U.S. patent application number 14/901012 was filed with the patent office on 2016-05-26 for modular multi-joint rehabilitation training system and method.
This patent application is currently assigned to New York University. The applicant listed for this patent is NEW YORK UNIVERSITY. Invention is credited to Viswanath Aluru, Preeti Raghavan.
Application Number | 20160144229 14/901012 |
Document ID | / |
Family ID | 52144168 |
Filed Date | 2016-05-26 |
United States Patent
Application |
20160144229 |
Kind Code |
A1 |
Aluru; Viswanath ; et
al. |
May 26, 2016 |
MODULAR MULTI-JOINT REHABILITATION TRAINING SYSTEM AND METHOD
Abstract
The present invention relates to a device or apparatus for
aiding in upper extremity rehabilitation treatment. The apparatus
is a portable mobile rehabilitation device which has first and
second arms attached to the central fulcrum of a tabletop platform
which is supported by a height adjustable side pillar and base
piece. Each arm has 3 links or segments attached at the ends by
detachable and adjustable rotating support which are termed as
joints. The distal end of each arm has an end-effector which is a
hand hold module that is attached to the distal part of the subject
arm. The proximal end of each arm is attached to the central
fulcrum. The arms along with the modules will provide support for
the patient to move the arm at different joints either by passive
movement or active assist movement.
Inventors: |
Aluru; Viswanath; (Brooklyn,
NY) ; Raghavan; Preeti; (Brooklyn, NY) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
NEW YORK UNIVERSITY |
New York |
NY |
US |
|
|
Assignee: |
New York University
New York
NY
|
Family ID: |
52144168 |
Appl. No.: |
14/901012 |
Filed: |
July 1, 2014 |
PCT Filed: |
July 1, 2014 |
PCT NO: |
PCT/US14/45103 |
371 Date: |
December 22, 2015 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
61842251 |
Jul 2, 2013 |
|
|
|
Current U.S.
Class: |
482/92 |
Current CPC
Class: |
A63B 21/068 20130101;
A63B 23/12 20130101; A63B 21/4019 20151001; A63B 21/0058 20130101;
A63B 23/03541 20130101; A63B 2022/0094 20130101; A63B 2209/10
20130101; A63B 23/1209 20130101; A63B 2220/13 20130101; A63B
24/0087 20130101; A63B 21/00181 20130101; A63B 23/16 20130101; A63B
2230/605 20130101; A63B 21/4017 20151001; A63B 21/4047 20151001;
A61H 2201/0142 20130101; A63B 21/4033 20151001; A63B 2071/0638
20130101; A63B 2210/04 20130101; A61H 2201/1253 20130101; A63B
21/4035 20151001; A63B 23/14 20130101; A63B 2024/009 20130101; A63B
2071/0655 20130101; A63B 2071/0018 20130101; A63B 21/4021 20151001;
A63B 2022/0092 20130101; A63B 2024/0096 20130101; A63B 23/1281
20130101; A63B 2225/093 20130101; A61H 2201/1276 20130101; A63B
23/03533 20130101; A61H 1/0274 20130101; A63B 21/4043 20151001;
A63B 2210/50 20130101 |
International
Class: |
A63B 23/12 20060101
A63B023/12; A63B 23/14 20060101 A63B023/14; A63B 23/16 20060101
A63B023/16; A63B 21/00 20060101 A63B021/00 |
Claims
1. A rehabilitation system comprising: a platform; a first arm
comprising a plurality of links connected by a plurality of
corresponding joints, the first arm connected at a first end to the
platform; and the first arm configured to accept an end effector
for therapy.
2. The rehabilitation system of claim 1, further comprising a
second arm having a plurality of second arm links connected by a
plurality of corresponding second arm joints.
3. The rehabilitation system of claim 1, wherein the platform
further comprises a tabletop.
4. The rehabilitation system of claim 3, wherein the tabletop
platform includes a detachable center piece.
5. The rehabilitation system of claim 3, wherein the tabletop
platform is foldable.
6. The rehabilitation system of claim 1, further comprising a first
arm splint.
7. The rehabilitation system of claim 1, wherein the end effector
is selected from a group consisting of a shoulder module, a
sagittal plane movement module; a hand supination module, a wrist
module, and a finger module.
8. The rehabilitation system of claim 6, wherein the finger module
comprises a sensitubes.
9. The rehabilitation system of claim 1, further comprising a
height adjustable side pillar supporting the platform.
10. The rehabilitation system of claim 1, where the arm links are
lockable to enable movements at some links and not at others.
11. A rehabilitation system comprising: a tabletop platform, the
tabletop platform comprising a folding portion; a height adjustable
side pillar supporting the tabletop platform; a first arm
comprising a plurality of links connected by a plurality of
corresponding joints, the first arm connected at a first end to the
tabletop platform; and the first arm configured to accept an end
effector for therapy.
12. The rehabilitation system of claim 11, further comprising a
second arm having a plurality of second arm links connected by a
plurality of corresponding second arm joints.
13. The rehabilitation system of claim 11, wherein the tabletop
platform includes a detachable center piece.
14. The rehabilitation system of claim 11, further comprising a
first arm splint.
15. The rehabilitation system of claim 11, wherein the end effector
is selected from a group consisting of a shoulder module, a
sagittal plane movement module; a hand supination module, a wrist
module, and a finger module.
16. The rehabilitation system of claim 15, wherein the finger
module comprises a sensitubes.
17. A rehabilitation system comprising: a tabletop platform; a
height adjustable side pillar supporting the tabletop platform at a
first end and having a base at a second end; a first arm comprising
a plurality of links connected by a plurality of corresponding
joints, the first arm connected at a first end to the tabletop
platform; and the first arm configured to accept an end effector
for therapy.
18. The rehabilitation system of claim 17, further comprising a
second arm having a plurality of second arm links connected by a
plurality of corresponding second arm joints.
19. The rehabilitation system of claim 17, wherein the tabletop
platform includes a detachable center piece.
20. The rehabilitation system of claim 17, further comprising a
first arm splint.
21. The rehabilitation system of claim 20, wherein the end effector
is selected from a group consisting of a shoulder module, a
sagittal plane movement module; a hand supination module, a wrist
module, and a finger module.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims priority to U.S. Provisional
Application No. 61/842,251 filed Jul. 2, 2013, reference of which
is herein incorporated in its entirety.
FIELD OF THE INVENTION
[0002] Certain embodiments of the present invention provides a
novel approach to train isolated joint movements in the upper limb
for individuals with muscle weakness from any cause using a
specially designed device. More specifically, the certain
embodiments of the invention is for a mobile, portable, manually
controlled multi-purpose upper limb rehabilitation trainer.
BACKGROUND OF THE INVENTION
[0003] Hand movements require that the arm and shoulder are
relatively stable. When there is generalized weakness in the arm,
it is difficult to perform exercises to train hand movements as
there is instability further up in the shoulder. The present
invention provides a means for self- or manually
assisted-rehabilitation to train individual joint movements for
individuals with muscle weakness.
Causes of Upper Limb Weakness
[0004] Upper limb weakness is a common problem. Weakness is defined
as loss of strength or power manifesting as an inability to
generate normal forces. Muscle weakness can lead to incoordination,
and incoordination can present as weakness. Determining the true
cause of muscle weakness is critical for planning a treatment
approach.
[0005] Upper limb muscle weakness can be caused by various
neurological or musculoskeletal problems. Neurological muscle
weakness may occur due to damage to the brain or spinal cord as
after a stroke, traumatic brain injury, cerebral palsy, multiple
sclerosis etc, or after damage to the peripheral nerves as with
polyneuropathy, radiculopathy, brachial plexus injury,
Guillain-Barre syndrome etc. Diseases of the neuromuscular junction
such as myasthenia gravis and muscle diseases such as muscular
dystrophy also produce weakness.
[0006] Muscle weakness may also be seen in orthopedic conditions,
especially after trauma or surgery due to prolonged immobilization
of the limb. It is also a presentation of congenital conditions
such as Arthrogryposis. Upper limb muscle weakness is also a common
manifestation in critically ill patients and ICU survivors due to
prolonged immobilization. The weakness may persist for months and
years after discharge from the ICU.
[0007] Regardless of the cause of the muscle weakness, common
consequences are disuse, muscle atrophy, shortening of the muscles,
and finally permanent contractures.
Mechanisms of Recovery of Upper Limb Function
[0008] Upper limb range-of-motion training exercises and
strengthening are necessary to maximize functional outcomes. Range
of motion training is necessary to preserve muscle length and
prevent contractures which can lead to abnormal posturing.
Strengthening exercises and neuromuscular re-education help improve
movement quality and performance during functional daily
activities.
[0009] It is well known that there is a complex exchange of
information between the two limbs. Bilateral upper limb training
using symmetric movements (when both arms are moving together) or
alternating movements (one arm moves first followed by the other
arm) may be effective approaches to restore sensorimotor
coordination when one limb is partially paralyzed.
[0010] Several factors contribute to the success of rehabilitation
therapy. The first and foremost factor is the patient's motivation
and level of engagement in the treatment.
[0011] Rehabilitation professionals include physiatrists, physical
therapists, occupational therapists, speech therapists, social
workers, rehabilitation nurses and neuropsychologists, who work as
a team in order to accomplish the therapy goals set for the
patient. The most important aspects of motor rehabilitation are
facilitating gross motor and fine motor skills by physical and
occupational therapists. The challenge for the therapists is not
being able to effectively assist at the bedside when patients are
very sick and bed bound. The therapist must exert significant
effort to provide manual assistance and often cannot get the
patient properly positioned to deliver effective therapy. This can
be physically challenging to the patient as well and lead to
fatigue, which diminishes the patient's participation and
engagement in therapy.
[0012] In most acute situations in-hospital, the therapy and
nursing staff have to be very careful about emergency equipment
attached to the patient. The therapist often spends more time
focusing on logistics of therapy rather than delivering therapy in
these situations. Many of the available rehabilitation devices
focus on delivering therapy in an outpatient setting, but cannot be
easily adapted for the acute care or inpatient setting and are thus
not useful for a bedside therapy approach.
[0013] Existing rehabilitation devices are complex, therefore not
suitable to use in acute care settings as in the ICU or in a home
environment. One goal of the current health care system is to
decrease the length of stay in the hospital and discharge the
patient early into the community. There is a need for
multi-functional devices that can be useful in diverse
environments.
[0014] Present devices are designed to train one or the other
movement, but not all movements. For example, a device may train
shoulder and elbow movements, but not wrist and hand movements also
at the same time. This requires that there be several devices
requiring large spaces.
[0015] Improving sensory feedback is one of the most important
aspects of rehabilitation training and also one of the most
challenging. Improving sensation will automatically improve the
signals reaching the brain; so that the brain can effectively send
appropriate motor impulses to aid improved function. Lack of
sensation can promote disuse. The present invention is designed
with a sensory re-education kit to improve tactile and kinesthetic
feedback to further enhance motor recovery.
SUMMARY OF THE INVENTION
[0016] One embodiment of the invention relates to a rehabilitation
system comprising a platform. The system further includes a first
arm comprising a plurality of links connected by a plurality of
corresponding joints, the first arm connected at a first end to the
platform. The first arm is configured to accept an end effector for
therapy.
[0017] In another embodiment, the invention relates to a
rehabilitation system comprising a tabletop platform. The tabletop
platform comprises a folding portion. The system further includes a
height adjustable side pillar supporting the tabletop platform. A
first arm of the system comprises a plurality of links connected by
a plurality of corresponding joints. The first arm is connected at
a first end to the tabletop platform. The first arm is configured
to accept an end effector for therapy.
[0018] In another embodiment, the invention relates to a
rehabilitation system comprising a tabletop platform. The system
further includes a height adjustable side pillar supporting the
tabletop platform at a first end and having a base at a second end.
A first arm of the system comprises a plurality of links connected
by a plurality of corresponding joints, the first arm connected at
a first end to the tabletop platform. The first arm is configured
to accept an end effector for therapy.
[0019] Additional features, advantages, and embodiments of the
present disclosure may be set forth from consideration of the
following detailed description, drawings, and claims. Moreover, it
is to be understood that both the foregoing summary of the present
disclosure and the following detailed description are exemplary and
intended to provide further explanation without further limiting
the scope of the present disclosure claimed.
BRIEF DESCRIPTION OF THE DRAWINGS
[0020] The foregoing and other objects, aspects, features, and
advantages of the disclosure will become more apparent and better
understood by referring to the following description taken in
conjunction with the accompanying drawings, in which:
[0021] FIG. 1 shows the general perspective of the invention. This
view shows the trainer with the therapy table (workspace) and two
arms, two hand hold modules, a hospital type bed and a monitor
which can be used to control the device and also can be used to
provide virtual reality interface for therapy (such as games).
[0022] FIG. 2 shows a detailed view of the trainer with tabletop
design, twin arms, links within each arm, end-effectors (handhold
modules), detachable center piece and a base piece connecting the
table by a height adjustable pillar.
[0023] FIG. 3 shows partial detail of the trainer as depicted in
FIG. 2, but shows the folding mode when the trainer is not in use
or when it is mobile or during transportation.
[0024] FIG. 4 shows a detachable end-effector which is a handhold
module which can be attached to the arms and which is useful for
shoulder movements in the longitudinal axis.
[0025] FIG. 5 shows detachable end-effectors which are handhold
module which can be attached to the arms and which are useful for
shoulder and elbow movements in the sagittal and frontal axes.
[0026] FIG. 6 shows detachable forearm support splint which can be
attached to the arm support splint (not shown in the Figure) which
in turn is attached to the front edge of the therapy table.
[0027] FIG. 7 shows detachable end-effectors which are handhold
module which can be attached to the arms and which are useful for
forearm movements--pronation and supination.
[0028] FIG. 8 shows detachable end-effectors which are handhold
module which can be attached to the arms and which are useful for
wrist movements--flexion and extension.
[0029] FIG. 9 shows detachable end-effector which is a handhold
module which can be used to train finger movements and also shows a
sensory re-learning kit. Together this module serves as a hand
therapy module.
[0030] FIG. 10 illustrates a height adjustable pillar with
rotatable metal plates engageable with the table.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0031] In the following detailed description, reference is made to
the accompanying drawings, which form a part hereof. In the
drawings, similar symbols typically identify similar components,
unless context dictates otherwise. The illustrative embodiments
described in the detailed description, drawings, and claims are not
meant to be limiting. Other embodiments may be utilized, and other
changes may be made, without departing from the spirit or scope of
the subject matter presented here. It will be readily understood
that the aspects of the present disclosure, as generally described
herein, and illustrated in the figures, can be arranged,
substituted, combined, and designed in a wide variety of different
configurations, all of which are explicitly contemplated and made
part of this disclosure.
[0032] The present invention will be discussed in the context of
patients with neural, neuromuscular, musculoskeletal disorders and
ICU-related weakness. It can also be used in an otherwise healthy
aging population. The invention may be utilized in inpatient,
outpatient, nursing home or home care environments.
[0033] The present invention is helpful in delivering focused
active, or active-assisted or passive manually-assisted repetitive
range-of-motion training and strength training at isolated joints
and during functionally important movements to preserve muscle
length, prevent contractures, and restore muscle strength.
Importantly, the invention does not require external power,
although it may be motorized. The invention will be particularly
useful at early stages of weakness-causing conditions to mitigate
the effects of immobilization. The device may be used with one or
both hands.
[0034] In one embodiment, the present invention is designed to
facilitate practice of symmetric or alternating movements with both
limbs. Hence this multipurpose mechanical rehabilitation trainer
can train both limbs together or each limb independently.
[0035] In one embodiment, the present invention is particularly
aimed at enabling the patient with very limited movement to
function optimally using a structured physical therapy approach.
The device has been developed to give the patient maximum physical
and psychological autonomy and to improve quality of life.
[0036] In one embodiment, the present invention has been developed
to be used even when the patient is in bed and in any position,
recumbent, seated or standing, and in any orientation, so that the
alignment of the patient to the device is always maintained. This
can save valuable therapy time as the patient will not be required
to transfer out of bed just to initiate therapy.
[0037] In one embodiment, the present invention is particularly
suited for very early therapy in an acute medical setting such as
in an intensive care unit or in a stroke unit, or even in a nursing
home. The portability of the trainer and its adjustable position
and orientation can enable the therapist to deliver therapy rather
than worry about the logistics of emergency equipment and
transferring a patient from the monitored setting. The trainer is
portable, easily movable from place to place, can be taken to the
patient room, and is also modular and multi-functional.
[0038] In one embodiment, the present invention meets important
criteria for multi-environment use such as light-weight frame,
portability, affordability, adaptability for a variety of arm and
hand movements, and sensorimotor integration. The present
rehabilitation trainer can be used in any kind of setting--ICU,
inpatient, outpatient, nursing home or home environment. The
compact version of this trainer is designed in such a way that it
can be easily carried in the trunk of a car. The device has a very
simple and easy to assemble design. Anyone who can read and follow
simple instructions from a manual will be able to use the device.
The modular design will enable practice of a variety of movements
with just one device rather than requiring a separate device for
each movement.
[0039] In one embodiment, the present invention has been designed
to be multi-functional. The jointed arms with locking capability of
each arm segment, along with strategically placed straps will
enable training of all movements of the upper limb joints with a
single compact device. The devices will enable a therapist or a
trained caregiver to work efficiently and consistently with reduced
inter-individual variability. Frequent repetitive practice of
isolated joint movements will be possible early in the course of
rehabilitation which will improve functional outcome.
[0040] The main objective of the current invention is to increase
patient's accessibility to rehabilitation-which includes but are
not limited to cost of the device, ease of use, portability and be
able to use in any kind of environments-inpatient, outpatient,
nursing home or at home.
[0041] Another objective is to develop a low cost rehabilitation
device that can bridge the gap in health care disparities and aid
in health care equality in low-resource settings especially in
middle and low-income countries.
[0042] The goal of the present invention is to develop a compact
rehabilitation trainer that is convenient to carry to any place in
a car trunk. The present design or platform can be easily modified
to develop this type of compact version. The future goals using the
current invention are to develop a high-end robotic device with
advanced features which include but are not limited to automatic
controls, resistance controls, EMG biofeedback, virtual reality
platform for task--specific training and cognitive intervention,
performance tracking system, pain detection platform, joint and
trunk alignment sensors and sensory feedback.
[0043] Certain embodiments are illustrated by way of example below
and in FIGS. 1 through 9. As depicted in FIG. 1, one embodiment
relates to a portable, height adjustable, easily rotatable mobile
multipurpose rehabilitation system 100 includes an easily rotatable
and table 110 (serving as a therapy workspace) supported by a
height adjustable side pillar 121 with a base piece 122, the first
arm 130, second arm 140 and an easily mountable, detachable
end-effector 131, 132. The first arm 130 and second arm 140 are
made up of several segments, termed as links 132, 142 which are
pivotally attached such that the segments or links 132, 142 of each
arm 130, 140 can rotate about a communication point 133, 134. The
first arm 130 and second arm 140 are attached to a central fulcrum
111 situated on the rear margin at the center of the table 110.
[0044] Although certain embodiments are discussed herein in the
context of specific diseases producing weakness, using a manual
version, such is not intended to be limiting. Rather, other
embodiments can be utilized in patient populations such as
traumatic brain injury, spinal cord injury and musculoskeletal
rehabilitation of the upper extremity in the context of other
environments such as inpatient, outpatient, nursing home or home
care.
[0045] FIG. 1 shows the general perspective of the invention. This
view shows the trainer with the therapy table (workspace) 110 and
two arms 130, 140, two hand hold modules, 131, 141, a hospital type
bed 10 and a monitor 102 which can be used in certain embodiments
to control the device, track the performance and also can be used
for cognitive aspects of task-specific training (e.g.: Virtual
Reality games).
[0046] As further shown in FIG. 1, the system 100 is adaptable for
positioning with respect to the hospital bed 10 (only for general
perspective) whose head end is elevated. However, certain
embodiments of the system 100 are a purpose unit that can be used
in standing mode, in a sitting mode, or using a wheel chair.
Shoulder straps 11 may be provided for trunk balance. Belly straps
12 along with the shoulder straps 11 control the balance of the
trunk while the patient is working on the trainer. One or more arm
support splints 150 are provided in one embodiment on either side
to support one right and/or left arm. One or more arm splints 150
are attached to a bar 150 which is attached to the front edge of
the table 110. The arm splits 150 are detachable and can be slid
towards or away from the patient's trunk as per the need. These arm
support splints 150 (illustrated as two arm support splits 150 in
FIG. 1) are especially useful when the patient is using a
pronation-supination module and also for other movements to hold
the arms 130, 140 in position and to isolate the joints during
movements. They are provided with arm straps 153 which keep the arm
in position. The base of the splint 150 is provided with slots for
screws which can be used to attach forearm support splints 180
(FIG. 6) as needed during the therapy sessions.
[0047] In one embodiment shown in FIG. 1, the arm 130 is attached
to a rotating support 114 on a first the first link 142a which is
attached at the center by a fixed support. In one embodiment, the
proximal end of the first the first link 142a which is attached
rotating support 114 can be moved vertically to adjust the height
as per the patient's needs. In one embodiment, the arm 130 is made
of magnet free metal. The embodiment illustrated in FIG. 1 has
three links 132 (illustrated as first the first link 132a, second
the first link 132b, and third the first link 132c) and three
joints 133 (illustrated as first the first joint 133a, second the
first joint 133b, and third the first joint 133c). In one
embodiment, the center of each link 132 is hollow and can have
circular slots (not shown) to adjust the total length of the arm
depending on the patient's needs. For example, set screws (not
shown) may be used to secure the position of the link within a
slot.
[0048] In one embodiment, the first the first link 132a is fixed.
The proximal end of it is attached to the rotating support 114 and
can be moved vertically to adjust the height from the table 110.
The distal end of the first the first link 132a is attached to the
proximal end of the second link 132b by a first joint 133a which
has horizontal rotational movement.
[0049] In one embodiment, the second link 132b is mobile. The
proximal end of second link 132b is attached to the first joint
133a and the distal end is attached to the third link 132c by the
second joint 133b which has horizontal rotational movement.
[0050] In one embodiment, the third link 132c is mobile. The
proximal end of the third link 132c is attached to the second joint
133b and the distal end is attached to end-effector 131, which may
be a handhold module, by the third joint 133c which is fixed.
[0051] In one embodiment, a second arm 140 is utilized. The second
arm 140 may have the same structure as the first arm 130 or may
have an alternative structure. The second arm 140 is attached by a
first link 142a which is attached at the center by a rotating
support 114 or a fixed support 115. The proximal end of the first
link 142a which is attached to pivot can be moved vertically to
adjust the height as per the patient's needs. It is made of magnet
free metal. It has three links 142 (illustrated as first the first
link 142a, second the first link 142b, and third the first link
142c) and three joints 143 (illustrated as first the first joint
143a, second the first joint 143b, and third the first joint 143c).
In one embodiment, the center of each link 142 is hollow and can
have circular slots to adjust the total length of the arm 140
depending on the patient's needs.
[0052] In one embodiment, the first link 142a is fixed. The
proximal end of it is attached to the center pivot fixed support
115 and can be moved vertically to adjust the height from the table
110. The distal end of the first link 142a is attached to the
proximal end of the second link 142b by the first joint 143a which
has horizontal rotational movement.
[0053] In one embodiment, the second link 142b is mobile. The
proximal end of the second link 142b is attached to the first joint
143a and the distal end is attached to the third link 142c by the
second joint 143b which have horizontal rotational movement.
[0054] Different embodiments of an end-effector 131 may be
utilized. Further, where two arms 130, 140 are provide, two end
effectors 131, 141, one corresponding to each arm, are utilized.
The end effector 131 is selected based upon the therapy, for
example for shoulder, forearm, wrist, or hand. FIGS. 4-9 illustrate
nonlimiting examples of end effectors 131 that may be used as
modules for specific types of therapy.
[0055] The fixed support 115 is attached to the one or more arms
130, 140 by a pivot joint at the center by means of the first link
132a, 142a. The arms can be vertically movable and thus the height
of the arms from the base (surface of the table) can be
adjusted.
[0056] In one embodiment, the system may include or be in
communication with a console 102 that may be a computer or
connected to a computer in order to control the system 100 or to
train the patient using task-specific cognitive training exercises
(virtual reality games).
[0057] The system 100 includes a supporting structure 120 that
elevates the table 110 for proper position with respect to the
patient and also provides stability and support.
[0058] One embodiment of the supporting structure 120, best shown
in FIG. 10, includes a height adjustable support pillar 121 that
supports the table 110 which is attached to a the pillar support
base 122. In one embodiment, two hollow non-magnetic metal pillars
124, 125 are in a "telescoping" or nesting arrangement and attach
to the base 122 and support the table 110 to act as main vertical
support to the entire system. The table 110 is connected to either
the inner pillar or the outer pillar 125, such as through the use
of plates 128. One of the inner pillar 124 and the outer pillar 125
may rest on a resistance spring to provide a bias to the pillar
121. In one embodiment, one or both of the inner pillar 124 and the
outer pillar 125 is provided with slots which correspond to the
slots on the inside pillar. The height can be adjusted by locking
the inner pillar 124 relative to the outer pillar 125 (or the outer
pillar 125 relative to the inner pillar 124, in another embodiment)
at a certain height. In one embodiment, the outer pillar 125
connects to the bottom of the therapy table by a first plate 128
which in turn is connected to second plate 129 which attaches to
the table. One or more of the plates 128, 129 may be circular
and/or metal (non-magnetic). The second metal plate 129 is fixed to
the table 110 and the first plate 128 is attached to second plate
129, such as by a fixed support 126 or by a rotating support at the
center. Preferably, the table 110 can be rotated at least 90
degrees and a rotating table lock 127 is provided which can used to
lock the table 110 in a specific position. In one embodiment, the
rotating table lock 127 comprises a lock button 127a that is
attached to the second plate 129 and corresponding lock button
slots 127b are provided on the first plate 128. The button 127a
automatically locks in to the slot 127b on the first plate 128 when
rotated and can be set in a specific position. Thus, embodiments of
the height adjustable pillar 121 utilizing rotating plates 128, 129
allows for adjustment and securing of the vertical height and
horizontal rotation of the table 110.
[0059] As mentioned above, the system 100 may be used with various
types of furniture, including, for example, a hospital bed 10. In
one embodiment, the pillar base 122 comprises a railing provided to
connect to the bed (FIG. 2).
[0060] FIG. 2 shows a detailed view of the system 100 with a
tabletop design, twin arms 130, 140, links 132, 142 to each arm
130,140, end effectors 131, 141 (handhold modules), detachable
center piece 112, and a base piece 122 connecting to the table 110
by a height adjustable pillar 121. The device of FIG. 2 is show
without railing 122 for connecting to a bed, but includes the base
piece 122, which may include, for example, wheels 123 to aid in
movement of the system 100 from one patient to another.
[0061] The table 110 includes, in one embodiment show in FIG. 2, a
detachable center piece 112. In the illustrated embodiment, the
detachable center piece 112 is semicircular shaped, but it should
be appreciated that various shapes and sizes may be utilized. The
detachable center piece 112 of the system 100 that can be detached
when the patient is working on movements of the shoulder joint
(example: shoulder abduction) or when the system 100 needs to be
close to the patient. Removal of the detachable center piece 112
allows a user to position their torso within a portion of the table
110.
[0062] In the embodiment illustrated in FIG. 2, the base piece 122
is provided. The base piece 122 couples the table 110 of the system
by the height adjustable pillar 121 on one side. On the other side,
the base piece 122 is provide with a lock mechanism 118 for the
foldable half 117 of the therapy table, when the system 100 is not
in use. The system 100 is designed to be easily mobile with a
provision to lock in position during therapy sessions. In one
embodiment, the base piece 122 includes auto-locking wheels 123.
The wheels 123 are connected to the bottom of the base piece 122
and aid in the mobility of the system 100 but when the system 100
is in use, the wheels 123 can be locked to secure the system 100 in
the place.
[0063] In one embodiment, a kit can be provided for various
therapies. The kits may include specific links 132, joints 133,
end-effectors 141 and sensitubes 250. Once all the links are
attached, the length of each arm needs to be adjusted as per the
dimensions of the patient's arm. Both arms 130, 140 of the system
100 are length adjustable. This means that the attachment of the
links 132 can be changed based on the measurements of the patient's
arm there by optimizing the workspace in which the patient will be
practicing the movements. In order to determine the length of each
arm 130 of the trainer, the length of the patient's arm and forearm
are to be determined. In one embodiment, the length of the arm is
measured from the acromion process of the scapular bone to the
lateral condyle of the elbow joint. The length of forearm is
measured from the lateral condyle of the elbow joint to the radial
styloid process at the wrist joint. For certain embodiments, once
the length of the trainer's arms 130 is determined and adjusted,
the distance between the first arm 130 and the second arm 140 has
to be determined. This can be calculated by measuring the distance
between two acromion processes of the scapular bones of the
patient. Now the distance between the arms 130, 140 can be adjusted
accordingly. One another final setting that needs to be done before
starting the therapy, is adjusting the location of the arm support
splints 150. The arm support splints 150 are detachable and easily
adjustable structures that are attached to the system 100, such as
at a front edge of the table 110. The position of the arm support
splints 150 is adjusted and fixed depending on the patient's arm
position. The arm supports 150 are provided with straps, such as
utilizing hook and loop fasteners, to secure the patient's arm in
position. If necessary, the lower end of the patient's bed 10 can
be lowered before start of the therapy session. This will make it
more comfortable for the patient while working on the system
100.
[0064] Depending on the assessment of the patient's hand function
by a certified therapist and as per the recommendations of the
attending physician, the therapist (OT or PT) can determine which
movements need to be trained or which joint movements need to be
facilitated. It is advised that the patient is given 5-10 minutes
of stretching and warm up exercise by the skilled therapist before
practicing the movements on the trainer. Also the therapist should
take in to consideration the general condition of the patient,
cognitive abilities, pain, and all other presenting symptoms before
determining the appropriate therapy protocol for the patient using
the trainer. The movements can be trained starting with the
proximal joints and progressive towards distal joints in the
order--shoulder, elbow, wrist and hand or the movements can be
trained starting with the distal joints and progressing towards
proximal joints in the order--hand, wrist, elbow and shoulder. All
movements need not be necessarily trained in the same session. The
training protocol is at the discretion of the attending
rehabilitation specialist and the therapist. It is to be noted that
the trainer can be used to train one arm only or both arms
simultaneously or alternatively as explained in detail elsewhere in
this document. So, while performing the movements the therapist may
encourage the patient to perform similar movements on both sides at
the same time.
[0065] FIG. 3 shows partial detail of the trainer as depicted in
FIG. 2, but shows the folding mode when the system 100 is not in
use or when it is mobile or during transportation. In one
embodiment, a locking mechanism 118 of the table 110 provides a
locking mechanism when the system 100 is unfolded during the
therapy session. In one embodiment, best illustrated in FIG. 3, the
table 110 is divided into foldable 117 and non-foldable areas 116.
The foldable parts 117 can be folded and lock on to the base piece
122 by means of locking mechanism 119 provided on the sides of the
base piece 122. The non-foldable part is attached to the inner
supporting pillar by rotating twin non-magnetic metal plates
(described above) and is also supported by a non-magnetic metal
frame at the bottom.
[0066] The system 100 is unfolded by unlocking the side locking
mechanism 119 on the base piece 122 of the system 100 and the table
110 is locked in flat position by using the safe locking system 118
provided on front and rear margins of the system 100. The table 110
is easily rotated using a specially designed mechanism to adjust
the orientation of the table 110 and can be locked in that position
throughout the session. The first link 132a attached to a central
fulcrum is fixed but can be moved up or down vertically to adjust
the height of the arm from the table top surface. In order to
determine the height of the trainer arms 130, from the tabletop
110, the patient's arms are placed such that the shoulders are at
zero degrees, and forearms are at 90 degrees. Now the elbow on each
side is lined up with the table 110. If the tabletop 110 is not in
line with the elbow, the height of the system 100 is adjusted
easily by using height adjusting locking and unlocking mechanism of
the pillar 121 to makes sure that the system 100 is at appropriate
height comfortable to the patient. In one embodiment, if the
patient is not able to sit erect and is in a semi-recumbent
position, the system 100 will allow tilting the table 110 forward
slightly using a locking and unlocking mechanism at the pillar 121
underneath the table 110 which will enable the patient to work on
the system 100 more comfortably. Once the height, tilt and the
distance of the system 100 are adjusted and fixed, now the height
of the trainer's arms 130 are adjusted by sliding the attachments
at the support 114 and securing in place to maintain the same
height throughout the session. Once the distance of the system 100
from the patient is determined, the trainer's wheels 123 are locked
in position, so that the system 100 remains stable and fixed
throughout the training session. It is to be noted that while
training on certain movements like shoulder abduction, adduction,
shoulder internal rotation, external rotation and shoulder
extension, the system 100 needs to be brought closer to the patient
than when training on the elbow, wrist and finger movements. Before
training the patient on shoulder movements in sagittal axis in a
transverse plane, the trainer's wheels 123 are unlocked and the
system 100 is moved close to the belly of the patient and the
wheels 123 are locked again to secure the system 100 in position.
The distance, height and tilt of the system 100 can be adjusted if
needed during the course of the therapy session.
[0067] In one embodiment, the support pillar 121 is foldable or
otherwise collapsible to reduce the height of the system 100 when
not in use, such as described with respect to FIG. 10.
[0068] FIG. 4 shows a detachable end-effector 131 which is a
handhold module which can be attached to the arm 130 (or both arms
130, 141) and which is useful for shoulder movements in
longitudinal axis. Although FIG. 4 illustrates one end effector
131, it should be appreciated an identical end effector could be
utilized with the second arm 140 and that certain end effectors
131, such as shoulder modules, may provide better therapeutic
results when used in tandem. With respect to the end effector, the
proximal end of the third link 132c is attached to rotating the
second joint 133b and the distal end is attached to fixed
detachable joint 133c of the end-effector 131. The third link 132a
is movable by means of rotating the second joint 133b. The second
joint 133b is present between the second link 132b and the third
link 132c. The second joint 133b couples the distal end of the
second link 132b and the proximal end of the third link 132c. The
second joint 133b can be locked or unlocked depending on what
movement the patient is performing. The proximal end of the second
link 132b is attached to the first link by means of the first joint
(not shown in the drawing) and the distal end is attached to the
third link by the second joint which has horizontal rotational
movement. Both the first joint and the second joint can rotate in
horizontal plane which moves the second link. The joints can be
locked and unlocked depending on what movement the patient is
performing.
[0069] In the embodiment of FIG. 4, the end-effector 131 is
designed to train the shoulder movement in longitudinal axis
(forward and upward, downward and backward movement). The shoulder
module 170 is provided with a base 172, such as a wooden base, to
support the module 170 and T shaped handle 174 which is attached to
pivot joint 176 inside the module 170. A horizontal arm 177 of the
handle 174 is used to hold the module 170 by the patient and straps
(not shown) are used to secure the hand to the handle 174. The
therapist will assist the patient in placing the hand on the
horizontal arm 177 of the handle 174 and aid in moving the arm in
longitudinal axis to train the shoulder flexion and extension
movements.
[0070] FIG. 5 shows detachable end-effectors 131 which can be
attached to the arms 130, 140 and which are useful for shoulder and
elbow movements in sagittal axis and frontal axis, i.e. a sagittal
plane movement module 190. The connection between the arm 130 and
the end effector 131 may be universal between the various
therapeutic modules. Grasping handle 191 connects the hand support
192 to the detachable the third joint 133c. The grasping handle 191
is, in one embodiment, made of non magnetic metal and is used by
the patient to grasp the hand hold module 190. Forearm straps 184
and/or hand straps are used (not shown in the picture) if necessary
to keep the patient's hand in place.
[0071] Hand support 192 is a base, for example wooden, that
supports the patient's hand while grasping the handle 191. It also
attaches the handle 191 to the third joint 133c of the distal end
of the third link 132c.
[0072] Forearm support 185 may be a forearm splint 180 and include
padding 183 (best shown in FIG. 6) that may be used in one
embodiment. The hand hold module 190 includes a base which is flat
narrow and rectangular which acts as a forearm support 185. It is
provided with hard cushioning with forearm straps 184 to keep the
forearm in position. It is very useful in isolation of joint
movements. The forearm splint 180 is used with the arm support
splint 150.
[0073] FIG. 6 shows detachable forearm support splint 180 which can
be attached to the arm support splint 150 (FIG. 1) which in turn is
attached to the front edge of the table 110. The forearm splint 180
is useful for providing the forearm support especially while the
patient is performing forearm movements like pronation and
supination in transverse plane, shoulder movements in longitudinal
plane. It should be appreciated that a forearm splint 180 may be
used with each arm 130 where more than one arm 130 is utilized. In
one embodiment, the forearm support splits 180 provided elevated
sides for proper forearm position--The forearm support splints 180
hold the forearm of the patient and, in one embodiment, a surface
of the splint 180 is contoured and the edges 186 are elevated for
proper alignment of the forearm on the splint. In one embodiment,
the surface of the forearm splint 180 is provided with hard cushion
and enough padding 183 for the comfort of the patient. The forearm
splint 180 may be attached to the arm support splint 150, for
example by screws 187.
[0074] FIG. 7 shows detachable end-effectors 131 which can be
attached to the arms 130, 140 and which are useful for forearm
movements--pronation and supination module 200. The hand module 200
is useful for performing forearm pronation and supination
movements. The module 200 consists of a T shaped structure. One end
of the longitudinal arm 202 of the module 200 fits into the third
joint 133c at the distal end of the third link 132c and can be
fixed tight. In one embodiment, the distal end of the longitudinal
arm 202 of module 200 is provided with a slot (not shown) into
which the rotating handle 201 is fixed. The patient holds the
rotating handle 201 which is attached to the distal end of the
lateral arm 203. The proximal end of the lateral arm 203 is
attached to the longitudinal arm 202 which in turn couples with the
third joint 133c at the distal end of the third link 132c. In one
embodiment, the grasping handle 201 is made of non magnetic metal
and is a hollow rectangular frame like structure and the grasping
side is provided with cushion and padding for additional comfort of
the patient. Hand straps (not shown) can be used to hold the hand
in position attached to the handle 201.
[0075] FIG. 8 shows detachable end-effectors 131, 141 which are
handhold wrist module 210 which can be attached to the arms 130,
140 and are useful for wrist movements--flexion and extension. The
proximal end of the third link 132c is attached to a rotating the
second joint 133b and the distal end is attached to a fixed
detachable joint 133c of the end-effector (the third joint). The
third link 132c is movable by means of the rotating the second
joint 133b. Grasping handle 211 connects the hand support 212 to
the detachable the third joint 133c. The grasping handle 211 is, in
one embodiment, made of non magnetic metal and is used by the
patient to grasp the hand hold module 210. Hand straps are used
(not shown in the picture) if necessary to keep the patient's hand
in place. A hand support 212 is provided, for example as a wooden
base that supports the patient's hand while grasping the handle
211. A moving track 213 is provided so that the handle can be moved
along the track forwards and backwards, the track 213 may be a slot
for engaging the third link 132c via the third joint 133c. The
distal end of the grasping handle 211 is attached to the moving
track 213, in one embodiment semi-circular or semi-elliptical. The
movement of the handle 211 forwards and backwards causes the
movement at the wrist joint.
[0076] FIG. 9 shows detachable end-effector 131 which can be used
to train finger movements as a finger module 220. Further, the
finger module 220 is configured, in one embodiment, to utilize
sensitubes 250, which may be one or more different types of sensory
devices for hand therapy. The hand hold module 220 of FIG. 9 is
specifically designed to train finger movements. It has three
movable finger splints 221 and one thumb splint 227. The distance
between the individual finger splints 221 and the position of each
finger splint 221 as well as that of the thumb splint 227 can be
adjusted depending on the dimensions of the patient's hand. Each
finger splint 221 is a vertical hollow structure provided with
elastic loops 222, such as four. In one embodiment, each loop 222
can hold one finger in position. The four finger loops 222 will
hold the index, middle, ring and little finger in position. The
thumb splint has two thumb loops 228 for each segment of the thumb.
Each finger splint 221 is mean for each segment of the finger. Each
finger is divided into three segments--Proximal, middle and distal.
A first finger splint 222a will hold the proximal segments of all
the four fingers in position. A second, finer, splint 222b will
hold all the middle segments in position and a third finger splint
222c will hold all the distal segments in position. The finger
splints 222 are designed as vertical tubes for two reasons--1) to
eliminate the effect of gravity when the patient is performing the
finger movements and 2) to provide training close to the functional
usage of the fingers. The tension in the elastic loops 222 can be
adjusted using finger tension knobs 223 provided for each loop 222.
Depending on which finger segment is moving, the tension in the
loops 222 can be adjusted to provide training to specific finger
segments or to all finger segments at the same time.
[0077] In one embodiment, the hand module 220 has one thumb splint
227. The thumb splint 227 has two finger loops 228 for each segment
of the thumb. Thumb finger is divided into two segments--Proximal
and distal. A first thumb loop 228 will hold the proximal segment
of the thumb and a second thumb loop 228 will hold the distal
segment in position. The thumb splint 227 is attached to a base
piece 224 of the finger trainer and is positioned in relation to
the position of the thumb. It is provided with two tension
adjustable knobs 229 to adjust the tension in the elastic loops
228.
[0078] Three rows of slots (not show) are provided on the surface
of the finger module 220 to fit the sensitubes 250. In one
embodiment, the slots have metal threads to fix the sensitubes 250
for sensory training. Sensitubes 250 are hollow tubes with
different shapes, sizes, weights and different surface textures
that will help the patient with sensory training especially during
acute recovery phase. There can be any number of sensitubes. The
bottom of each tube 250 is provided with a screw and threads that
can be fixed into the slots provided on the surface of the finger
module 220. The sensitubes 250 will help the subject to feel
different textures, shapes and weights during the finger training
process. The finger module 220 together with sensitubes 250 is
called the hand therapy module 220.
[0079] In one embodiment, the finger module 220 has a base piece
224 which acts like a forearm and wrist support. The surface is
provided with padding and cushion and there are slots 251 for
sensitubes, for example 3 rows of slots. The finger module 220 is
provided with a pair of wrist straps 225 to keep the wrist in
position and to maintain proper alignment when the patient is
performing the finger movements. The base portion 224 of the finger
module 220 is provided with a pair of forearm straps 226 to keep
the forearm in position and to maintain proper alignment of the
elbow and wrist joints when the patient is performing the finger
movements.
[0080] The device described herein enables patients to perform
upper extremity strengthening and range of motion training
exercises at shoulder, elbow, wrist and finger joints in order to
maximize the functional outcomes. The special design of the device
enables the patient to practice repetitive arm movements in a more
intense and co-ordinated fashion very early in the course of
rehabilitation which is essential for functional recovery.
Portability and mobile features will allow the patient to practice
their exercises even at home in a supervised or semi-autonomous
environment providing continuum of rehabilitation care, and
maximizing functional outcomes and reducing complications such as
contractures, stiffness and further impairment of hand function.
Upper extremity strengthening exercises using the current invention
will help to improve the quality of movement and overall
performance of functional daily activities in patients. Sensory
retraining using the Sensilearn module of the present invention
will improve the overall sensory feedback to the brain, further
helping in the recovery of hand motor function and overall well
being of the patient. Certain embodiments of present invention
allows the therapist to start the therapy early in the acute phase,
thereby increasing the interaction with the patient, which will
improve self-confidence and creates sense of well-being, reducing
depression and other negative mood disorders. The device with
additional advanced features can be used to quantitatively diagnose
upper limb function disorders in relation to range of motion, upper
limb muscle strength and co-ordination between different joints in
a hospital or clinic setting by a qualified therapist.
[0081] The device is intended to be used by anyone who needs upper
extremity rehabilitation. A skilled therapist or a skilled
attendant would be present during the course of treatment to set up
the device, give proper instructions to the patient and also to
help the patient move the device practicing movements at different
joints--shoulder, elbow, wrist and fingers. The device can be used
for in-bed therapy, bedside therapy, inpatient therapy, outpatient
therapy or as a home rehabilitation device. The attendants of the
patient and care givers should be adequately trained before using
the device in a home environment. The device can be used to train
the patient in a semi-recumbent position when the head end of the
bed is elevated, in standing position, in sitting position
comfortably seated in a chair or in a wheel chair.
[0082] Before the trainer can be used, the therapist or the skilled
attendant must calibrate the work space and set up the device as
per the needs of the patient. The trainer is easily mobile, so when
a patient is unable to move out of his/her bed due to various
reasons but still is eligible to get the therapy as per the
recommendations of the attending physician, then the physician can
order bed side or in-bed therapy to the patient using certain
embodiments of the present invention. The therapist then may take
the mobile trainer to the patient's room. It should be noted that,
during the transportation, the trainer is in a folding mode to make
it compact and easy to navigate through the hallways. Also the
links of each arm and the end-effectors are easily detachable.
[0083] When in patient's room, the therapist may raise the head end
of the patient's bed before proceeding with the system settings.
The trunk balance and position of the patient should be assessed
properly. It is important to make sure that the patient is
maintaining proper trunk position. If necessary shoulder straps
and/or belly straps may be used to maintain proper alignment and
stability of the upper body. The side rails of the patient's bed
are lowered.
[0084] The end-effectors are designed to help train specific
movements. In the present description we will start with the more
proximal joints and proceed towards distal joints. As mentioned in
the above paragraph, the training of movements at different joints
and the order of training may differ from patient to patient and
the best training protocol needs to be determined by the
rehabilitation team comprising of a Physiatrist, physical
therapist, occupational therapist and other team members. Before
starting the therapy session using the system, the specific hand
module needs to be mounted to the distal end of each arm and
secured and fixed (locked) in place. At this point, the therapist
has to once again make sure that all the system settings are
appropriate and specific to that patient. The system along with all
the modules are carefully and specially designed keeping in view
the specific needs of each patient in order to provide maximum
comfort to the patient during therapy. However, if the patient
feels uncomfortable because of improper positioning or settings of
the trainer, the therapist in charge should stop the training
session and adjust the settings before resuming the session.
[0085] To train the shoulder flexion movements, the shoulder
flexion module needs to be mounted to the distal end of each arm of
the system and secured in place. It is to be noted that the module
is coupled to the distal end of the arm by a fixed attachment, so
that there is no rotating or oscillatory movement at the joint of
the end-effector. At this point, the therapist in-charge should
once again assess the position of the tabletop platform of the
system in relation to the patient and if necessary can be adjusted
by unlocking the system wheels and by moving the trainer close to
or away from the patient. Once the distance is properly adjusted,
the trainer is locked and secured in position. Before helping the
patient to stretch the arms, the range of motion of the shoulder
joint especially on the affected side has to be determined by the
therapist and patient is asked for any pain or discomfort while
stretching the arm forward. Once the approximate range is
determined at the shoulder joint, now the patient is asked to
actively stretch the arms forward or the therapist can provide
assistance by passively stretching the arm on the affected side, so
that the shoulder joint is flexed and elbow is extended. Now both
arms are placed on the horizontal handle of the end-effector and
hand is secured in position using soft velvet straps. The vertical
arm of the `T` shaped handle of the shoulder module is attached to
the axis inside the module, which will allow the movement of the
handle in a vertical plane. The shoulder module has a base which is
supported on the tabletop surface. Now the therapist will attach
the forearm support splints to the base of the arm support splints.
But it is to be noted that the position of the arm support splits
should be horizontal or might be kept pointing in the downward
direction while practicing shoulder movements in vertical axis in
order to avoid interfering with the movement. The forearm of the
patient is rested on the forearm support splints.
[0086] Each time the patient performs the shoulder movement in the
vertical axis and returns to the starting position, the forearm
support splints will serve as the resting or landing platforms.
Using the forearm support splints is optional as per the discretion
of the therapist. The patient is allowed to practice the shoulder
movements in a vertical plane in the range permitted as determined
by the therapist before start of the movement. The patient
practices movements on both sides by bimanual training either by
active movement of both arms, active movement of the unaffected arm
and active assist of the affected arm or active movement of the
unaffected arm and passive assistance on the affected side by the
therapist. The number of coordinate repetitions is determined by
the therapist. Frequent rest breaks should be given to the patient
during the course of the therapy session. The module along with the
forearm support splint will allow the patient to grasp the handle
of the end-effector and also properly position and support the arm
while performing the movements at the shoulder joint. When the
patient moves the hand in the vertical plane holding the horizontal
handle, the vertical arm of the `T` will rotate along the pivot
enabling the movement. The base of the module will provide the
support to the module and the fixed joint at the distal end of the
arm will hold the module in position during the movement. After
enough number of repetitions, the shoulder flexion module can be
detached very easily and the next module can be mounted to the
arms.
[0087] The second module termed the shoulder and elbow module as
depicted in FIG. 5 is used to train the shoulder and elbow
movements in a sagittal plane for forward reaching movements and in
a transverse plane in a frontal axis for sideward movements. Using
this module as shown in FIG. 5, shoulder flexion, shoulder
extension, elbow flexion, elbow extension movements can be trained
in a sagittal plane and shoulder abduction, shoulder adduction,
shoulder internal rotation and external rotation movements can be
trained in a transverse plane.
[0088] To train shoulder movements using the shoulder and elbow
module, the module needs to be mounted to the distal end of each
arms and secured in place. It is to be noted that the module is
coupled to the distal end of the arm by a fixed attachment, so that
there is no rotating or oscillatory movement at the joint of the
end-effector. At this point, the therapist in-charge should once
again assess the position of the tabletop platform of the trainer
in relation to the patient and if necessary can be adjusted by
unlocking the wheels and by moving the trainer close to or away
from the patient. Once the distance is properly adjusted, the
trainer is locked and secured in position. Before helping the
patient to place the arms on the module, the range of motion of the
shoulder and elbow joints especially on the affected side has to be
determined by the therapist and the patient is asked for any pain
or discomfort while stretching the arm forward. Once the
approximate range is determined at the shoulder and elbow joint,
the position of the patient and the trainer is adjusted such that
the shoulder joint is at zero degrees and the elbow joint is at 90
degrees and the forearm of the patient on both sides is comfortably
rested on the forearm support of the module. The therapist can
provide assistance to the patient to get in to proper position. Now
the forearms on either side are secured in position using forearm
straps and the grasping handle is grasped by the hand. The
patient's hand is held in position using soft velvet straps and
supported by a quadrangular base of the hand module. The patient is
asked to move the modules on both sides in sagittal plane
performing forward reaching motion on the table top platform. If
the patient has little or no movement on the affected side, the
therapist can hold the module on the top by means of the end
effector knob on the affected side and help the patient in reaching
movements. When the patient attempts to move the shoulder and elbow
module by active movement or by active assist movement, the ball
joints between the first link and the second link and between the
second link and the third link will rotate in synchrony to provide
smooth movement of the arm.
[0089] However, it is to be noted that the joint at the
end-effector to the distal end of the arm is fixed and there will
be no rotational movement. The patient is allowed to practice the
forward reaching movements in sagittal plane in the range permitted
as determined by the therapist before start of the movement. The
patient practices movements on both sides by bimanual training
either by active movement of both arms, active movement of the
unaffected arm and active assist movement of the affected arm or
active movement of the unaffected arm and passive assistance on the
affected side by the therapist. The number of coordinate
repetitions is determined by the therapist. Frequent rest breaks
should be given to the patient during the course of the therapy
session. The module along with the forearm support will allow the
patient to grasp the handle of the end-effector and also properly
position and support the forearm while performing the movements at
the shoulder and elbow joint. Using this type of reaching
movements, shoulder flexion, elbow flexion and elbow extension can
be trained in a co-ordinate fashion. After enough number of
repetitions, the shoulder and elbow module can be used to practice
other shoulder movements.
[0090] The shoulder and elbow module is also used to train
extension, abduction, adduction, internal and external rotation at
the shoulder joint. Before training the patient, it is important to
make some adjustments to the trainer. Firstly, the patient's arms
are slowly removed from the module by untying, for example, the
hook and loop straps. Now the semi-circular center piece of the
table top platform is slowly detached creating a semi-circular
space which will enable the therapist to move the trainer closer to
surround the patient. Once the therapist makes sure that the
trainer is sufficiently surrounding the patient evenly on both
sides, the wheels are locked securing the trainer in place. The
patient is instructed to grasp the handle of the module on both
sides. The therapist assists the patient grasping the handle on the
affected side. Now once again, the forearm and hand are secured in
position by using, for example, hook and loop or velvet straps such
that the shoulders are at zero degrees and elbows on both sides are
at 90 degrees. The patient is asked to move the modules on both
sides in a sagittal plane performing forward and backward motion on
the table top platform. If the patient has little or no movement on
the affected side, the therapist can hold the module on the top by
means of the end-effector knob on the affected side and help the
patient with shoulder flexion and extension movements. When the
patient attempts to move the shoulder and elbow module by active
movement or by active assist movement, the ball joints between the
first link and second link and between the second link and the
third link will rotate in synchrony to provide smooth movement of
the arm. However, it is to be noted that the joint at the
end-effector to the distal end of the arm is fixed and there will
be no rotational movement.
[0091] The patient is allowed to practice forward reaching and
backward movements in a sagittal plane in the range permitted as
determined by the therapist before start of the movement. The
patient practices movements on both sides by bimanual training
either by active movement of both arms, active movement of the
unaffected arm and active assist movement of the affected arm or
active movement of the unaffected arm and passive assistance on the
affected side by the therapist. The number of coordinate
repetitions is determined by the therapist. Frequent rest breaks
should be given to the patient during the course of the therapy
session. The module along with the forearm support will allow the
patient to grasp the handle of the end-effector and also properly
position and support the forearm while performing the movements at
the shoulder and elbow joint. Using this type of reaching
movements, shoulder flexion, shoulder extension, elbow flexion and
elbow extension can be trained in a co-ordinate fashion. After
enough number of repetitions, the shoulder and elbow module can be
used to train other shoulder movements.
[0092] In order to perform shoulder internal and external rotation
movements, the ball joint between links 1 and 2 of the arms on
either side of the trainer are fixed, so that the horizontal
rotational movement is only around the communication point between
links 2 and 3. The trainer is close to the patient so that it
completely surrounds the patient on both sides. Now the patient
holds the handles with the forearms resting on the forearm support.
The shoulder is at zero degrees and the elbow is at ninety degrees.
Shoulder internal and external rotations are performed in frontal
axis in a transverse plane by moving the hand module close to or
away from the body by rotating the shoulder joint. In order to
perform shoulder adduction and shoulder abduction movements, the
ball joint between the links 2 and 3 is fixed on both sides and the
horizontal rotational movements are performed only around the point
between links 1 and 2. The position of the patient and the arms on
both sides remain the same but now the patient tries to move the
arms close to or away from the body in such a way that the shoulder
and elbow move in synchrony at the same time, in order to practice
shoulder adduction and abduction movements.
[0093] The patient is allowed to practice the movements in
transverse plane in the range permitted as determined by the
therapist before start of the movement. The patient practices
movements on both sides by bimanual training either by active
movement of both arms, active movement of the unaffected arm and
active assist movement of the affected arm or active movement of
the unaffected arm and passive assistance on the affected side by
the therapist. The number of co-ordinate repetitions is determined
by the therapist. Frequent rest breaks should be given to the
patient during the course of the therapy session. The module along
with the forearm support will allow the patient to grasp the handle
of the end-effector and also properly position and support the
forearm while performing the movements at the shoulder and elbow
joint. Using this type of movements in frontal axis in a transverse
plane, shoulder adduction, shoulder abduction, shoulder internal
and external rotation can be trained in a co-ordinate fashion.
After enough number of repetitions, the shoulder and elbow module
can be detached very easily and the next module can be mounted to
train other joint movements.
[0094] A pronation-supination module as shown in FIG. 7 is very
useful to train the patient on rotation movements of the hand and
forearm wherein the surface of the palm is facing upward
(supination) or downwards (pronation). The ideal position of the
arm in order to perform these movements is by the side with the
angle of shoulder at zero degrees and the elbow at 90 degrees at
right angles to the arm. Before training the patient on pronation
and supination movements, it is important to make some adjustments
to the trainer. Firstly, the patient's arms are slowly removed from
the module by untying, for example, the hook and loop, straps. Now
the semi-circular center piece of the table top platform is slowly
attached to the platform and the trainer is moved little away from
the patient so that the front margin of the trainer is just
touching the belly of the patient but not completely surrounding
the patient. Now the wheels are locked securing the trainer in
place. The position of the arm support splints is adjusted on
either side, such that it supports the patient's arm and is held in
position using, for example, hook and loop straps. The forearm
support splint is attached to the base of the arm support splint on
either side and screws are tightened. The patient's forearms are
placed on the forearm supports and secured in place using, for
example, the hook and loop, straps. The patient is instructed to
grasp the handle of the module on both sides. The therapist assists
the patient grasping the handle on the affected side. Now once
again, the forearm and hand are secured in position by using, for
example, the hook and loop or velvet straps such that the shoulders
are at zero degrees and elbows on both sides are at 90 degrees. The
patient is asked to move the modules on both sides in sagittal
plane performing rotation movements of the hand and forearm wherein
the surface of the palm faces upwards (supination) or downwards
(pronation). If the patient has little or no movement on the
affected side, the therapist can hold the module on the top by
means of the end-effector knob on the affected side and help the
patient in performing the movements. When the patient attempts to
move the pronation-supination module by active movement or by
active assist movement, the shaft of the handle rotates within the
shaft of the end effector in both forward and backward directions
to provide smooth rotational movement of the forearm and hand.
However, it is to be noted that the ball joints between the first
and second links and the second and third links are fixed during
the course of the movement. The joint where the end effector is
attached to the distal end of the arm is also fixed and there will
be no rotational movement.
[0095] The patient is allowed to practice the movements in the
transverse plane in the range permitted as determined by the
therapist before start of the movement. The number of co-ordinate
repetitions is determined by the therapist. Frequent rest breaks
should be given to the patient during the course of the therapy
session. The module along with the forearm support will allow the
patient to grasp the handle of the end-effector and also properly
position and support the forearm and arm while performing the
rotational movements of the forearm. After enough number of
repetitions, the pronation and supination module can be detached
very easily and the next module can be mounted to train other joint
movements.
[0096] A wrist module as shown in FIG. 8 is very useful to train
the patient on movements of the wrist joint wherein the hand is
bend forward and backwards in a transverse plane or upwards and
downwards in a vertical plane while holding the forearm in
mid-prone or neutral position. The ideal position of the arm in
order to perform these movements is by the side with the angle of
shoulder at zero degrees and the elbow at 90 degrees at right
angles to the arm. The forearm and hand is held in mid-prone or
neutral position.
[0097] Before training the patient on wrist movements, it is
important to make some adjustments to the trainer. Firstly, the
patient's arms are slowly removed from the module by untying, for
example, the hook and loop, straps. Make sure the semi-circular
center piece of the table top platform is in place and the position
of the trainer is adjusted so that the front margin of the trainer
is just touching the belly of the patient but not completely
surrounding the patient. Now the wheels are locked securing the
trainer in place. The position of the arm support splints is
adjusted on either side, such that it supports the patient's arm
and is held in position using, for example, the hook and loop
straps. The forearm support splint is attached to the base of the
arm support splint on either side and screws are tightened. The
patient's forearms are placed on the forearm supports and secured
in place using for example, the hook and loop straps. The patient
is instructed to grasp the handle of the module on both sides. The
therapist assists the patient grasping the handle on the affected
side. Now once again, the forearm and hand are secured in position
by using, for example, hook and loop or velvet straps such that the
shoulders are at zero degrees and elbows on both sides are at 90
degrees. In order to train the wrist flexion and extension
movements, the patient is asked to move the modules on both sides
in a transverse plane along the semi-circular track performing the
forward and backward bending movements at the wrist joint. If the
patient has little or no movement on the affected side, the
therapist can hold the module on the top by means of the
end-effector knob on the affected side and help the patient in
performing the movements. When the patient attempts to move the
wrist module by active movement or by active assist movement, the
top of the handle moves along the semi-circular track of the end
effector in both forward and backward directions to provide smooth
movements of the wrist in a transverse, gravity eliminated plane.
However, it is to be noted that the ball joints between the first
and second links and the second and third links are fixed during
the course of the movement. The joint where the end-effector is
attached to the distal end of the arm is also fixed and there will
be no rotational movement. To train the wrist ulnar and medial
deviation movements, the handle of the end-effector is locked in
the semicircular track allowing movements only in the vertical
plane along the vertical axis without any transverse motion. The
patient is instructed to lift the handle of the wrist module in a
vertical axis by performing upward or downward movement at the
wrist joint which will cause the deviation of the wrist towards
ulnar (medial side) or radial (lateral) side of the wrist
joint.
[0098] The patient is allowed to practice movements in the
transverse or vertical plane in the range permitted as determined
by the therapist before start of the movement. The number of
co-ordinate repetitions is determined by the therapist. Frequent
rest breaks should be given to the patient during the course of the
therapy session. The module along with the forearm support will
allow the patient to grasp the handle of the end-effector and also
properly position and support the forearm and arm while performing
the movements at the wrist joint. After enough number of
repetitions, the wrist module can be detached very easily and the
next module can be mounted to train other joint movements.
[0099] Hand therapy module as shown in FIG. 9 can be used to train
finger movements. It also has a sensory re-learning kit consisting
of sensitubes --together this module serves as a hand therapy
module. Hand therapy module is specifically designed to train
finger movements. It has three movable finger splints and one thumb
splint. The distance between the splints and the position of each
splint can be adjusted depending on the dimensions of the patient's
hand. Each finger splint is a vertical hollow structure provided
with four elastic loops. Each loop can hold one finger in position.
The 4 finger loops will hold the index, middle, ring and little
finger in position. The thumb splint has two finger loops for each
segment of the thumb. Each finger splint is meant for each segment
of the finger. Each finger is divided into 3 segments--Proximal,
middle and distal. A first finger splint will hold the proximal
segments of all the four fingers in position. A second finger
splint will hold all the middle segments in position and third
finger splint will hold all the distal segments in position. The
tension in the elastic loops can be adjusted using the knobs
provided for each loop. Depending on which finger segment is
moving, the tension in the loops can be adjusted to provide
training to specific finger segments or to all finger segments at
the same time. The base portion of the finger trainer is provided
with a pair of forearm and wrist straps to keep the forearm in
position and to maintain proper alignment of the elbow and wrist
joints when the patient is performing the finger movements. Three
rows of slots are provided on the surface of the finger trainer to
fit the sensitubes. The slots have metal threads to fix the
sensitubes for sensory training.
[0100] Before training the patient on finger movements, it is
important to make some adjustments to the trainer. Firstly, the
patient's arms are slowly removed from the module by untying, for
example, the hook and loop straps. Make sure the semi-circular
center piece of the table top platform is in place and the position
of the trainer is adjusted so that the front margin of the trainer
is just touching the belly of the patient but not completely
surrounding the patient. Now the wheels are locked securing the
trainer in place. The position of the arm support splints is
adjusted on either side, such that it supports the patient's arm
and is held in position using, for example, the hook and loop
straps. The patient's forearms are placed on the base piece and
secured in place using for example, hook and loop, straps. The
patient is instructed to place the fingers in to the elastic loops
and the loops are gently tightened to keep the fingers in position.
If the patient has little or no movement in the finger joints, the
therapist can assist the patient to stretch the fingers before
helping the patient to place the fingers in to the elastic loops.
Depending on which segments of the fingers need to be trained, the
therapist will use the knobs to adjust the tension in the loops
there by allowing the movement of the fingers in specific joints or
all the joints at the same time. Because of the elastic nature of
the loops, the loops will not only provide enough tension while
performing the movements but also will automatically recoil to
bring the finger segment back to the resting position allowing the
patient to move the joint again. Improving the sensation in the
hand is also considered as one of the important aspects of
improving hand function through sensorimotor integration. The
Sensilearn tubes are specifically designed to provide sensory
feedback to the patient while the patient is practicing movements
at the finger joints. These Sensilearn tubes are hollow
non-magnetic metal tubes that have different surface textures,
different weights, and different shapes. These tubes can be in any
number and will help the patient to identify different surface
textures, different shapes, different weights of the objects,
different sizes. The patient also can perceive the sensation on the
unaffected side first and then can try to learn different
sensations on the affected side. The therapist can develop a
customized protocol using different combinations of these
sensitubes to provide sensory re-education to the patient.
[0101] The patient is allowed to practice movements in the
transverse plane eliminating the effect of gravity, in the range
permitted as determined by the therapist before start of the
movement. The number of coordinate repetitions is determined by the
therapist. Frequent rest breaks should be given to the patient
during the course of the therapy session. The module along with the
forearm support will allow the patient to properly position and
support the forearm and arm while performing the movements at
finger joints. While practicing the finger movements, the therapist
will use different combinations of sensitubes to provide sensory
feedback to the patient. These tubes can be conveniently fixed in
the slots provided on the module. After enough number of
repetitions, the module can be detached very easily and the next
module can be mounted to train other joint movements. At the end of
the therapy session, enough precaution is taken to remove the
patient's arms from the module. The links of the arms are detached
and the tabletop platform is unlocked on the side margins, to fold
the table and locked again using the locking system on the base
piece. Because of the portable and mobile nature of the trainer,
the trainer can be easily moved around like a therapy cart and can
be stored easily in a safe place.
[0102] The patient does not necessarily need to be in a bed. All
the above movements using various modules can be practiced by a
patient in a sitting position comfortably seated in a chair, or a
wheel chair or even in a standing position. These modules will be
very helpful for the therapist to practice intensive coordinate
repetitive movements with the patient at arm, forearm, hand and
finger joints without significant effort or manual assistance. The
device can be easily used by a skilled caregiver to practice
movements with the patient at home using different modules.
[0103] The foregoing description of illustrative embodiments has
been presented for purposes of illustration and of description. It
is not intended to be exhaustive or limiting with respect to the
precise form disclosed, and modifications and variations are
possible in light of the above teachings or may be acquired from
practice of the disclosed embodiments. It is intended that the
scope of the invention be defined by the claims appended hereto and
their equivalents.
* * * * *