WO2014136852A1 - Electrical stimulation device - Google Patents

Abstract

The present invention involves synchronizing the timing of exercise of the site of a lesion of a patient (joints, etc.) and healthy sites (joints, etc.) and applying electrical stimulation to the site of the lesion such that training wherein the image of exercising in the brain is integrated into actual exercise motions can be conducted, the synergistic effect thereof allowing for dramatic functional improvements to be achieved. This electrical stimulation device comprises: an exercise detection sensor which detects the exercise state of a site on the healthy side of a patient that is in a symmetric relationship with a site on the lesion side; electrodes which provide electrical stimulation to the site on the lesion side; and a controller which outputs an electrical stimulation signal to the electrodes on the basis of the signal from the exercise detection sensor. Electrical stimulation is provided to the site of the lesion on the basis of the output signal of the exercise detection sensor.

Description

Electrical stimulator

In the fields of sports, medical care, and welfare, the present invention provides pain relief and muscle strength enhancement for target sites in which movement of the upper limbs and lower limbs is difficult due to pain, paralysis due to central and peripheral nerve disorders, muscle atrophy due to fixation or immobilization In addition, the present invention relates to an electrical stimulation apparatus capable of performing training such as joint range of motion expansion and neuromuscular retraining.

Generally, electrical stimulation is a rehabilitation technique used for analgesia, functional regeneration, and muscle strength enhancement. Examples of conventional specific technology relating to electrical stimulation are as shown in Patent Documents 1 to 3.

In the technique of Patent Document 1, an electrical stimulation signal is applied to the arm or leg, which is an obstacle site of a disabled person, via a surface electrode to stimulate a plurality of muscles, and a comb-shaped electrical signal corresponding to the tension generated at that time is converted into an electrical signal. After converting by the converter and correcting the delay by the low-pass filter, the joint torque is estimated by the joint torque estimation circuit, the joint angular acceleration is obtained by the equation of motion, and the trajectory corresponding to the electrical stimulation signal is generated via the integration circuit. Yes. Then, based on the generated model data, an electrical stimulus is applied to the damaged part. That is, the technique of Patent Document 1 creates a model suitable for an individual by applying electrical stimulation to the subject's musculoskeletal system and measuring the motion at that time, and based on the model, electrical stimulation is performed. Like to give.

The technique shown in Patent Document 2 is related to the technique previously filed by the present applicant. Many conventional mechanical load type or electrical stimulation type muscle strength enhancers are based on an open movement chain that works only the main muscle, and only one muscle can be trained in one movement. It was developed in view of the above. A muscle strength enhancer having means for contracting the main muscle or antagonist muscle by applying electrical stimulation when the main muscle is contracting and the antagonist muscle is stretching By providing it, the main and antagonist muscles can be trained at the same time.

The technique shown in Patent Document 3 is also related to the technique previously filed by the present applicant. In the technique of Patent Document 3, when performing an exercise such as maintaining or strengthening muscular strength by applying electrical stimulation to a muscle, a virtual image linked to the exercise is displayed on a display surface, and a person who receives the electrical stimulation receives the virtual stimulation. It is possible to exercise while observing the movement of the image. In exercise using a muscle strength enhancer, by providing playability, the consciousness of actively exercising is improved, and the exercise can be enjoyed.

Japanese Patent Laid-Open No. 11-76430 Japanese Patent No. 3026007 Japanese Patent No. 4840926

In the conventional electrical stimulation device technologies described in Patent Documents 1 to 3, a command of a signal for applying electrical stimulation is passively performed regardless of the intention of the person. Electrical stimulation is local. For this reason, the effect on the central nervous system is poor, and the effect of cooperation with intracerebral nerve activity could not be expected. Therefore, there was a problem that the effect of improving the function of the damaged part by rehabilitation training was low. In addition, unlike the technique of Patent Document 1, the electrical stimulation created based on the generated model data has a drawback that it imposes a mental and physical burden on the patient, unlike the muscle contraction pattern that actually moves the joint. there were.

Recently, a method of actively performing electrical stimulation using myoelectricity on the damaged side has been proposed. However, in order to implement this method, muscle strength is required to detect myoelectricity. However, there are drawbacks in that it is difficult to apply when the site of failure is insufficient or when the muscle on the disabled side cannot be moved properly by the patient's will. In addition, in order to learn, in addition to the improvement of muscular strength, it was also necessary to learn how to use the equipment.

Furthermore, the conventional electrical stimulation is intended for mild or moderate hemiplegia with some voluntary persistence, and there is no muscle strength to detect myoelectricity in the improvement of severe hemiplegia with poor volatility, There was a problem that it could not be implemented because it was difficult to move only the target muscle.

The present invention is an improvement and removal in view of the conventional problems described above, and detects the motion status of a healthy part (joint or the like) that is symmetrical to the patient's own disordered part (joint or the like). Electrical stimulation that can realize dramatic function improvement by synergistic effect by performing exercise that integrates the movement image in the brain and the actual movement movement by performing electric stimulation of the damaged part based on the detection signal The device is intended to be provided.

The means of claim 1 adopted by the present invention to solve the above-mentioned problems is a motion detection sensor for detecting a motion state of a healthy side part that is symmetrical to the disordered part of the patient, An electrical stimulation apparatus comprising an electrode for applying a stimulus and a controller for outputting an electrical stimulation signal to the electrode based on a signal from the motion detection sensor.

According to the present invention, it is possible to adjust the timing of the electrical stimulation for the damaged side part by attaching the motion sensor for detecting the movement to the healthy part of itself. As a result, the electrical stimulation at the timing synchronized with the movement of the healthy part can be controlled by the person's own intention to the part that is difficult to move by his / her own intention due to the obstacle. Therefore, it is possible to train both peripheral (muscle) and central (body image) at the same time by integrating the movement image (willingness to move) in the brain and the actual movement (movement of muscle and joint, somatosensory). .

According to a second aspect of the present invention employed in order to solve the above-mentioned problem, the controller outputs a signal for applying electrical stimulation to the electrode by the motion start signal of the motion detection sensor, and the motion end signal of the motion detection sensor. An electrical stimulation end signal is output to the electrode.
The stimulation timing is started at the same time as the start of the movement of the healthy part, the stimulation is continued while the movement is continued, and the stimulation is also ended at the end of the movement. Thereby, it is possible to match the timing of exercise and stimulation between the site on the disabled side and the site on the healthy side that is symmetrical with this, and a synergistic effect is obtained in the training.

The means of claim 3 adopted by the present invention in order to solve the above-mentioned problem is that a motion detection sensor for detecting a motion state of a healthy side portion that is symmetrically related to a disordered side portion of a patient, and a myoelectricity of the healthy side portion. An electrical stimulation device is composed of a myoelectric sensor to detect, an electrode for applying electrical stimulation to a site on the obstacle side, and a controller that outputs an electrical stimulation signal to the electrode based on signals from the motion detection sensor and the myoelectric sensor is doing.
In the third aspect of the invention, in addition to the function of adjusting the timing of the electrical stimulation obtained in the first aspect of the invention, a function of making the magnitude of the electrical stimulation appropriate is added. As a result, it is possible to provide an electrical stimulation signal having a magnitude corresponding to the degree of training of the patient, and does not place an unreasonable burden on the patient.

The means of claim 4 adopted by the present invention in order to solve the above-mentioned problems is to realize the electrical stimulation timing adjustment and the optimization of the size of the electrical stimulation of the invention of claim 3. In this invention of claim 4, the controller outputs a signal for applying electrical stimulation to the electrode by the motion start signal of the motion detection sensor, and outputs an electrical stimulation end signal to the electrode by the motion end signal of the motion detection sensor. At the same time, the magnitude of the electrical stimulation applied to the electrodes is changed according to the output signal of the myoelectric sensor.

In the present invention, electrical stimulation is performed on the disabled side (paralysis side) in accordance with the exercise on the healthy side, and active neuromuscular electrical stimulation is possible at the timing of the trainee's intention. Therefore, a synergistic effect can be obtained by combining neuromuscular electrical stimulation with exercise re-education training tailored to his own healthy joint movement, so-called bilateral exercise.

Also, in contrast to the movement of moving the disabled side in a passive manner, paralysis due to CNS disorders induces pathological reflexes, resulting in muscle contraction that differs from the physiological muscle contraction pattern, resulting in a rehabilitation effect. Because of this, general rehabilitation requires techniques that do not induce pathological reflexes. Movements that match their own intention and timing are characterized by the fact that this pathological reflex is less likely to be induced. In addition, when local pain or abnormal sensation due to peripheral neuropathy or inflammation is observed, by other people touching the local area, due to a defensive response to noxious stimuli (defense reflex, pain induction, unpleasant psychological reaction, etc.) The patient's own intention, which is similar to a pathological reflex, will be different. According to the present invention, by synchronizing with the timing of one's own intention, joint motion with reduced induction of pathological reflex is possible, and the exercise retraining training effect can be enhanced. In addition, since the joint movement can be performed without the other person touching the obstacle site, the induction of the defense reflex can also be avoided, so that the exercise re-education without physical or mental stress of the person can be achieved.

In addition to this, even if it cannot be moved well due to the pain on the paralyzed side, it can be moved in accordance with the movement on the healthy side, so there is also an advantage that the paralyzed side can be moved easily without pain. Furthermore, it is possible to use a complex motion involving a plurality of joint movements and a variety of motions in which a plurality of motions are combined.

On the other hand, the entire structure of the electrical stimulation device is only a motion detection sensor, an electrode and a controller, and is lightweight, small and compact, so it is easy to carry and can be used easily in various parts. For example, it can be used not only in a training room but also on a bed or at home. In addition, for example, even in the case of nerve hypersensitivity, the person can move without touching the skin surface.

Furthermore, neuromuscular electrical stimulation can be performed in accordance with the timing of the desired purposeful two-handed work operation, and there is diversity in practice. In addition, it can be used for paralysis without any muscle strength, and has the advantage of a wide range of subjects. In addition, even complex movements of shoulder joints and fingers can be stimulated according to complex movements on the healthy side while finely selecting the stimulation site.

It is a top view which shows the whole structure of the electrical stimulation apparatus which concerns on one embodiment of this invention. It is drawing which shows the state which mounted | wore the patient's left arm with the motion detection sensor of the electrical stimulation apparatus which concerns on one embodiment of this invention. It is drawing which shows the state which mounted | wore the both arms with the electrical stimulator which concerns on one embodiment of this invention. It is drawing which shows the state which mounted | wore the both shoulders with the electric stimulator which concerns on one embodiment of this invention. It is a flowchart figure which shows the process of the electrical stimulation apparatus which concerns on one embodiment of this invention. It is a flowchart figure which shows the process process at the time of using together the electrical stimulation apparatus which concerns on one embodiment of this invention with mirror therapy.

Hereinafter, the configuration of the present invention will be described based on one embodiment shown in FIGS. 1 and 2 as follows. As shown in FIG. 1, the electrical stimulation device 1 includes a controller 2, two electrodes 3 and 3 attached to the main muscle side and the antagonistic muscle side, and a motion detection sensor 4.

The electrode 3 is configured by coating a thin sheet-like material such as a plastic film or a nonwoven fabric with a composite of silver and carbon, and further providing a conductive gel layer thereon. The gel layer is in contact with the patient's skin and has a function of transmitting the electrical stimulation output from the controller 2 to the damaged part of the human body. Since the base material is a thin sheet-like material such as a plastic film or a non-woven fabric, the electrode 3 is excellent in flexibility and easily adapted to a human or animal body shape (body surface shape). Moreover, it is easy to follow the movement of the muscles during use, and is excellent in stability.

The conductive material silver alone has the problem of aging and impedance rise, but by making it a composite material of silver and carbon, it is possible to maintain stable performance by suppressing aging and realizing low impedance. Yes. Moreover, it is possible to remove skin keratin adhering to the surface by rinsing the surface with a small amount of water even after peeling from the skin after use, and it is possible to suppress an increase in impedance due to continuous use. .

The motion detection sensor 4 includes a winding drum 5 installed on the fixed side of the limb and an adapter 7 installed on the movable side of the limb attached to the tip of the wire 6 led out from the winding goram 5. have. The winding drum 5 and the adapter 7 are fixed to a mat 8 having a surface fastener function.

Next, regarding exercise therapy by electrical stimulation using the electrical stimulation device 1 according to the present embodiment, with reference to FIG. 2 and FIG. 3, the right elbow joint is the disordered part and the left elbow joint is on the healthy side Based on First, the motion detection sensor 4 is attached to the left elbow joint part on the healthy side of the patient. The motion detection sensor 4 is mounted by applying the winding drum 5 to the upper arm and the adapter 7 to the forearm. Specifically, a supporter 9 having a hook-and-loop fastener function is wound around the upper arm of the patient's left arm, and a mat 8 having a hook-and-loop function of the winding drum 5 is attached to the supporter 9 and fixed. Similarly, in the case of the adapter 7, the supporter 9 having a hook-and-loop function is wound around the forearm portion of the left arm, and the mater 8 having the hook-and-loop function of the adapter 7 is attached and fixed to the supporter 9.

After that, a gel layer is attached to the skin surface of these two parts 3 and 3 to correspond to the main arm and antagonist muscles of the upper arm, which are the working muscles of the right elbow joint part, which is the obstacle side. To do. The gel layer is sticky and does not fall off, but it is accompanied by movement, so the supporter 9 may be wound from above (the supporter 9 is not shown in FIG. 3).

In the exercise therapy, the controller 2 is turned on, the forearm of the left and right arms are simultaneously synchronized, and the elbow joint flexing and stretching exercises with the joint as a fulcrum is raised. The right arm does not move smoothly because it involves obstacles. Therefore, the motion detection sensor 4 detects the motion state of the left arm that operates smoothly. As the forearm of the left arm moves, the wire 6 attached to the adapter 7 is pulled out from the winding drum 5. The winding drum 5 outputs an electrical signal to the controller 2 in accordance with the directionality of movement of the wire 6 (in the extending direction or the contracting direction) and the amount of movement thereof. The output electrical signal can be, for example, an open collector system or a voltage system. In the open collector method, when the amount of movement of the wire exceeds a certain value, the transistor is switched from the OFF state to the ON state, and output to the controller 2 so as to apply electrical stimulation. That is, an ON / OFF switching signal is output. On the other hand, in the voltage method, the output voltage is changed according to the movement amount of the wire 6 and output to the controller 2.

The controller 2 outputs an electrical stimulation signal to one of the electrodes 3 and 3 based on the electrical signal from the motion detection sensor 4 according to the moving direction and the moving amount of the wire 6. By this electrical stimulation signal, the right arm is given electrical stimulation with the same momentum as the left arm, and is assisted by electrical stimulation so that its main muscles move in the same manner. Since this electrical stimulation is based on the patient's intention and is performed at the will timing to perform his / her own exercise, as shown in FIG. 5, the image of movement in the brain (intention to move) and the actual arm It integrates movements (muscle and joint movement, somatosensory) and can train both peripheral (muscle) and central (body image) simultaneously. It is well known that when both the peripheral and the central are trained at the same time, the effect is dramatically improved.

FIG. 4 is a drawing showing the positional relationship between the motion detection sensor 4 and the electrode 3 when the right shoulder joint is an obstacle site and the left shoulder joint is a healthy site. In this case, exercise training for raising the shoulder joint outside is performed. The basic operation mode is the same as that of the elbow joint, and a detailed description thereof is omitted here. Thus, it can be used not only for single-axis joints but also for multi-axis joints.

FIG. 6 shows a flowchart when the exercise therapy by electrical stimulation of the present invention and the conventionally known mirror therapy are used in combination. In mirror therapy, the motion on the healthy side is reflected in a mirror to make an illusion, and the voluntary movement that has been impaired by this illusion visual information (visual feedback) is corrected and re-educated. According to this, it is possible to perform integrated training of somatic sensation by electrical stimulation, motor image, and visual image by mirror therapy, and a synergistic effect thereof can be obtained.

Also, an electromyographic sensor 10 that measures the potential generated when operating the muscle on the healthy side can be added to the electrical stimulation device 1 shown in FIG. 1 (see FIG. 3 for the state of use). In this case, in addition to detecting the amount of exercise on the healthy side and the timing of the exercise, the potential generated in the main muscle or antagonist muscle on the healthy side at that time is detected by the myoelectric sensor 10, and the electric potential of the same potential is detected. Exercise training can be performed by applying stimulation to the main or antagonist muscles on the impaired side through the electrodes 3 and 3.

Hereinafter, although an example is given and explained, the present invention is not limited to these examples.

[Example 1: Trauma (upper limb)]
The patient is a 49 year old male. The patient has been diagnosed with a left thumb distal phalange fracture, left proximal phalanx release fracture, extensor tendon rupture, and left middle finger / ring finger middle phalanx fracture. Training for this patient was performed by applying electrical stimulation to the forearm, opening and closing the fingers and bending and extending the wrist joint 10 times, 10 sets for about 15 minutes. This training was performed a total of 8 times from the 6th week to the 8th week after the operation. Table 1 shows the effect of the training of Example 1.

Here, the numerical value of pain in Table 1 is a value when “0” is assumed as no damage and “100” is the greatest damage experienced so far. The normal range of motion of each joint in Table 1 is 0 ° to 100 °. The score of the simple upper limb function test is a value when “100” is a perfect score.

As shown in Table 1, in the patient after training, the pain decreases from 42 to 13, the finger joint flexion range of motion extends from 0 ° to 60 ° to 0 ° to 70 °, and the middle finger joint flexion range of motion is 0 °. From 50 ° to 0 ° to 80 °, the simple upper limb function test increased from 62 points to 70 points. Thus, the improvement was seen in all the items of Table 1. The improvement of the finger joint flexion range of motion is 10 °, and the improvement of the middle finger joint flexion range of motion is 30 °, both of which seem to be small. large.

[Example 2: Trauma (lower limb)]

The patient is a 23 year old female. The patient has been diagnosed with a right ankle open fracture and complex regional pain syndrome. The training for this patient was performed for 10 minutes with 10 sets of ankle flexion and extension for about 15 minutes by electrically stimulating the lower leg.
This training was performed a total of 24 times from the 12th week to the 16th week after the operation. Table 2 shows the effect of the training of Example 2.

Here, the numerical value of the pain in Table 2 is a value when “0” is assumed as no damage and “100” is the greatest damage experienced so far. The pain region in Table 2 is a value when “0” indicates no region and “100” indicates the entire region. Further, the normal value of the ankle dorsiflexion movable range in Table 2 is 0 ° to 20 °.

As shown in Table 2, in the patient after training, the pain decreases from 70 to 50, the pain area decreases from 100 to 30, the skin color returns from dark purple to normal, and the ankle dorsiflexion range of motion is 0. From 5 ° to 5 °, the normal value returned to 0 ° to 20 °, and the moving means changed from a wheelchair to a T-cane. Thus, the improvement was seen in all the items of Table 2.

[Example 3: Chronic pain (upper limb)]

The patient is a 50 year old woman. This patient has been diagnosed with right shoulder syndrome (complex regional pain syndrome). This patient was trained for 10 minutes with 10 sets of shoulder abduction, shoulder abduction, and wrist flexion for about 15 minutes by applying electrical stimulation to the forearm. This training was performed a total of 24 times from the 16th week to the 23rd week after the operation. Table 3 shows the effect of the training of Example 3.

Here, the numerical value of the pain in Table 3 is a value when “0” is regarded as no scratch and the greatest pain experienced so far is “100”. Further, the normal value of the shoulder joint abduction range of motion in Table 3 is 0 ° to 180 °. The score of the simple upper limb function test in Table 3 is a value when “100” is a perfect score. Moreover, the normal value of the grip strength in Table 3 is 28.4 ± 4 kg. The performance level and satisfaction level in Table 3 are values when “10” is maximized.

As shown in Table 3, the post-training patient's pain decreased from 70 to 12, the range of shoulder joint abduction increased from 0 ° to 70 ° to 0 ° to 150 °, and 83 simple upper limb function tests were performed. The grip strength increased from 6kg to 12kg, the performance level increased from 1 to 7, and the satisfaction level increased from 1 to 9. Thus, all items in Table 3 were improved.

[Example 4: Central nerve palsy (upper limb)]

The patient is a 64-year-old man. This patient has been diagnosed with thalamic hemorrhage and right hemiplegia. The training for this patient was performed by applying electrical stimulation to the forearm, bending and extending the wrist joint and opening and closing the fingers 10 times, 10 sets for about 15 minutes. Twelve years have passed since onset. This training was carried out 12 times, 3 times a week for 4 weeks. Table 4 shows the effects of the training of Example 4.

Here, the numerical value of voluntaryness (upper limb) in Table 4 is a value when the maximum volatility is “6” in the case of voluntary volatility equivalent to normal. The numerical value of sensory disturbance (numbness) in Table 4 is a value when “10” is the most severe numbness.

As shown in Table 4, in the patient after training, voluntary (upper limb) and sensory disturbance (numbness) did not improve, but the time for changing clothes on the jacket was shortened from 61 seconds to 40 seconds. It was.

[Example 5: CNS paralysis (lower limbs)]

The patient is a 64-year-old man. This patient has been diagnosed with hemorrhagic cerebral infarction and left hemiplegia. The training for this patient was performed for 10 minutes with 10 sets of ankle flexion and extension for about 15 minutes by electrically stimulating the lower leg. 15 years have passed since onset. This training was conducted twice a week for 4 weeks for a total of 8 times. Table 5 shows the effects of the training of Example 5.

Here, the numerical value of voluntaryness (upper limb) in Table 5 is a value when the maximum voluntary volatility is equal to “6”. The values of the deep sensation in Table 5 are values when “0” is given when there is no sensation, and “10” is given as the sensation equivalent to that on the healthy side. Timed up & go test is an evaluation test of mobility and balance ability that is performed by measuring the time it takes to get up from a chair, go around the mark 3 meters ahead, and sit on the chair again.

As shown in Table 5, in the post-training patient, the deep sensation increased from 0 to 3, and the 10m walking time decreased from 15.4 seconds to 12.5 seconds, but voluntaryness (lower limbs) improved. I couldn't. Timed up & go test was almost unchanged and no improvement was seen.

By the way, the present invention is not limited to the above-described embodiments of the elbow joint and the shoulder joint, and appropriate modifications are possible. For example, it can be applied to joints such as hands, hips, knees, and feet.

DESCRIPTION OF SYMBOLS 1 Electrical stimulator 2 Controller 3 Electrode 4 Motion detection sensor 5 Winding drum 6 Wire 7 Adapter 8 Mat 9 Supporter 10 Myoelectric sensor

Claims (4)

A motion detection sensor that detects the motion status of a healthy site that is symmetrical to the patient's impaired site, an electrode that provides electrical stimulation to the disabled site, An electrical stimulation apparatus comprising a controller that outputs a stimulation signal. The electrical controller according to claim 1, wherein the controller outputs a signal for applying electrical stimulation to the electrode in response to a motion start signal from the motion detection sensor, and outputs an electrical stimulation end signal to the electrode in response to a motion end signal from the motion detection sensor. Stimulator. A motion detection sensor for detecting the motion state of a healthy site that is symmetrical to the patient's impaired site, a myoelectric sensor for detecting myoelectricity of the healthy site, and an electrode for applying electrical stimulation to the disabled site An electrical stimulation apparatus comprising: a controller that outputs an electrical stimulation signal to the electrodes based on signals from the motion detection sensor and the myoelectric sensor. The controller outputs a signal to apply electrical stimulation to the electrode with the motion start signal of the motion detection sensor, outputs an electrical stimulation end signal to the electrode with the motion end signal of the motion detection sensor, and responds to the output signal of the myoelectric sensor The electrical stimulation device according to claim 3, wherein the magnitude of electrical stimulation applied to the electrode is changed.

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