EP1768637B1 - Device for the reeducation of motory deficiencies, particularly deficiencies when walking, in patients - Google Patents

Description

The present invention relates to a device for the rehabilitation of motor impairments of patients. It applies more particularly, but not exclusively, to the rehabilitation of walking.

In general, patients with neurological deficiencies following central nervous system injury (paraplegia and incomplete tetraplegia, hemiplegia of vascular origin, etc.) lose, among other functions, walking.

Depending on the severity of the neurological lesion, a certain degree of motor and sensory recovery is possible and allows a certain functional recovery of walking, which however remains mostly difficult.

The goal of rehabilitation by a physiotherapist is to stimulate sensory-motor function and body coordination in order to improve limb and trunk movements.

After a rehabilitation focused on isolated movements such as flexion and extension of the knee, it is the function in its entirety that is re-educated, for example the reeducation of walking.

The work of the walk begins then after a certain delay and is done on the ground with a permanent gestural correction performed in an oral and physical way. Different tools such as a walker, canes, parallel bars, splints can be used at different stages of progression.

Over the past decade, many medical studies have shown the benefit of using a treadmill for walking rehabilitation in these people. In most of these studies, the treadmill is used to perform walking more intensively and more repetitively than what is practiced in conventional rehabilitation. The presence of a therapist is helpful at the beginning to help the limb to move over the carpet while correcting movement defects. The walking on the carpet is accompanied by a more or less important weight reduction, this relief is achieved by a traction system supporting the person via a harness worn at the trunk (chest, abdomen and basin). By brisk body weight, the mass of the patient being constant, it means a decrease in the bearing force corresponding to said mass on the carpet.

Part of the traction system is above the user, so the existing devices are large volume. For example, the document US2004 / 005962 .

This system has advantages, in particular, the possibility of practicing a reeducation of walking much earlier and more intensively (in terms of speed and endurance) than what is done with a progression and a traditional technique. Indeed, the smooth running of the carpet forced to a greater regularity of movements of the lower limbs during walking. The body weight can be more or less lightened to reduce, in the early times, the difficulties of equilibration.

The precocious and straightforward focus on the walk is clearly understood by the person, which increases his interest and motivation.

Rehabilitation of the walk is done without risk of falling which reassures the patient who can all the better focus on the quality of the gesture.

For example, the document US5526893 which describes a rehabilitation device comprising a height-adjustable shoulder belt to adapt to the morphology of the patient to provide an optimum support generating the least possible stress for the user.

Medical studies tend to show that this new method is more effective than conventional rehabilitation techniques in terms of recovery of the walking quality that is to say speed, ease, distance traveled. This efficacy is seen both in people with long-term disability and in those who have just undergone neurological damage. Over time, the persistence of the positive effect after stopping this type of rehabilitation is not known.

• Ces systèmes sont le plus souvent prévus pour être utilisés par des professionnels et leurs coûts sont élevés, ainsi seuls des services hospitaliers peuvent les acquérir. Les kinésithérapeutes libéraux et encore moins les particuliers ne peuvent posséder de tels appareils.

However, many disadvantages exist:

• These systems are most often intended for use by professionals and their costs are high, so only hospital services can acquire them. The liberal physiotherapists and even less the private individuals can not possess such devices.

In addition, the rehabilitation of people in the long term is also problematic.
Patients with neurological inability to walk, after rehabilitation and after returning home, manage to walk more or less with difficulty during their daily life.
Patients walk most of the time to make their necessary trips and some, more motivated, walk more to perform a real exercise to better maintain or improve their remaining walking abilities.
At the same time, in order to maintain these functional abilities, doctors prescribe physiotherapy sessions at home or in the office which, in practice, are sometimes too short and, after a certain period, limited in number by Social Security. Moreover, it is common for patients to spend part of the sessions doing useful exercises but often at the expense of the time spent on the more specific work of walking.

In total, to progress to the march or simply to maintain the acquired one, it is necessary to walk more than it requires the life inside the home (that is true as well for the ease as for the endurance). In practice, we note that in many patients, this specific work is not intensive enough in duration and intensity.

Clinical experience shows that most patients would be willing to make more effort to improve their walking ability but living conditions (lack of room to walk) and the dependence of a third person to go out and walk outside (apprehension, risk of falling, climatic conditions, poor accessibility ...) often result in confinement to the home and a practice of very limited walking.

Given this situation, we can think that many people could benefit from a treadmill walk home training. This practice would increase walking time by using a tool that is increasingly proven in rehabilitation centers.

The practice of walking on treadmill at home therefore has several potential advantages, but in many cases, the use of a single treadmill by the patient alone is not possible because there is no device available. to avoid a fall always possible on this type of device. In addition, these treadmills do not include means of lightening corporal space and compatible with a home.

Indeed, a treadmill associated with body lightening means is a bulky material especially in height because the traction points and the attachment straps of the harness constituting the body lightening means are located above each shoulder, this device therefore always has a bulky part located above the head of the person. Part of the device is also located in front or on the sides of the body, this size is a disadvantage in the case where the device is installed in a small room.

Such a device has the advantage of preventing any fall but also the disadvantage of over-securing the user who has no imbalance to catch up. But walking is largely based on an ability to catch a fall forward including the advancement of a foot and swinging arms. Therefore, in this device, an important element of rehabilitation is not exploited.

The claimed invention aims to solve these disadvantages by leaving a certain freedom to the user while securing against falls.

For this purpose, it proposes a device for the rehabilitation of motor deficiencies of a user in a vertical position, this device comprising a harness provided with connection means intended to be worn by the user, means for lightening the body weight of the user. user having straps disconnectably attached to said connecting means and suspension members of said straps at suspension points, said apparatus further comprising reeducation means consisting of a treadmill, a step simulator or a simulator of cross-country skiing.

• lesdites sangles sont entraînées par des enrouleurs respectifs de manière à exercer sur le baudrier une force de traction vers le haut,
• les moyens de connexion des sangles sur le baudrier sont situés en-desous du centre de gravité de l'utilisateur,
• les susdits points de suspension sont situés au niveau, voire au-dessus du centre de gravité de l'utilisateur de manière à le maintenir dans une zone de stabilité réduite et à l'obliger ainsi à faire des efforts appropriés pour conserver son équilibre,
• des moyens de prévention de chute antérieurs étant prévus à hauteur de l'ombilic, en regard de l'abdomen de l'utilisateur tandis que des moyens de prévention de chutes postérieures sont prévus à hauteur de l'ombilic au regard de la région lombaire de l'utilisateur, ces moyens de prévention de chute étant disposé de manière à retenir le corps en avant et en arrière, en empêchant un basculement complet de celui-ci (en avant et en arrière).

According to the invention this device is characterized in that:

• said straps are driven by respective winders so as to exert on the belt a pulling force upwards,
• the connection means of the straps on the shoulder belt are located below the user's center of gravity,
• the aforesaid suspension points are located at or above the user's center of gravity so as to maintain it in an area of reduced stability and thus force it to make appropriate efforts to maintain its equilibrium,
• anterior fall prevention means being provided at the level of the umbilicus, facing the abdomen of the user while means for preventing posterior falls are provided at the level of the umbilicus with regard to the lumbar region of the umbilicus. the user, these fall prevention means being arranged to hold the body forward and backward, preventing a complete tilting thereof (forward and backward).

The harness may comprise a belt element, support straps and / or leg support attached to said belt element and connecting means to the lightening means, these means being disconnectable and fixed at the waist member.

Said belt member may be located at or below the user's center of gravity.

Said connecting means of the belt to the lightening means may be n number distributed over the belt member.

According to a first variant, said means for connecting the harness to the lightening means may be two in number, each being located on one side of the belt member so as to secure and lift the user while maintaining a certain instability of the user favorable to the rehabilitation.

According to a second variant, this instability may be further controlled: said means of connection of the harness may be in number greater than two, in particular the number of four distributed on the sides of the belt element so that two of the means are on one side, one in front, the other behind the user and the other two on the other side, one in front, the other behind the user.
Thus, the vertical projection of the user's center of gravity is located in the vicinity of the center of a lift polygon, that is to say a polygon formed by the vertical projection, in a horizontal plane, connecting means of the harness on the lightening means. In other words, the device according to the invention makes it possible to keep the user inside the polygon thus creating a zone of reduced stability so as to retain a possibility of causing the user to make an effort to maintain his equilibrium.

Said user holding means may also comprise support bars that allow the user to support with its upper limbs and thus increase its stability.
They can be adjustable in height and / or width.

Said bars may be mobile or fixed.

Moving bars from front to back will be able to reproduce a movement of forward and backward arms as is the case in normal walking.

These bars may include means on which the user, his wheelchair, can support to lift and settle in the device according to the invention.

Said means for lightening the body weight of the user may comprise straps driven so as to exert an upward pulling force on the holding means. For example, the pulling force is applied by means of a winder around which one end of the straps is wound, the other end being disconnectably attached to the holding means of the user.

Means for adjusting the traction force may be provided so as, on the one hand, to maintain a constant traction force during exercise, the center of gravity moving during walking, and on the other hand, adapting said traction force to the user and / or the therapeutic indication.

Said prevention means may comprise straps and / or bars in order to prevent any lateral and / or frontal and / or rear falls.

Removable marks may be provided on the surface of the treadmill to give an indication of where to put the foot during walking thus prompting the user to achieve a certain length of step.

According to a first advantage, the device according to the invention is much less bulky than the devices of the prior art, so it can be installed and used in the patient's home.
Indeed, the height of the device does not exceed the height of the horizontal plane passing through the lower end of the sternum, so there is no structure of the device above the shoulders of the user which reduces its overall size.
Moreover, with a harness, the installation constraints are less important than with a harness wrapping around the pelvis, the abdomen and a part of the thorax.

According to a second advantage, it is easy for the patient to use with a third health professional and later, depending on the evolution, by the patient alone or with a member of the family.

According to a third advantage, its cost is much lower than that of existing devices.

According to a fourth advantage, the device according to the invention may be foldable and / or removable.

• La figure 1 représente un mode de réalisation du dispositif selon l'invention ;
• La figure 2 représente un deuxième mode de réalisation du dispositif selon l'invention ;
• La figure 3 est une représentation d'une vue en coupe selon le plan A du dispositif de la figure 1 ;
• La figure 4 représente un troisième mode de réalisation du dispositif selon l'invention ;
• La figure 5 est une représentation du dispositif de la figure 4 en fonctionnement.

Embodiments of the invention will be described below, by way of non-limiting examples, with reference to the accompanying drawings in which:

• The figure 1 represents an embodiment of the device according to the invention;
• The figure 2 represents a second embodiment of the device according to the invention;
• The figure 3 is a representation of a sectional view along the plane A of the device of the figure 1 ;
• The figure 4 represents a third embodiment of the device according to the invention;
• The figure 5 is a representation of the device of the figure 4 Operating.

In the example of the figure 1 , the device comprises two lateral uprights 1 of parallelepipedic section located on either side of a conveyor belt 2 possibly connected to each other by a horizontal part 3 passing under the conveyor belt, this part 3 being able to lengthen or retract in order to of allow adjustment of the spacing of the two uprights closer to the trunk of the user.

In addition, these amounts 1 each comprise a bend 4 so as to bring their ends together and thus adjust the adjustment of the spacing between said uprights.
It should be noted that each of the uprights may comprise at least two moving parts in vertical translation with respect to each other, one vertical 5 and the other bent 6, and comprising fixing means relative to different levels. to account for the height of the user so that the upper end of the uprights is at the level of the umbilicus.

Inside each of the uprights are a strap 7, one end of which is placed in a reel 8 located at the base of the upright and whose other end terminates at a pulley or bar 9 located at the upper end of the upright, that is to say above the minimum height of positioning of a belt Ba, this end comprises complementary disconnectable connection means 10 of disconnectable connection means 11 located on said harness of which equips the user ( Figure 3 ). This harness Ba also comprises a belt member C, holding straps and / or supporting legs S attached to said belt member C.

Thus, the ends of the straps 1 are slightly above the position of the shoulder belt so as to exert an upward pulling force on the shoulder belt.

It should be noted that an intermediate pulley 13 at the elbow 4 of the amount 1 may be provided.

Furthermore, each winder 8 may also be located at the upper end of the lateral uprights 1.

These reels can be operated and held in position using mechanical means or an electric motor.

Fall prevention means are also attached to the ends of the lateral uprights. They comprise at least two straps 14, anterior, a posterior, one end of each strap being fixed at the upper end of a lateral upright 1 and the other end of each strap being fixed at the level of the upper end of the other side jamb.

These straps 14 are positioned so as to be located at the height of the umbilicus one facing the lumbar region, the other facing the abdomen.
These straps each comprise disconnectable connection means 15 to allow easier installation of the user.

Bars or lateral support bars 16 or anterior 17 worn in front of the user can be provided, these bars or handles being mounted on the lateral uprights and the user can thus grasp them with the hands in order to take support ( Figure 2 ).

The example of figure 4 illustrates another embodiment of the device according to the invention.

In this example, the lateral uprights 18, 18 'are fixed relative to each other.

Each upright comprises two vertical bars 19, 19 ', 20, 20' interconnected at their vertices by a horizontal bar 21, 21 'whose axis is collinear with the axis of travel x of a carpet rolling 22.

Each horizontal bar 21, 21 'comprises two double-curvature bars, anterior respectively 23, 23' and posterior 24, 24 ', vertically oriented, the lower ends of these double-curved bars are fixed on the horizontal bars 21, 21 'by means of a hinge 25 having a "rotational" axis collinear with that of the horizontal bars 21, 21', the upper ends of these double-curved bars 23, 23 ', 24, 24' are also connected by a horizontal bar 26, 26 'by means of a hinge 25' identical to that already described, this bar being at a height greater than the minimum fixing height of the Baudrier Ba.

The double-curved bars 23, 24 of a lateral upright 18 are situated in opposite pairs of double-curved bars 23 ', 24' of the other lateral upright 18 '.

Traction straps 27, 27 'which are fixed on the harness to make it possible to lighten the weight of the user each comprise one of their ends at the level of the base of the lateral uprights which constitute here the base of the treadmill, this end being held in a reel 28, 28 'in order to adjust the traction force provided to support the user's shoulder belt.

Each of the straps 27, 27 'is then passed around each horizontal bar 26, 26' which acts as a pulley for returning the strap 27, 27 'towards the harness, the ends of the traction straps and the harness comprising disconnectable connection means 29 and 11, respectively.

Straps 30, 31 are also provided as prevention means to prevent a fall of the user forward or backward. They comprise two parts 32, 33 connected by means of disconnectable connection means 34.

The anterior straps 30 that is to say located at the height of the umbilicus opposite the abdomen are fixed on the two double curvature bars 23, 23 'located vis-à-vis the front of the horizontal bars 21, 21 '.

The posterior straps 31, that is to say located at the height of the umbilicus facing the lumbar region are fixed on the two double curvature bars 24, 24 'located vis-à-vis the back of the horizontal bars 21, 21 '.

It should be noted that these straps 30, 31 can be replaced by rigid bars and curved arch-shaped fixed at one end to one of the lateral uprights by means of a vertically oriented hinge allowing to move them to the side during installation of the user.

• Chaque partie du dispositif permet d'exercer une action sur le sujet dont le principe est le suivant :
  • Le baudrier Ba est attaché aux sangles 27 de chaque coté du sujet, au niveau d'un point A situé au-dessus du grand trochanter, à peu près au niveau de la crête iliaque.

The operation of the device represented on the figures 1 or 5 is the next :

• Each part of the device makes it possible to exert an action on the subject whose principle is as follows:
  • The shoulder belt Ba is attached to the straps 27 on each side of the subject, at a point A above the greater trochanter, approximately at the level of the iliac crest.

Each strap 7, 27, 27 'is then directed to a point B defined by a precise position in the extracorporeal space, it is located laterally a few centimeters from the abdomen, in a frontal plane and at a height slightly above above the umbilicus.

On a subject standing in an anatomical position, the point B towards which the strap is moving is between the elbow and the trunk.

Materially, the point B is included in the bar or the pulley 9, 26, the strap 7, 27, 27 'is supported to change direction join a retractor 8, 28 located at the base of the lateral upright 1, 18, 18 '.

This retractor comprises a spiral spring and means for more or less banding said spiral spring (not shown in the figures) in order to to exert a pulling force on the straps (7, 27, 27 '), depending on the mass of the user and / or the therapeutic indication.

This traction force can also be kept constant during exercise.

Said means for more or less banding said spiral spring may be manual or electric such as an electric motor.

This device for pulling the strap can be located anywhere in the device from the moment it allows to exert, at point A, an ascending traction force in the frontal plane to lift the basin.
The pelvis is lifted bilaterally which allows the device to support a part of the body mass of the subject.
The other specific feature of the device is to ensure the retention of the subject in case of a fall. The wearing of the harness and the ascending traction of the pelvis allows to retain a fall but only partially, in fact the body can still tilt forwards or backwards around an axis connecting the two points A.

The straps 14, 30, 31 prevent a complete tilting by holding the body forward and back. Indeed, they join the two points B passing in front and behind the subject at the height of the umbilicus.

The invention is not limited to the examples described above.

Indeed, the horizontal bars 21, 21 'may have a shape allowing the user in his wheelchair to bear to lift and settle in the device according to the invention. It may be a C-shaped extension.

Claims (16)

1. Device for re-educating motory deficiencies in a user in an upright position, this device comprising:

   • re-education means such as a treadmill, a walking simulator or a ski simulator,

   • at least two lateral uprights arranged one on each side of the re-education means,

   • a harness (Ba) intended to be worn by the user and disconnectable means of connection to means for taking some of the weight of the user (7, 27, 27'),

   • means (14, 16, 17, 21, 21', 30, 31) for preventing the user from falling,

   characterized in that:

   • the disconnectable means of connection are connected to the harness in such a way as to be situated, in use, below the centre of gravity of the user,

   • and in that the means (7, 27, 27') of taking some of the weight of the user are able to maintain a constant tensile force during exercise.
2. Device according to Claim 1, in which:

   • the means (7, 27, 27') for taking some of the weight of the user comprise straps connected at one end to winders able to adjust the tensile force supplied in use in order to support the user's harness and, at another end, to additional disconnectable means of connecting the disconnectable means of connection to the harness,

   • the lateral uprights each comprise at least one turn-back point (9, 26-26', B) at which a strap between the winder and the disconnectable means of connection to the harness is turned back, the turn-back points being situated, in use, above the disconnectable means of connection to the harness so as to be able to exert an upward tensile force on the holding means.
3. Device according to Claim 1, in which the harness (Ba) comprises a belt element (C), straps (S) for holding and supporting the legs, which are attached to the said belt element (C), and means (10, 29) of connection to the means of taking some of the weight, these means being disconnectable and fixed at the level of the belt element (C).
4. Device according to Claim 3, in which the said belt element (C) is situated below the centre of gravity of the user, in the position of use.
5. Device according to Claim 3, in which the said means (10, 29) of connecting the harness to the means of taking some of the weight are n in number distributed on the belt element (C).
6. Device according to Claim 3, in which the said means (10, 29) of connecting the harness to the means of taking some of the weight are two in number, each one being situated on one side of the belt element (C) in the position of use.
7. Device according to Claim 3, in which the said means of connection of the harness are four in number distributed on the sides of the belt element (C) so that, in the position of use, two of the means are on one side, one at the front and one at the rear of the user, and the other two are on the other side, one at the front and the other at the rear of the user, the vertical projection of the same in a horizontal plane forming a support polygon.
8. Device according to Claim 1, further comprising height-adjustable and/or width-adjustable lateral support bars (16, 17, 21, 21').
9. Device according to Claim 8, in which the said support bars are mobile.
10. Device according to Claim 8, in which the said support bars are mobile forwards and backwards.
11. Device according to Claim 8, in which the said support bars comprise support means allowing the user to raise himself out of his wheelchair and install himself on the re-education device.
12. Device according to Claim 1, comprising means of adjusting the tensile force exerted by the straps (7, 27, 27').
13. Device according to Claim 12, in which the said means of adjusting the tensile force are manual or electric such as an electric motor.
14. Device according to Claim 1, in which the said winder comprises a spiral spring and means of adjusting the tensile force in order to wind up the said spiral spring to a greater or lesser extent.
15. Device according to Claim 1, in which the said fall-prevention means comprise straps and/or bars in order to prevent any falls sideways (14, 16, 21, 21') and/or forwards and/or backwards (17, 30, 31).
16. Device according to Claim 1, in which removable marks on the surface of the treadmill provide an indication as to where to place the foot during walking.

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