitation
centers.
[0862] It will be appreciated that the above described methods of
rehabilitation may be varied in many ways, including, omitting or
adding steps, changing the order of steps and the types of devices
used. In addition, a multiplicity of various features, both of
method and of devices have been described. In some embodiments
mainly methods are described, however, also apparatus adapted for
performing the methods are considered to be within the scope of the
invention. It should be appreciated that different features may be
combined in different ways. In particular, not all the features
shown above in a particular embodiment are necessary in every
similar embodiment of the invention. Further, combinations of the
above features are also considered to be within the scope of some
embodiments of the invention. Also within the scope of the
invention are kits which include sets of a device, one or more
tearing pins, one or more attachments and/or software. Also, within
the scope is hardware, software and computer readable-media
including such software which is used for carrying out and/or
guiding the steps described herein, such as control of arm position
and providing feedback. Section headings are provided for
assistance in navigation and should not be considered as
necessarily limiting the contents of the section. When used in the
following claims, the terms "comprises", "includes", "have" and
their conjugates mean "including but not limited to". It should
also be noted that the device is suitable for both males and
female, with male pronouns being used for convenience.
[0863] It will be appreciated by a person skilled in the art that
the present invention is not limited by what has thus far been
described. Rather, the scope of the present invention is limited
only by the following claims.
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