RU2659132C1 - Modular orthopedic apparatus - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine. Modular orthopedic device for medical rehabilitation of patients with infantile cerebral palsy contains humeral, lumbar, femoral and ankle modules, connected together by elastic drafts. Each module on both sides has ears, locks for elastic rods. Upper main elastic bands fixed to the shoulder modules are directed towards each other and through the ears on the shoulder modules further crosswise for attachment to the lumbar module. Lower main elastic bands, fixed on the ankles of the ankle modules, are directed towards each other through the ears of the femoral and lumbar modules, further cross-pass from one to the other the lower limb for attachment to the back of the femoral modules. Lower main elastic bands installed on the femoral modules face each other through the lumbar and femoral module lugs, then cross over from one to the other lower limb to fix the ankle modules on the heels. Individual elastic traction, fixed on the femoral module, is guided and fixed on the lumbar module. Modules are placed on the patient's body in the following way: the humeral – on the upper third of the shoulder, the lumbar – on the lower back, the femoral – on the lower third of the thigh, the ankle – on the foot. All modules are made, for example, from thermoplastic on a 3D printer according to individual patient sizes: for shoulder – girth and height of the upper third of the shoulder, for lumbar – girth and waist height, for the femoral – girth and height of the lower third of the thigh, for the ankles – the height of the lower third of the shin and the size of the foot. Modules humeral, lumbar, femoral have a perforated surface, the ankle is made in the form of a boot with a perforated surface.

EFFECT: invention provides an opportunity to take into account the individual characteristics of patients, the possibility of prolonged use of the device for a day or more, the possibility to carry out hygienic measures, as well as the possibility of periodic correction of the module of the device to improve the functional capabilities of patients and shorten the period of rehabilitation, and improve the quality of life of the patient.

4 cl, 7 dwg

Description

The invention relates to medicine and can be used for the treatment and medical rehabilitation of patients with cerebral palsy (cerebral palsy) and the consequences of damage to the central nervous system (CNS).

Currently, for the medical rehabilitation of patients with cerebral palsy and the consequences of central nervous system damage, there are, for example, suits in the form of overalls, which can be pneumatic. However, they have several disadvantages. Pneumatic rehabilitation overalls are expensive devices that are used in their entirety, acting on all segments of the body, while limiting the functionality of unaffected limbs or segments of the body, and also adversely affect the functioning of the respiratory, cardiovascular systems due to compression of the chest , disrupting her excursion, and abdomen, increasing intra-abdominal pressure. Overalls can be used for a certain short time.

There is a direction of developed devices for the treatment of patients with cerebral palsy and patients with the consequences of central nervous system injuries using supporting staging bandages in the form of separate modules interconnected, devices to facilitate walking, to facilitate movement, and to train the body.

A device is known "Overalls for the treatment of patients with cerebral palsy and patients with the consequences of traumatic brain injury." [Patent RU2131232 C1, IPC A61F 5/02, published June 10, 1999, patent holders Andrey Averyanov, Ksenia Semenova, Vitaliy Viktorovich Chugunov, Sergey Borisovich Shvarkov, Application No. 98116903/14 dated September 15, 1998].

The jumpsuit contains supporting staging bandages for the shoulder girdle, chest, and lower extremities, made with specific anthropometric dimensions of the user, fixing longitudinal elements connected to them, forming a flexible frame for the trunk and limbs, as well as corrective and rotational elements - flexible hooks . The surfaces of the bandages and the corrective-rotational elements are made with the possibility of their mutual fixation, and the latter have an elongation of 5-50%. Bandages for the lower extremities are the patella, the band for the forefoot, and the ankle band. The suit may include a collar-shaped head holder. Corrective-rotation elements can be multilayer, detachable, of various geometric shapes, with perforation. For the interlocking of individual elements, the jumpsuit may contain a device in the form of a surface capable of connecting to one side of the Velcro fastener, buttons, loops, buttons, hooks. Pelots, flexible chokes, corrective-rotational elements can be made of Tricor fabric. The foot brace can be detachable or one-piece.

The technical result of the invention is to ensure the correct physiological position of the patient’s body in space, reduce pathological reflexes and normalize the patient’s movements.

The disadvantages of the overalls considered are the following. Shoulder braces do not eliminate the pathological installation of the shoulders and trunk (rotary adductors, kyphotic or lordotic posture, characteristic of patients with this pathology). Corrective-rotational elements are located longitudinally to the body. There is no anatomical congruence of bandages. The device cannot be installed for a long time, and it is also impossible to use an individual approach when correcting pathological settings of body segments.

Known "Device for training the body" [US patent 5716307, IPC A63B 21/02, publ. 02/10/1998, the inventor and patent owner of Vadher Diesh L., application No. 676471 of 08/08/1996].

The device includes modules of the shoulder, knee and ankle, which have fixation zones with the ability to control by changing the tension of the elastic rods. The knee module is fixed directly in the area of the knee joint. The ankle module allows you to perform correction of the pathological installation of the foot, made of soft material, which is customized when secured with a lacing. The elastic traction connecting the modules are parallel to the axes of the limbs and trunk.

The disadvantages are as follows. Elastic traction is located along the body, parallel to the axes of the limbs and trunk, which does not completely eliminate the pathological settings of the trunk segments characterized by torsion. It is not possible to install the device for a long time on the body. There is no anatomical congruence of modules made of material that is fitted with lacing, due to which improper fastening, for example, to tighten or not to tighten, is possible. The location of the knee modules directly in the area of the knee joints limits the movement in them, and these are the most functionally significant joints in terms of taking a step. The use of soft material for the modules, which does not make it possible to completely eliminate the pathological installation of the trunk segment. There is no way to correct pathological settings of the body segments, taking into account individual characteristics.

Known "Device to facilitate walking, containing a rotary joint device, a device for transportation, a manipulator" [US Application US No.201026262969 A1 of September 15, 2016. IPC A61H 3/00. Published March 9, 2016. Applicant "JTEKTCorporation", Osaka-shi (Jp), national application No. 15/065481 of 03/09/2016].

The device has a module in the form of a mechanical drive to facilitate walking, mounted on the hip of a person with a wide belt, which is supported and regulated by rods thrown across the shoulder, on the thigh, on the lower leg, so that the foot rests on a rigid element of the mechanism. The device is intended for use by installing it on a patient’s clothing.

Disadvantages are: a complex bulky device that does not correct the pathological installation of the trunk and upper limbs, the restriction of use in time, you need to periodically remove it, including for hygiene procedures, for the treatment of cerebral palsy is not applicable. There is no anatomical congruence of the modules. The device is difficult to manage and regulate. The device cannot be installed for a long time.

The well-known "Portable human exoskeleton system" [US Application US No. 2016/0158087 IPC (2006.01) A61H 3/00, A61F 2/60, A61H 1/02, publication date June 9, 2016, applicant iMobility Inc (TW), authors Chen- MingHuang (TW), Yen-ChienMao (TW), application filing date 09.02.2016, application 15/018446, international application No.PCT / CN2014 / 084000 from 08.08.2014, priority dated 08/10/2013 No. 61/864529].

Portable human exoskeleton system including the pelvic module, foot module, foot module. The modules are interconnected by a rigid metal hinge device with a drive located along the leg from the support in the form of a back, fixed on the waist with straps, and to the foot. The portable modular exoskeleton system of a person is fixed on clothes, refers to devices that help patients or people with disabilities to move while walking.

The disadvantages of the system are: a complex device made of component parts - modules. Devices included in the system do not allow eliminating pathological settings; there is no anatomical congruence. The device cannot be installed for a long time. There is no possibility of individual correction of pathological settings of body segments.

The well-known "Mobility Aid Apparatus" [US Application US No. 2016/0235616 IPC (2006.01) A61H 3/00, A61H 1/02, published on 08/18/2016. Applicant Re Walk Robotics Ltd. (US), authors AmitGoffer (IL), OrenTamari (IL), application number No. 15/136844 of 22.04. 2016, priority from 21.10. 2010 No. 12/909746].

The apparatus for facilitating movement includes several modules mounted on the body of the user, on the body, above the pelvis, on the legs, which are interconnected by strips (elastic rods) or belts. The device includes one tilt sensor mounted on an exoskeleton of an exoskeleton tilt sensing device and a controller for receiving received signals from the tilt angle sensor, which are further programmed using an algorithm with instructions for actuating motorized joints in accordance with the received signals. The apparatus for facilitating movement is fixed on clothes, refers to devices that help patients or people with disabilities to move.

The disadvantages of the apparatus are as follows. The device is complex, bulky, expensive. A complex application algorithm, since the tilt sensor is installed, the device works according to the installed program. The lack of selective effect on individual pathological settings of the body segments. There is no anatomical congruence of the modules. A limitation in the duration of use and for additional correction of other pathological settings.

Known "Device to facilitate standing and / or movement of a person" [US Patent US 6783555 August 31, 2004 IPC A61F 2/74, A61F 5/00, A61H 3/00. Authors, applicants, patent holders MarkR. Kuhn (US), JoshuaA. Gillfland (US). Application No. 09/999345 dated November 26, 2001, published US 2002/0082711 A1 on June 27, 2002. Continuation of the previously filed application No. 60/243968 of 10.27.2000].

A device for facilitating the standing and / or movement of a person comprises a rear support unit (module) placed around the body of the user, to which modules for connecting to the legs of a person made of metal are attached. The leg support assembly is adapted to connect to a user's legs or to replace a user's missing leg in order to provide stable support to the user when the user is in an upright position. The device is fixed on clothes, refers to devices that help patients or people with disabilities to move while walking.

The disadvantages of the device to facilitate standing and / or movement of a person. Technically sophisticated device. When using the device is not achieved anatomical congruence between the elements of the device and the patient’s body. Does not eliminate the pathological installation of the upper limbs and trunk. There is no possibility of individual correction of pathological settings. Limitation in long-term use. Using the device can cause damage to soft tissues due to the solid structural elements.

The device “Modular orthopedic apparatus” is known [patent RU 2309709 C1 IPC A61F 5/00, patent holder Regional charity fund “Rehabilitation of the child, Center G.N. Romanova ”, authors Romanov Vladimir Nikolaevich, Druyan Mikhail Vladimirovich, application No. 2006102329 from 01/27/2006, publ. November 10, 2007].

A modular orthopedic apparatus contains orthopedic modules, including an orthopedic module based on thigh sleeves, for correction of the lower extremities, as well as devices for attaching modules to the body. As one of the modules, the device contains a rigid orthosis on the lumbar spine, containing flat landing sites in the area of the hip joints, on which hinges are placed that connect this orthosis with tires rigidly fixed to the side of the thigh sleeves. A modular orthopedic apparatus is used to treat patients with the consequences of central nervous system damage and with damage to the musculoskeletal system.

The disadvantages of a modular orthopedic apparatus are. Technically sophisticated device. Rigid construction. No anatomical congruence is created between the device modules and the patient’s body. There is no possibility of individual correction of pathological settings. Restriction on prolonged use and use at the same time for the treatment of other disorders.

All considered analogues have the same disadvantages, which are as follows.

All devices can only be used by installing modules that affect all segments of the body, including unaffected ones.

All analogues can be installed for a limited time.

It is impossible to achieve anatomical congruency in the above analogues, since all modules are installed on clothes, and the methods of fixing them require some experience.

The connection of modules on the patient’s body is performed parallel to the longitudinal axes of the body, upper and lower extremities.

Analogs do not have the possibility of a phased correction of pathological settings of the trunk due to changes in the dynamics of the severity of pathological settings of the segments of the trunk.

Of all the analogues, there is no one in which it would be possible to create a device for the rehabilitation of patients with cerebral palsy and the consequences of central nervous system damage from separate modules, taking into account the individual characteristics of the pathological settings of the body segments.

For all analogues, when using the device elements are fixed on clothes, therefore, monitor and control the condition of the skin, as well as observe hygiene measures, which negatively affects the quality of life of the patient.

All analogues have a complex device, expensive to manufacture.

The closest adopted for the prototype is the "Device for training the body" [US patent 5716307, IPC A63B 21/02, publ. 02/10/1998, the inventor and patent owner of Vadher Diesh L., application No. 676471 of 08/08/1996].

The device includes modules of the shoulder, knee and ankle, which have fixation zones with the ability to control by changing the tension of the elastic rods. The knee module is fixed directly to the knee joint. The ankle module allows you to perform correction of the pathological installation of the foot, made of soft material, which is customized when secured with a lacing. The elastic traction connecting the modules are parallel to the axes of the limbs and trunk.

The disadvantages are as follows. Elastic traction is located along the body, parallel to the axes of the limbs and trunk, which does not completely eliminate the pathological settings of the trunk segments characterized by torsion. It is not possible to install the device for a long time on the body. There is no anatomical congruence of the modules. The modules are made of material that is fitted with lacing, which may result in improper fastening, for example, overtightening or not tightening. The location of the knee models directly in the area of the knee joints limits the movement in them, and these are the most functionally significant joints in terms of taking a step. The use of soft material for the modules, which does not make it possible to completely eliminate the pathological installation of the trunk segment. There is no way to correct pathological settings of the body segments, taking into account individual characteristics.

The technical task of the invention is the creation of a modular orthopedic apparatus that can be used to eliminate pathological settings of the body segments during cerebral palsy and the consequences of central nervous system damage, taking into account individual characteristics, with the possibility of prolonged use for a day or more, the implementation of hygiene measures, as well as the possibility of periodic correction of modules to improve the functional abilities of patients, reducing the rehabilitation time and improving the quality of life ienta, with a simple device, easy to use, cheap to manufacture.

A technical solution of the device is proposed.

The “Modular Orthopedic Apparatus” device consists of several modules. Modules of the shoulder, lumbar, femoral and ankle, are interconnected using elastic traction.

The shoulder, lumbar and femoral modules are cylindrical in shape with a perforated surface, the ankles are made in the shape of a boot and also have a perforated surface. All modules are made of durable material, for example, thermoplastics, which allows you to adjust the pathological settings of the body segments against the background of increased muscle tone in patients with cerebral palsy and the consequences of central nervous system damage.

All modules for attaching and adjusting the tension of elastic traction are equipped, for example, with ears, for pulling the elastic traction and its sliding, and locks, for securing, they are located in an amount of at least two on both sides of each module. Ears and locks are part of the modules and are made of the same material - thermoplastic. The locks have a rectangular shape, through which an elastic rod comes and is fastened with, for example, Velcro, the eye has an oval shape, in addition, the elastic rods have a knot for adjusting the length and tension, for example, buckles.

In the manufacture of modules, the number and location of the ears and locks are determined in advance, which depends on the estimated number of installed modules and elastic rods, as well as the characteristics of the pathological settings of the trunk segments in patients.

The modules are mounted on the patient’s body as follows: the humeral - on the upper third of the shoulder, the lumbar - on the lower back, the femoral - on the lower third of the thigh, the ankle - on the foot in the form of a boot.

All modules are made, for example, of thermoplastic on a 3D printer according to individual patient sizes: for the shoulder - the volume and height of the upper third of the shoulder, for the lumbar - the circumference and height of the waist, for the femoral - the circumference and height of the lower third of the thigh, for the ankle - the height of the lower third lower legs and foot size. The thickness of each module formed from thermoplastic on a 3D printer is not more than 5 mm.

Before installation, the modules prepared according to the individual sizes of the patient are heated in warm water, applied to body parts and give functionally advantageous positions of the body segments for the further development of motor skills, while anatomical congruence between the modules and the patient’s body is achieved.

Modules connected by elastic rods can be used during the day and up to several days and even weeks, while only changing the tension of the elastic rods, then re-manufacture the modules and re-apply to the necessary parts of the body, taking into account changes in orthopedic status. This allows you to form the correct position of body parts for a long time. A patient with installed modules made with perforation can receive physiotherapeutic procedures, exercise therapy classes, water procedures, as well as carry out hygiene measures.

The installed modules are interconnected according to the scheme using elastic rods: the main ones - upper, lower, and individual, allowing you to adjust the pathological settings of the body segments.

The upper main elastic rods, mounted on the shoulder modules, are directed towards each other, then crosswise for fixing on the lumbar module to correct the pathological installation of the trunk in the frontal and sagittal planes.

The main lower elastic rods are used depending on the prevalence of a syndrome, so with Rectus syndrome, elastic rods move from the front of one lower limb towards each other through the ears on the lumbar module, then cross over to the other lower limb through the ears on the femoral modules and fixed in the heel, with Hamstring syndrome, elastic traction runs from the area of the toes of the ankle modules through the ears of the femoral and lumbar modules towards each other, fixed on the back side edrene modules.

It is also possible to connect modules with individual traction depending on the revealed features of the individual pathological settings, for example, with adductor spasm and internal femoral rotation, the individual elastic traction from the femoral module is guided and fixed on the lumbar module, thus forming the course of the individual elastic traction opposite pathological installation of the trunk segment.

The tension force of elastic rods is created subjectively and corrected by the patient's response - the appearance of motor capabilities. As elastic traction, for example, an elastic cord can be used with the possibility of adjusting the force by changing its length and tension.

The proposed technical solution of “Modular orthopedic apparatus” allows to achieve a technical result.

Since the device consists of modules, it can be used on affected segments of the body, for example, only the lower limbs, only the upper limbs or upper and lower limbs, right or left limbs, depending on the clinical manifestation of cerebral palsy or the consequences of central nervous system damage.

The possibility of prolonged use in the process of medical rehabilitation of a patient who can carry the modules for a day or more without removing them, from a few days to 3-4 weeks, then you can re-manufacture and install the modules if correction of pathological settings is necessary. This allows you to effectively form the correct position of body parts for a long time, as well as the possibility of a phased correction of pathological settings of the body, replacing the modules in connection with a change in time with the dynamics of the severity of the pathological settings of the segments of the body.

Creating an individual approach to eliminating pathological settings of the trunk or limbs by combinations in the installation of the necessary modules, as well as due to the possibility of using individual elastic rods.

Creating anatomical congruence of costume elements to the patient’s body.

Convenience and ease of use, since the apparatus of the necessary modules, made, for example, of thermoplastic, with a perforated surface is installed directly on the body.

Easy to manufacture and maintain, as well as low cost.

The technical nature of the claimed invention is illustrated by drawings.

Depending on the combination of the use of modules on different affected areas of the body, examples of layout schemes of modules on the patient’s body are given.

FIG. 1 is a diagram of a general view of the arrangement of device modules on a patient’s body, for example, during kyphotic posture.

FIG. 2 is a diagram of a general view of the arrangement of device modules on a patient’s body, for example, with lordotic posture.

FIG. 3 - Scheme of a general view of the arrangement of device modules on the patient’s body, for example, with Rectus syndrome.

FIG. 4 - Scheme of a general view of the arrangement of device modules on the patient’s body, for example, with Hamstring syndrome.

FIG. 5. - Scheme of a general view of the arrangement of device modules on the patient’s body, for example, with kyphotic posture and with Hamstring syndrome.

FIG. 6 is a diagram of a general view of the arrangement of device modules on a patient’s body, for example, with Hamstring syndrome and adductor syndrome.

FIG. 7 - Scheme of a general view of the location of the modules on the patient’s body, indicating the positions of the component elements

The device "Modular orthopedic apparatus" contains:

1 - shoulder module;

2 - lumbar module;

3 - femoral module;

4 - ankle module;

5 - upper main elastic traction;

6 - lower main elastic traction;

7 - individual elastic traction;

8 - lock for attaching elastic rods;

9 - ears for the passage of elastic rods.

The claimed technical solution "Modular orthopedic apparatus" is as follows.

The shoulder modules 1, lumbar 2, femoral 3 have a cylindrical shape with a perforated surface, the ankle 4 are made in the shape of a boot and also has a perforated surface.

All modules 1, 2, 3, 4 are made, for example, of thermoplastic on a 3D printer according to individual patient sizes: for the shoulder - the volume and height of the upper third of the shoulder, for the lumbar - the circumference and height of the waist, for the femoral - the circumference and height of the lower third of the thigh , for the ankle - the height of the lower third of the leg and the length of the foot. The thickness of each module formed from thermoplastic on a 3D printer is not more than 5 mm.

Modules 1, 2, 3, 4, prepared according to the patient’s size, are heated in warm water and applied to the body, simulated, giving a corrective position to the body segment. When thermoplastics cools down, parts of the body are in a functionally advantageous position for further correction of pathological settings of the body segments and the formation of motor skill, and also have anatomical congruence.

Modules can be worn from several days to 3-4 weeks, then can be re-manufactured and installed if correction of pathological settings is necessary. This allows you to effectively form the correct position of the body segments for a long time, as well as the possibility of a phased correction of the pathological settings of the body segments, replacing the modules in connection with the change in the orthopedic status of patients.

The modules are installed on the patient’s body as follows: shoulder 1 - on the upper third of the shoulder, lumbar 2 - on the lower back, femoral 3 - on the lower third of the thigh, ankle 4 for the foot in the form of a boot.

All modules for mounting, the direction of tension, adjusting the tension of the elastic rods are equipped, for example, with locks for attaching 8 elastic rods, ears 9 for the direction of tension, sliding.

After the hardening of the modules, using the upper main elastic rods 5 connect the modules 1 to each other as follows.

Depending on the need for correction of the segments of the body and taking into account the individual orthopedic status, the modules are arranged and connected with the main elastic rods, while creating a connection between the modules of the same name, which consists in the opposite direction and is fixed with a cross-stroke.

Individual elastic traction 7 is used to correct individual characteristics of the orthopedic status of patients.

The tension force of elastic rods is created subjectively and corrected by the patient's response. As elastic traction, for example, an elastic cord can be used.

The following are examples of device module layouts and the direction of their connection with elastic rods.

FIG. 1 is a diagram of a general view of the arrangement of device modules on a patient’s body, for example, during kyphotic posture.

The upper main elastic rods 5, mounted on the shoulder modules 1 at the back on the back, are directed towards each other, then through the ears 9 on the opposite shoulder modules 1 are directed crosswise for fixing on the lumbar module 2.

The device allows you to keep the body in an upright position while walking and in a sitting position due to the fact that the elastic traction, correct kyphotic posture.

FIG. 2 is a diagram of a general view of the arrangement of device modules on a patient’s body, for example, with lordotic posture.

The upper main elastic rods 5, mounted on the shoulder modules 1 in front, are directed towards each other, then through the ears 9 on the opposite shoulder modules are directed crosswise for fixing on the lumbar module 2.

The device allows you to keep the torso in an upright position while walking and in a sitting position due to the fact that the elastic traction straightens the body, adjusts the lordotic posture.

FIG. 3 - Scheme of a general view of the arrangement of device modules on the patient’s body, for example, with Rectus syndrome.

The lower main elastic rods 6, mounted on the front side of the femoral modules 3 of the lower extremities, are directed towards each other, then through the ears 9 on the lumbar module 2 cross cross from one lower limb to another, then through the ears 9 on the femoral modules for fixing in the heel on ankle modules 4 (heels of boots).

The device contributes to the implementation of the step in patients due to the correction of pathological settings of the lower extremities. Due to the elastic rods, fixed in such a way that their cross travel allows, when bending one limb, to weaken the traction from the other limb to unbend it, it facilitates the efforts for the phases of the push, support and transfer.

FIG. 4 - Scheme of a general view of the arrangement of device modules on the patient’s body, for example, with Hamstring syndrome.

The lower main elastic rods 6, mounted on the front side of the ankle modules 4 of the lower extremities (toes of boots), are directed through the ears of the femur 3 and lumbar 2 modules towards each other, cross over from one lower limb to another and fixed on the back side of the femoral modules 3.

The device contributes to the implementation of the step in patients due to the correction of pathological settings of the lower extremities. Due to the elastic rods, fixed in such a way that their cross-travel allows, when unbending one limb, to weaken the traction from the other limb to bend it, making it easier to carry out the phases of the push, support and transfer.

FIG. 5. - Scheme of a general view of the arrangement of device modules on the patient’s body, for example, with kyphotic posture and with Hamstring syndrome.

The upper main elastic rods 5, mounted on the shoulder modules 1 at the back on the back, are directed towards each other, then through the ears 9 on the opposite shoulder modules 1 are directed crosswise for fixing on the lumbar module 2.

The lower main elastic rods 6, mounted on the front side of the ankle modules 4 of the lower extremities (toes of boots), are directed through the ears of the femur 3 and lumbar 2 modules towards each other, cross over from one lower limb to another and fixed on the back side of the femoral modules 3.

The tension force of elastic rods is created subjectively and corrected by the patient's response. As elastic traction, for example, an elastic cord can be used with the ability to control the force by changing its length in tension and fixation.

On the lower extremities, due to such a course of elastic rods, conditions are created for eliminating the pathological installation of the lower extremities and facilitating the movement of the contralateral lower limb due to the redistribution of traction from one lower limb to another.

FIG. 6 is a diagram of a general view of the arrangement of device modules on a patient’s body, for example, with Hamstring syndrome and adductor syndrome.

The lower main elastic rods 6, mounted on the front side of the ankle modules 4 of the lower extremities (toes of boots), are directed through the ears of the femur 3 and lumbar 2 modules towards each other, cross over from one lower limb to another and fixed on the back side of the femoral modules 3.

The individual elastic traction 7 from the femoral traction 3 is directed and fixed on the lumbar module 2, thus forming the course of the individual elastic traction opposite to the pathological setting of the trunk segment, thereby lowering the limb into the correct position and it is possible to perform a motor act.

The use of individual elastic rods 7 in order to correct pathological settings individually for each patient. To do this, in advance, in the manufacture of modules on a 3 D printer, ears and locks are made for individual elastic rods.

An example of using the “Modular Orthopedic Apparatus” for medical rehabilitation of patients with cerebral palsy and the consequences of injuries of the central nervous system:

A 14-year-old patient was in the rehabilitation department with a diagnosis of:

The consequences of severe traumatic brain injury (brain contusion). Right hemiparesis. Neurogenic contractures of the joints of the upper and lower extremities on the right.

Upon enrolment:

Complaints of dysfunction of the upper and lower extremities on the right, impaired walking and support.

Anamnesis: trauma 4 months ago as a result of a traffic accident, conservative treatment in the neurosurgery departments (drug therapy, massages, physiotherapy, physiotherapy exercises). I entered the rehabilitation department for medical rehabilitation.

Orthopedic status:

The head is in the right shape, in a normal position. The neck muscles are soft, elastic. Movement in the cervical spine is painless, not limited. The physique is normal. Asymmetric posture. Physiological bends of the spine expressed chest kyphosis. The axis of the spinous processes of the vertebrae is deviated from the midline in the supine position, manually straightens. The chest of the usual form, the tour is normal.

The right upper limb in a vicious position: shoulder cast syndrome and its internal rotation. The relative length is the same. The joints of the upper limbs are not deformed. Active movements are limited: abduction and external rotation in the right shoulder joint. Passive movements are not limited. The right lower limb in a vicious position: Spastic equinus installation of the foot (Silversweld test +++). Syndrome, accompanied by an increase in tone in the posteromedial group of femoral muscles (Hamstring syndrome), Hamstring test 90 °. The relative length is the same. Active movements are limited by flexion in the right ankle joint (45 ° -20 ° -0 °), extension in the right knee joint (140 ° -90 ° - 0 °). Ashworth Modified Spasticity Scale 3 points. The motor sphere: needs special devices for sitting with fixation of the pelvis and movement - a stroller. Physical assistance is required for movement. A teenager can keep his weight on his legs while moving upright. Indoors, short distances can be walked with the physical help of another person, using wheeled vehicles or walkers that support the body while walking. The patient is physically capable of driving a motorized wheelchair. There are restrictions on participation in physical activity and sports. The international scale for assessing global motor functions GMFMS Level 4.

A course of medical rehabilitation was carried out in order to restore the functions of the limbs, increase the range of motion in the joints, restore motor skills, and improve the quality of life. The medical rehabilitation program includes the use of the device (modules for the upper and lower extremities), continued exercise therapy, massage and FZT.

At discharge:

Complaints persist, according to the patient, there is a positive trend in the form of an improvement in the functions of the limbs.

Orthopedic status (examination without device):

The head is in the right shape, in a normal position. The neck muscles are soft, elastic. Movement in the cervical spine is painless, not limited. The physique is normal. Asymmetric posture. Physiological bends of the spine expressed chest kyphosis. The axis of the spinous processes of the vertebrae is deviated from the midline in the supine position, manually straightens. The chest of the usual form, the tour is normal.

The upper limbs are in a normal position. The relative length is the same. The joints of the upper limbs are not deformed. Active, passive movements are not limited. The right lower limb in a vicious position: spastic equinus installation of the foot (Silvershold test +). Syndrome, accompanied by an increase in tone in the posteromedial group of femoral muscles (Hamstring syndrome), Hamstring test 160 °. The relative length is the same. Active movements are limited by flexion in the right ankle joint (45 ° -0 ° -0 °), extension in the right knee joint (160 ° -0 ° - 0 °). Ashworth Modified Spasticity Scale 1 point.

The motor sphere: The patient walks in most situations. Environmental factors (uneven surfaces, slopes, long distances, time requirements, weather, peer perception) and personal choice are not affected by the choice of movement. The school can walk using hand-held mobility aids for safety. In open spaces and in public places, it can use wheeled vehicles when traveling long distances. The patient rises and descends the stairs, holding on to the railing or with the physical help of another person, if the railing is absent. Limitations in the performance of large motor functions are noted and adaptation is required to participate in physical activity and sports. International scale for the assessment of global motor functions GMFMS Level 2. The skin in the places of the shoulder, lumbar and femoral and ankle modules are not changed.

Thus, the proposed device “Modular orthopedic apparatus” can be used to eliminate pathological settings of the body segments with an individual approach with the possibility of long-term use while observing hygiene requirements, as well as periodic correction to improve the functional ability of patients, for example, with cerebral palsy and the consequences of central nervous system injuries, reduction at the same time, the modular device is simple, convenient to use, cheap to make tovlenii.

Claims (4)

1. A modular orthopedic apparatus for medical rehabilitation of patients with cerebral palsy, containing the shoulder, lumbar, femoral and ankle modules, interconnected by elastic rods, characterized in that each module on both sides has ears, locks for elastic rods, while the upper the main elastic rods mounted on the shoulder modules are directed towards each other and through the ears on the shoulder modules further cross to fix on the lumbar module, the lower main elastic rods, replicated on the toes of the ankle modules are directed towards each other through the ears of the femoral and lumbar modules, then cross cross from one lower limb to one another on the back of the femoral modules, and the lower main elastic rods installed on the femoral modules are directed towards each other through the ears of the lumbar and femoral modules, then cross over from one lower limb to another on the heels of the ankle modules, individual elastic traction, fixed The thigh module is guided and fixed on the lumbar module, while the modules are mounted on the patient’s body as follows: shoulder - on the upper third of the shoulder, lumbar - on the lower back, femoral - on the lower third of the thigh, ankle - on the foot, all modules are made, for example , from thermoplastic on a 3D printer according to individual patient sizes: for the shoulder - girth and height of the upper third of the shoulder, for the lumbar - girth and height of the waist, for the thighs - the girth and height of the lower third of the thigh, for the ankles - the height of the lower third of the lower leg and foot size, shoulder, lumbar, femoral modules have a perforated surface, the ankle is made in the form of a boot with a perforated surface. 2. A modular orthopedic apparatus according to claim 1, characterized in that the thickness of each module formed from thermoplastic on a 3D printer is not more than 5 mm. 3. The modular orthopedic apparatus according to claim 1, characterized in that, for example, elastic cords can be used as elastic rods. 4. The modular orthopedic apparatus according to claim 1, characterized in that each module has at least two ears for elastic rods and at least two locks on both sides.

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