Patent Application
20160367391
Not Applicable
Lonnie E. Paulos, Kim A. Nelson, Jordan Terry and The Lonnie and Shannon Paulos Trust (as Amended and Restated) F/K/A The James Dizikis Trust, Dated Feb. 26, 2008.
Not Applicable
Field of the Invention
Embodiments of the present invention relate to joint braces that can help prevent the hyperextension, flexion or undesirable movement of a joint, and more specifically relates to brace assemblies and methods utilizing adjusting facilities to adjust the force of brace elements on a body or the joint.
Background
Braces are often utilized to support joints when damage, deformation, surgery or the like has caused the joint to be instable. Sports, physical labor and everyday physical movement can create strains and injuries to joints such as the shoulder, elbow, back, wrist, ankle and knee. Specific to the knee, most of the running, jumping, cutting or twisting sports today have the risk of damaging the knee. These injuries frequently involve a tearing the ACL in the knee. Many injures to the knee joint have a mechanism of injury of hyperextension in which the ACL is stretched or torn. Many methods have been employed to prevent this action to the knee and prevent the injury to the ACL. Taping techniques as well as rigid braces have been designed to prevent this condition.
One common method of treatment and prevention for these injures today is the use of the rigid braces. Common to most, if not all, of these devises for use on the knee are, adjustable metal hinges on the medial and lateral side of the knee. Rigid arms on each side connect the hinges to curved thigh and calf pieces or cuffs. A series of Velcro straps attached to these rigid side pieces then wrap around the leg to mount and hold them in place with the cuffs and the hinges. Adjusting the hinge from allowing extension or hyperextension blocks the knee from moving into to these positions quite well.
With respect to these rigid braces however, many sports have rules in which players cannot have any metal or rigid devices on any part of their body to compete due to metal or hard structures that may cause injury to other players. One of these sports is soccer, which is also one of the most popular sports in the world. Additionally, with the introduction of bracing both knees for prevention of injury, the bracing must have a very low profile on the knees to prevent the braces from catching against each other during competition.
Another technique of treating and preventing joint injuries includes taping techniques. While reinforcing joint strength, taping typically does not involve rigid braces that cause problems with sporting rules.
Prior art embodiments of braces having strap elements that cross posterior to the knee joint include U.S. Pat. No. 4,817,588 filed on Jul. 1, 1987 to Gary Bledsoe (Bledsoe) and U.S. Pat. No. 6,368,297 filed on Oct. 22, 1999 to Jan F. A. Smits (Smits) both of which are incorporated by reference in their entirety. Bledsoe discloses a restraining strap network positioned entirely behind the knee that has to cooperate with additional brace elements including hinges and connecting means to connect the brace elements to the wearer's leg. Bledsoe does not disclose embodiments of the strap network extending anterior to the limbs about the joint. Smits discloses a brace having a strap that crosses at the back of the knee that like Bledsoe is entirely behind the knee and has to cooperate with other brace elements. Smits also specifically uses stop portions in a hinge to limit extension of the brace elements. Smits does not disclose limiting extension of the brace with the strap.
The following summary is included only to introduce some concepts discussed in the Detailed Description below. This summary is not comprehensive and is not intended to delineate the scope of protectable subject matter.
Example embodiments of the brace assembly utilize an elastic cross strap attached to mounting facilities about a joint to limit the extension of limbs about the joint. The cross strap has elastic properties that allow it to provide progressive resistance as the strap is stretched. The elastic cross strap assembly is positioned from a cross origin behind or in the fossa of the joint to attachment points on mounting facilities on either side of the joint such that the assembly provides an opposing tensile force that limits the extension of the mounting facilities and the limbs about a joint.
In some embodiments, a brace assembly for use by a wearer is provided, the brace assembly comprising an upper mounting facility and a lower mounting facility, at least one elastic cross strap coupled to the upper mounting facility and lower mounting facility.
In some embodiments, one of the upper mounting facility or the lower mounting facility further comprises an adjusting facility whereby the adjusting facility is configured to adjust the resistance force provided by the at least one elastic cross strap. In some embodiments, the adjusting facility comprises an attachment point of the elastic cross strap to the upper mounting facility or the lower mounting facility. In some embodiments, the adjusting facility comprises a cable and a tightening mechanism configured to operably couple with the at least one elastic cross strap.
In some embodiments, one of the upper mounting facility or the lower mounting facility comprises an adjusting facility whereby the adjusting facility is configured to adjust an inside radius of the upper mounting facility or the lower mounting facility.
In some embodiments, the adjusting facility comprises a cable and a tightening mechanism whereby the tightening mechanism operates as a ratchet to shorten an effective length of the cable.
In some example embodiments, a mounting facility for use by a wearer is provided, the mounting facility comprising a mesh material comprising a helically wound braided sleeve, the braided sleeve configured as a cylindrical sleeve having a longitudinal axis, an internal radius, a distal end and a proximal end, the distal end of the braided sleeve coupled to a distal edge stiffener and the proximal end of the braided sleeve coupled to a proximal edge stiffener, an attachment point configured to receive a tensile force pulling in a proximal direction and the attachment point coupled to the distal edge stiffener whereby the tensile force from the proximal direction urges the distal edge stiffener to move in the proximal direction and the braided sleeve is urged to extend along the longitudinal axis and reduce the internal radius of the braided sleeve. In some embodiments, the mounting facility further comprises a stave coupled to the attachment point and the proximal edge stiffener. In some embodiments, the mounting facility further comprises an adjusting facility coupled to the braided sleeve whereby the adjusting facility is configured to reduce the internal radius of the braided sleeve and increase the frictional engagement of the mounting facility with the wearer. In some embodiments, the adjusting facility comprises a cable and a tightening mechanism whereby the tightening mechanism operates as a ratchet to shorten an effective length of the cable. In some embodiments, the mounting facility further comprises at least one proximal stave coupled to the attachment point and the proximal edge stiffener, at least one distal stave coupled to the proximal edge stiffener and an adjusting facility coupled to the at least one proximal stave and the at least one distal stave whereby the adjusting facility is configured to reduce the internal radius of the braided sleeve and increase the frictional engagement of the mounting facility with the wearer.
In example embodiments for some joints, the brace assembly may provide a resisting force that influences appendages about a joint. For example: for an ankle, the brace can be used to prevent dorsiflection, plantar flexion or rolling of the ankle; for a back, the brace can be used to prevent or support bending about the waist; for an elbow, the brace can be used to prevent hyperextension; and for a shoulder, the brace can be used to control movement of the humerus about the shoulder such as to restrict abduction and external rotation.
In example embodiments for a knee joint, the brace assembly provides a resisting force to resist hyperextension of the knee. Some embodiments of the assembly are able to accommodate different joints, different size wearers of the assembly and different tension settings such as for athletes during competition. Some embodiments of the brace can be used bilaterally and can be made without metal bracing to comply with the requirements of some sports.
Some embodiments of the brace assembly provide an elastic knee brace assembly having an upper mounting facility for positioning the brace assembly about the thigh area of a user's leg, a lower mounting facility for positioning the brace assembly about the shin area of the user's leg, an elastic cross strap having a cross origin, and the cross strap is attachable to the upper and lower mounting facilities whereby the cross strap limits the extension of the upper mounting facility and the lower mounting facility about the joint when the cross origin is positioned posterior to the user's knee.
Some embodiments of the brace assembly comprise an upper mounting facility and a lower mounting facility, at least one elastic cross strap coupled to the upper mounting facility and lower mounting facility and the elastic cross strap further forming a cross origin between the upper and lower mounting facility whereby the cross strap provides a resistance force to an extension of the upper mounting facility and the lower mounting facility from the cross origin when the cross origin is positioned in a fossa of a wearer's joint.
In some embodiments, the upper mounting facility comprises an upper pad and an upper strap configured to wrap around a portion of an upper limb of a joint and the lower mounting facility comprising a lower pad and a lower strap configured to wrap around a portion of a lower limb of a joint of a wearer.
In some embodiments, the elastic cross strap is coupled to the upper mounting facility at an attachment point lateral or medial to an anterior point of the upper mounting facility and the elastic cross strap is coupled to the upper mounting facility at an attachment point lateral or medial to an anterior point of the upper mounting facility.
In some embodiments, the brace assembly further comprises at least one adjusting facility capable of adjustably coupling the elastic cross strap to the upper pad and the lower pad.
In some embodiments, the wearer's joint is a knee joint whereby the elastic cross strap provides the resistance force to the extension of the upper mounting facility and the lower mounting facility from the cross origin when the cross origin is positioned in the popliteal fossa of the knee joint.
In some embodiments, the elastic cross strap is coupled to the upper mounting facility at an attachment point at an anterior point of the upper mounting facility and the elastic cross strap coupled to the upper mounting facility at an attachment point at an anterior point of the upper mounting facility.
In some embodiments, the upper mounting facility comprises an upper pad and an upper strap configured to wrap around an upper limb of a joint and the lower mounting facility comprises a lower pad and a lower strap configured to wrap around a lower limb of a joint of a wearer.
In some embodiments, the upper mounting facility comprising an upper pad and an upper strap configured to wrap around an upper limb of a joint, the lower mounting facility lower pad and a lower strap configured to wrap around a lower limb of a joint of a wearer, the upper strap and the lower strap are made of an elastic material and the upper mounting facility and the lower mounting facility are coupled with a mechanical hinge.
In some embodiments, the inner surface further comprises a plurality of through holes extending through the upper pad and the lower pad to provide further frictional engagement of the upper and lower limb of the wearer.
In some embodiments, the upper strap and the lower strap are made of an elastic material and the upper pad and the lower pad are made of an elastic material.
In some embodiments, the upper pad and the lower pad have an inner surface configured to frictionally engage the upper and lower limb of the wearer and the inner surface having an indentation pattern. In some embodiments, the inner surface further comprises a plurality of through holes extending through the upper pad and the lower pad to provide further frictional engagement of the upper and lower limb of the wearer. In some embodiments, the inner surface further comprises a plurality of strips extending between the through holes to provide the first progressive resistance force.
In some embodiments, the elastic cross strap is configured to provide a dynamic, progressive or configurable resistance force as the resistance force.
In some embodiments the upper mounting facility and the lower mounting facility are not coupled with a mechanical hinge.
Some embodiments of the brace assembly comprise an upper mounting facility and a lower mounting facility, one of the upper mounting facility or the lower mounting facility comprising an elastic pad configured to provide a first progressive resistance force at least one elastic cross strap configured to provide a strap progressive resistance force and the elastic cross strap coupled to the upper mounting facility and lower mounting facility whereby the first progressive resistance force and the strap progressive resistance force provides a combined progressive resistance force to an extension of the upper mounting facility and the lower mounting facility about a wearer's joint. In some embodiments, the inner surface further comprises a plurality of through holes extending through the elastic pad to provide further frictional engagement of the upper and lower limb of the wearer and the inner surface further comprises a plurality of strips extending between the through holes to provide the first progressive resistance force. In some embodiments, the upper mounting facility comprises a first elastic pad configured to provide the first progressive resistance force, the lower mounting facility comprises a second elastic pad configured to provide a second progressive resistance force, the elastic cross strap forms a cross origin between the upper and lower mounting facility and the combined progressive force comprises the first progressive force, the second progressive force and the strap progressive force.
Some embodiments of the brace assembly comprise an upper mounting facility and a lower mounting facility, at least one elastic cross strap coupled to the upper mounting facility and lower mounting facility and the at least one elastic cross strap further forming a cross origin between the upper and lower mounting.
In some embodiments, the elastic cross strap is configured to provide a progressive change in a resistance force on the upper mounting portion and the lower mounting portion.
In some embodiments, the resistance force is a configurable resistance force.
In some embodiments, the resistance force is a progressive resistance force provided by the elastic cross strap comprising a composite of tensile elements.
In some embodiments, the composite of tensile elements comprises a first tensile element having a first tensile strength and a first resting length, a second tensile element having a second tensile strength greater than the first tensile strength and a second resting length longer than the first resting length whereby a first resistance force is provided through a first stretch range up to the second resting length and a second resistance force is provided in a second stretch range beyond the second resting length.
In some embodiments, the resistance force is a configurable resistance force provided by the elastic cross strap being one from a group consisting of: the elastic cross strap having one of a plurality of different lengths, the elastic cross strap having one of a plurality of different tensile elements, the elastic cross strap comprising one of a plurality of elastic materials having different tensile properties, the elastic cross strap comprising an adjustable length of the elastic training portion and a first end of the elastic cross strap having one of a plurality of attachment points on the lower mounting facility defining a lower resistance point and positioning a second end of the elastic cross strap on one of a plurality of attachment points on the upper mounting facility defining an upper resistance point.
Some embodiments of the invention provide a brace assembly comprising an elastic cross strap attached to an upper mounting facility and a lower mounting facility and the elastic cross strap further forming a cross origin between the upper and lower mounting facilities whereby the cross strap provides a resistance force to an extension of the upper mounting facility and the lower mounting facility about the cross origin when the upper and lower mounting facilities are positioned about a joint and the cross origin is positioned at a point relative to the joint and the point is on a side of the joint opposite a direction of the extension. In some embodiments, the point is one of: a location in an antecubital fossa of a wearer's elbow; a location in a popliteal fossa of a wearer's knee; a location proximal to a talus bone of a wearer's ankle; a location proximal to a lumbar area of a wearer's back; or a location in the axillary fossa of a user's shoulder.
In some embodiments, a brace assembly for use by a wearer is provided, the brace assembly comprising an upper mounting facility and a lower mounting facility, at least one elastic cross strap coupled to the upper mounting facility and lower mounting facility, the at least one elastic cross strap further forming a cross origin between the upper mounting facility and the lower mounting facility whereby the cross strap is configured to provide a resistance force to an extension of the upper mounting facility and the lower mounting facility from the cross origin when the cross origin is positioned in a fossa of a wearer's joint and the at least one elastic cross strap further comprises an adjusting facility whereby the adjusting facility is configured to adjust the resistance force.
In some embodiments, a brace assembly for use by a wearer is provided, the brace assembly comprising an upper mounting facility and a lower mounting facility, at least one elastic cross strap coupled to the upper mounting facility and lower mounting facility and the at least one elastic cross strap further comprises an adjusting facility whereby the adjusting facility is configured to adjust the resistance force.
Some embodiments of the methods of use provide a method of supporting a wearer's joint, the method comprising the steps of securing a first portion of an elastic cross strap about one body portion joined to a second body portion at a wearer's joint, positioning the elastic cross strap about the joint to form a cross origin at a point of the joint and securing a second portion of the elastic cross strap about the second body portion at the joint whereby the elastic cross strap is capable of providing resistance to an extension of the wearer's body portions about the joint.
In some embodiments of the methods of use, the joint may be one of: an elbow; a knee; a shoulder; a back; or an ankle.
The advantages and features of the present invention will become apparent to those skilled in the art when the following description is read in conjunction with the attached drawings and the appended claims.
In order that the manner in which the above-recited and other advantages and features of the invention are obtained, a more particular description of the invention briefly described above will be rendered by reference to specific embodiments thereof which are illustrated in the appended drawings. Understanding that these drawing depict only typical embodiments of the invention and are not therefore to be considered to be limiting of its scope, the invention will be described and explained with additional specificity and detail through the use of the accompanying drawings in which:
Although example embodiments are described in detail for use with knee bracing and reinforcement, it is understood that the methods and systems described can be used for similar medical situations where support of and resistance to moving joints may be needed. Examples of embodiments with other joints such as but not limited to the shoulder, elbow, back and ankle are also described and illustrated below. Notwithstanding the specific example embodiments set forth below, all such variations and modifications that would be envisioned by one of ordinary skill in the art are intended to fall within the scope of this disclosure.
Some embodiments of this elastic brace assembly comprise a non-rigid or semi-rigid brace utilizing an elastic cross strap to provide a progressive resisting force to joint movement such as hyperextension. In addition to providing a progressive resistance force, the elastic cross strap may provide neuromuscular feedback to help prevent atrophy of the wearer's muscles. Some embodiments of this brace assembly may include a flexible sleeve or other traditional brace components. Although some embodiments of the assembly do not need side hinges, metal upright stays or braces and hinges, it is contemplated that some embodiments of the brace assembly may also include these elements.
Although it is contemplated that embodiments of the assembly can support many different types of skeletal joints such as elbows, ankle, shoulder, backs, wrists or knees, the illustrative examples below will use an embodiment directed to support a person's knee. Therefore, references to anatomical portions of the wearer's knee are for illustration purposes and not as a limitation.
Additionally, the terms upper and lower as used herein, identify different sides of a joint and are meant to include other similar terms for defining positional relationships around joints such as such as proximal and distal, front and rear, and near and far.
As used herein, the term point, for example attachment point, in addition to defining a location or position, may also be used to define an element. For example, an attachment point may also define a coupling element used to couple and/or attach elements.
Example embodiments of this new brace assembly comprise at least one elastic hyperextension cross strap, at least one upper mounting facility and at least one lower mounting facility. In these embodiment, generally, the upper mounting facility positions and secures the brace assembly about the thigh area of a user's leg, the lower mounting facility positions and secures the brace assembly about the shin area of the user's leg and the elastic hyperextension cross strap attaches to the upper and lower mounting facilities whereby the elastic cross strap can provide progressively increasing resistance to the extension of the user's knee when the elastic cross strap is positioned posterior to the user's knee. In some embodiments, the upper and lower mounting facility are defined entirely by the elastic cross strap to help secure the assembly to the user's leg. In some embodiments, the upper and lower mounting facilities are separate elements defined by portions of brace elements, such as upper and lower cuffs/pads or side braces, cooperating with the elastic cross strap.
In some embodiments, the brace assembly stabilizes the knee from hyperextension in the 5-25 degree range.
In some embodiments, the brace provides progressive resistance starting at an angle of flexion of about 60-80 or about 70 degrees and has a maximum resistance at about 15-25 or about 20 degrees of flexion.
As shown in the example embodiments of
In some embodiments, the elastic cross strap comprises one or more straps of pre-determined lengths and elastic cross straps are selected based on the length needed for that wearer. In other embodiments, the elastic cross strap has adjustment facilities or elements that allow the cross strap to be adjusted to fit the wearer and provide different resistance properties to help prevent joint extension.
The elastic cross strap can be made from material to provide resistance to stretching in one direction. In one example embodiment, the elastic cross strap is a pliable elastic material that provides progressive resistance to stretching and as the material stretches, the resistance to stretching increases. As an example, the resistance properties of embodiments function similar to the resistance properties of a rubber band. In one embodiment, the elastic material is similar to elastic sports tape. In other embodiments, the elastic material can comprise a rubber material, a plastic material or a spring that can provide resistance properties similar to those of a rubber band. It is also contemplated that the elastic cross strap may comprise a combination of elastic and non-elastic material that still provide the elastic properties required of the strap. As an example, and not for limitation purposes, these combinations may comprise combinations or laminates including cloths, fabrics, threads, struts or other materials combined with an elastic material through sewing, adhesives, Velcro® type attachment or even simple adjacent placement to elastic materials. These combinations or laminates may comprise multiple materials that can increase the adherence of the cross strap to itself or other materials and may be comprise combined materials at particular, not all areas of the cross strap. Combinations of elastomeric materials with varying resistance properties are also contemplated.
The length, width and elastic properties of the elastic cross strap can be varied based on the properties desired for the wearer and/or the sport the wearer will participate in. Although some of the discussion relates to a single elastic cross strap, it is understood that multiple elastic cross straps or straps can be used to provide the functional properties of the elastic cross strap. More than one elastic cross strap or strap can be used such that their properties combine to provide the desired resistance properties.
As shown in
Means to attach or couple the elastic cross strap arms to the mounting facilities include, but are not limited to common attachment means such as: rigid fasteners such as rivets, adhesives or sewing; slidable attachment points such as slots or channels, pivoting fasteners such as rivets or buttons; and removable fasteners such as Velcro, buttons, buckles, snaps or hooks. It is contemplated that the means of attachment, such as with Velcro straps or buckles, will let the cross strap be tightened or loosened as desired for comfort, support or specific resistance reasons.
As shown, the attachment of the elastic cross strap in
It is also contemplated that the shin shell can be configured to allow the same straps, or additional straps, clips or bands, to wrap around the wearer's lower leg to secure the lower arms of the elastic cross strap.
The upper mounting facility positions the brace assembly about the upper limb of a wearer's joint. Embodiments of this facility can similarly include those possible for the lower mounting facility. In the embodiment shown in
For the embodiment of
In embodiments where the upper mounting facility comprises an upper pad or thigh pad, as shown in
In embodiments, as shown in
It is contemplated that in some embodiments, rather than connecting or coupling the elastic cross strap 260 to the pads, the securing straps 224 and 244 can also provide the attachment means for the pads to the elastic straps. For example, the securing strap may wrap all the way around the limb and have the attachment means so that when the securing strap is secured to the pads, the elastic cross straps are attached to the securing strap.
The elastic cross strap 260 is attached to the upper and lower mounting facilities at upper and lower facility attachment points 242 and 222. This attachment can be made using any means that will secure the ends of the elastic cross straps onto the mounting facilities and is generally made at a front portion of the mounting facility. As shown in
For the embodiment of
In some embodiments of this brace assembly, it is beneficial for the elastic cross strap to provide a sufficient resistance force to an extension of the limbs about a joint at or near an anterior point of the wearer's leg. This resistance force is applied to the limbs about a joint by resisting an extension of elements of the brace itself between the cross origin and the anterior resistance points. By resisting the extension of elements of the brace, such as the anterior resistance points about the cross origin, elements of the brace are able to help limbs resist their extension about the bending axis of the joint. The bending axis of the joint is the actual or conceptually equivalent point of the joint about which the limb/body portions bend or rotate. When the cross origin is positioned posterior to the joint, which is posterior to the joint's bending axis such as in a fossa of the joint, this typically means that the anterior resistance point may be positioned anterior to the joint at a front portion of the mounting facilities. The anterior resistance point is typically the point at which the resistance force is applied to the brace portion that applies that resistance force to an extension force applied to the brace by the extension of the limbs. In most, but not necessarily all embodiments, the anterior resistance point is the same as the attachment points. For example, as represented in
The resulting angles shown in
In addition to providing superior resistance properties, embodiments utilizing an elastic cross strap may also provide the benefit of eliminating the immediate hard stop typical of prior art embodiments that use hard stop features such as in a hinge or with a non-elastic strap. This lack of a hard stop helps prevent migration of the brace and reduces the jerking feeling making the brace more comfortable for the wearer. The inclusion of providing progressive resistance with the elastic cross strap provides additional benefits. The elastic properties of the cross strap can provide resistive properties earlier in the motion arch of the joint thereby controlling extension sooner. Additionally, the elastic properties can provide increasing resistance in a linear fashion as the joint goes from flexion to extension which increases neuromuscular control and causes the extensor muscles to gradually strengthen which is good for joint stability.
In some embodiments, the elastic cross strap has a limiting resistance capability. For these embodiments, the limiting resistance may be provided by the elastic properties of the elastic cross strap reaching its maximum extension and therefore the cross strap provides a direct resisting force to further cross strap extension. This limiting resistance may also be provided by having a non-elastic material used in combination with an elastic material whereby when the limiting resistance point is met, the non-elastic material is engaged and that provides the direct resisting force to any further extension of the elastic cross strap.
One embodiment of the brace assembly comprises a single elastic cross strap mounted in a way that provides the functionality of the brace. As shown in
In this embodiment of the brace assembly 400, the wrapping around the shin 402 may start with the middle of the elastic cross strap 460 being placed in the back of the calf. The wrapping can continue around the lower leg once or multiple times. At the point that the elastic cross strap is extended from a position anterior to the shin and then up behind the knee. There may be elements to help define the strap attachment points 486 to assist in keeping the arms of the cross strap properly positioned anterior to the joint. The wrapping around the thigh 404 may also be done once or multiple times with attachment means or coupling means such as hooks, bands, buttons, buckles, loops, clips, Velcro or straps to keep the straps together and define the strap attachment point 476. To close the elastic cross strap, any connection means already disclosed, such as complementary hook-and-loop (Velcro) connectors can be used to secure the upper arms to each other. For the embodiment illustrated in
Although the embodiment in
One embodiment similar to that in
Another embodiment of the brace assembly utilizes a single elastic x-strap as the elastic cross strap. As shown in
Similarly, embodiments having two elastic straps can be made where two elastic straps are used to create the elastic cross strap.
Embodiments of a brace assembly also include having a brace sleeve to provide assembly elements. This type of embodiment is shown in
As shown in
Some embodiments of the brace assembly without metallic or rigid elements able to comply with current sporting regulations, such as the FIFA rules.
The embodiment shown in
Embodiments of the brace assembly can also include traditional knee braces elements such as upper and lower frames with central hinges as well as structures for patellar control. The elastic cross strap could be added to these assemblies to provide additional support and hyperextension protection. As shown in
Embodiments of the brace assembly can also include an elastic cross strap with a single rigid side strut and hinge or flexible upright. For example, this type of embodiment could be worn as a prophylactic brace on the lateral side of the knee to reduce knee injuries and reduce the chances of rigid brace elements colliding with each other and interfering with the user's leg movement. In these embodiments, the cross strap can comprise any of the descriptions included herein and is attached to the side strut or upright using the attachments means disclosed. The single rigid side strut and hinge can be similar to any of the side brace and hinge designs disclosed and the flexible upright can be similar to any of the flexible uprights disclosed in other embodiments with or without a sleeve.
Additional embodiments of the brace assembly are shown in
The composition of the side brace elements in this embodiment can be of any rigid or semi-rigid material that can engage the side of a wearer's leg, attach the side elements to the elastic cross strap and provide a degree of rigidity to the assembly when stationary or when the upper and lower mounting facilities pivot about the hinges. Suitable materials include but are not limited to plastics, metals, composites or any combination of these materials. The brace elements may further include padding or may be heat pliable, molded or contoured to be more comfortable for the wearer. As shown (
It is understood that alternative shapes of side braces may be used. For example, and not for limitation, one embodiment shown in
The composition of the elastic hyperextension cross strap is similar to the descriptions described for other embodiments. The composition, function and design of the elastic cross strap and other elastic components of the brace assembly may be similar to the elastic portions of the training brace assembly as described in U.S. patent application Ser. No. 13/541,796 filed Jul. 5, 2012 and published as U.S. Pub. No. 2012/02700708 on Oct. 25, 2012, now U.S. Pat. No. 9,320,634 issued Apr. 26, 2016, which application is herein incorporated by reference in its entirety.
When assembled, as shown in
Shown in
In one embodiment shown in
One embodiment of the brace assembly further comprises configuring the tibial pad to function as an endo-skeleton such as with a wearer's shin guard, as may be required in a sport such as soccer, to support anterior tibia and anterior drawer control.
Although not necessary, it is contemplated that some embodiments of the assembly can be capable of being integrated with a patellar control-open patellar donut as prescribed. In these embodiments, the assembly may include straps for patellar subluxation that stabilizes the elastic cross strap or hinges.
Although the above description and terminology of the components of the embodiments above utilize the terminology of a knee, it is understood and contemplated that the assembly can be applied to other joints. For example, and not for limitation, embodiments of the assembly can also be used with a person's elbow, back, shoulder or ankle. Such embodiments of the brace assembly are shown in
Additionally, for some of these alternative embodiments for joints other than knees, it is understood that the general description of the placement of the brace elements about the joint accommodates different joints and accommodates the extension/flexion resistance the brace is intended to provide. Posterior placement of the cross origin generally means on the opposite side of the extension or flexion that the brace is resisting and anterior placement of elements such as resistance points is on the same side of the body part going into extension or flexion. For example, the posterior placement of the cross origin is on the opposite (posterior) side of the extension of the elbow even though that side of an arm is generally anterior to the wearer's body when the arms are down. Similarly, the resistance points of the brace are on the same side as the extension even though that side of the arm is typically on the posterior side of the wearer's body.
In some embodiments for the ankle, the lower mounting facility or the lower attachment point can located at or near the bottom of the wearer's foot. For these embodiments, the mounting facility may be a frictional engagement of the strap with the bottom of the foot or an additional element such as a sole pad that also attaches to the strap.
Another embodiment could include a non-elastic portion of the cross strap that extends from the bottom of the sleeve to a point proximal to the sole of the foot such that the attachment of the non-elastic portion of the strap to an elastic portion functions as the lower attachment point. An embodiment of this type may be configured so that the lower resistance point is about where the sole of the foot transitions to the medial inside of the foot.
In some embodiments of the ankle, the brace can be positioned such that the cross origin is on the medial ankle to prevent the rolling of the ankle from the inside to out. It is also contemplated that the brace can be configured so that cross strap create a cross origin on the lateral ankle as well as create a cross origin on the medial ankle to help resist rolling of the ankle in either direction.
Although the embodiment in
Additional brace embodiments for the ankle are contemplated that include cuffs, frames, sleeves, hinges, struts and other elements as described herein.
Additional embodiments of the brace assembly are shown in
Referring to
Referring to
As shown in
In some embodiments, when the elastic cross strap is attached to the mounting facility at an attachment point that is a distance from the resistance point, the strips of mounting facility material are able to function as extensions of the elastic cross strap and extend the material providing the resistance force to a more ideal resistance point. For example, if the elastic cross strap was to attach to the mounting facility on a generally medial or lateral position around the knee of a leg, the continuous strips of mounting facility material may extend upward or downward from the attachment point to an anterior point on the leg and allow the resistant point of the brace to be higher and lower on the joint and in a more anterior position. The pads/cuffs may also be made from a non-elastic materials or an elastic material, similar to the elastic cross strap that allows the continuous strips to extend the elastic properties of the elastic cross strap. This can be done consistent with and with similar “strips” of mounting facility material allowing the mounting facility to provide resistance to the elastic securing straps.
The elastic cross straps may also be configured with openings. The openings in the cross straps may provide similar comfort and friction benefits as do the openings in the mounting facilities. In addition, the openings in the cross strap may allow for one design of a strap to have different resistance properties based on the size and/or the shape of the openings. For example, a similar elastic cross strap design can be made to have two resistance properties by having one size openings for one configuration and have less resistance by having larger sized openings (across the width of a strap designed to provide resistance along its length) for another configuration.
Referring to
In some embodiments, the brace assembly may also include adjusting facilities to allow portions of the brace assembly to be adjusted. These adjustments may be used to accommodate different users or to accommodate different situations encountered by the same user. In these embodiments, adjusting facilities may comprise a cable or lace and a tightening mechanism such that they cooperate with brace elements to move one portion of the brace assembly relative to another portion of the brace assembly. As used herein, the terms lace and cable have the same meaning unless specified otherwise. When used with the brace assembly, the cable and the tightening mechanism are able to put tension on portions of the brace. For example, in some instances the adjusting facilities may reduce the circumference of the mounting facility by wrapping the cable around the mounting facility and tightening the adjusting facilities similar to pulling a belt on both ends to provide varying degrees of tightness around your waste and using a buckle to hold the tension. In some instances, the cable is wrapped around one or more latches coupled to the mounting facilities and tightening the adjusting facilities acts like using shoe laces going thru shoe eyelets (latches) to tighten shoes on your feet. For example, the adjusting facilities may reduce the circumference of the inner surface of the mounting facility by tightening the adjusting facilities and therefore making the mounting facility tighter around the thigh or calf of the wearer of the brace. Additionally, the adjusting facilities may be coupled to one or more ends of the elastic cross strap so that tightening the adjusting facilities may reduce the effective length of the elastic cross strap and therefore create greater resistance of the brace to extend.
The cable may be any type of element capable of transferring a tensile force from one portion of the brace to another. For example only and not for limitation, the cable or lace may be made be a metallic cable, a nonmetallic cable, a lace or a fabric strap. In some embodiments, the cable is a nonmetallic, non-elastic and low-friction cable.
In some embodiments, the tightening mechanism may comprise a base and a control for drawing the cable towards the base thereby providing a tensile force onto the cable and portions of the brace assembly. In some embodiments, the tightening mechanism functions similar to a ratchet or a fishing reel. The mechanism function with the control configured to rotate in relation to the base such that it rotates in one direction to tighten the cable and the ratchet secures the position of the cable throughout the rotation and prevents rotation in the other direction. An example of a cable and tightening mechanism suitable for some embodiments of the adjustable brace assembly comprises the BOA Closure System sold by Boa Technology Inc. of Denver, Colo. USA. In some embodiments, the tightening mechanism may further comprise a housing. For illustration only, and not for limitation, examples of adjusting facilities, including cables and tightening mechanisms, may be similar to the tightening devices disclosed in U.S. Pat. No. 7,992,261, filed Aug. 20, 2007 and in U.S. Pat. No. 7,198,610 filed Dec. 21, 2005 both of which are herein incorporated by reference in their entirety.
In some embodiments, for example only and not for limitation, the cable and tightening mechanism may be similar to the lace and tightening mechanisms disclosed in U.S. Pat. No. 8,277,401, filed Sept. 12, 2007; the entire contents of which are herein incorporated by reference. In some embodiments, for example only and not for limitation, the cable and tightening mechanism may be similar to the cable and adjustment mechanisms disclosed U.S. Pat. No. 8,128,587, filed Oct. 1, 2010; the entire contents of which are herein incorporated by reference.
Referring to
Referring to
In some embodiments, the brace assembly may include elastic cross straps which may also have one or more adjusting facilities or the elastic cross straps may be coupled to these adjusting facilities. The configuration of the cross straps and adjusting facilities may be any configuration that allows the tension on the cross strap to be increased and decreased. In some embodiments, one end of the cross straps are coupled to an attachment point of the brace assembly on the medial side of the knee and, after passing posterior to the knee, the other end is coupled to an adjusting facility, such as a cable and the tightening mechanism, at an attachment point of the brace assembly on the lateral side of the knee. In some embodiments, the cross straps are wrapper further around the leg. For example, in some embodiments, one end of the cross straps are coupled to an attachment point of the brace assembly on the anterior side of the knee on one side of the joint, and after passing posterior to the knee, the other end is coupled to the adjusting facility, such as a cable and a tightening mechanism, at an attachment point of the brace assembly on the anterior side of the knee on the other side of the joint. Positioning the adjusting facilities on the lateral and anterior side of the joint makes it easier for a user to access and adjust the tightening mechanism.
Referring to the example embodiment of
It is contemplated that the embodiments of an outer sleeve with tightening mechanisms, similar to those shown in
It is also contemplated that the embodiments with cross straps, tightening mechanisms and cables may be used with the embodiments having a mesh material as disclosed above and shown in
In some embodiments, the mounting facilities may include a mesh material as a liner or as one of the materials forming the mounting facility. The mesh material may be a cylindrical, helically wound braid such as a biaxial braid, that fits around the wearer's leg as a helically wound braided sleeve. As a helically wound braid, the mesh functions like a “Chinese Finger Trap” that tightens around the wearer's leg as the ends of the mesh/cylindrical shape are pulled from each other. One of the benefits of this type of mesh design is that it helps to equalize the pressure applied by the mesh material across the surface engaged with the mesh as it tightens. This is different than the pressure that may be applied by straps or adjusting facilities that would apply pressure more locally to those areas were the straps or adjusting facilities engage the mounting facility. For example, if the mounting facilities were adjusted on a wearer's leg with two straps, the pressure on the leg may be more localized to the portion of the mounting facility that is attached to the straps. Furthermore, if the two straps had different tension applied to them, the pressure on the wearer's leg may be different at the different portions of the mounting facility that are more closely associated with each of the straps.
One embodiment of a mounting facility comprising a mesh material is shown in
Also shown in
Although a lower mounting facility is not shown, similar features may be provided in a lower mounting facility to complement and be used with these embodiment of the upper mounting facility.
Some embodiments of the brace assembly may be utilized as a hyperextension prevention brace with hinges. Embodiments may be unilateral or bilateral. Embodiments may maintain position of brace on the knee sliding due to the elastic cross straps. Embodiments may be used as post-operative hyperextension prevention for ACL surgery.
Some embodiments of the brace assembly may be utilized as a hyperextension patellar-femoral brace. Embodiments may apply a hinge unilaterally or bilaterally with extension stops and the elastic cross strap design to help position the knee for patella tracking in the grove. Embodiments may apply lateral buttress and straps to apply medial force to the patella.
In some embodiments, the mounting facilities may be calibrated and configured to restrict the blood-flow to the muscles around the joint to provide the benefits referred to as “occlusion training”. In these embodiments, the mounting facilities are configured to wrap around the top of a limb (proximal to the heart) at a pressure sufficient to occlude, or obstruct, blood flow to the veins but not in the arteries. A pressure from about a 70% of maximum tightness is typically sufficient to provide the benefits of occlusion training. The pressure is intended to allow the arteries to continue to deliver blood to the limb but the blood is retained in the limb since the veins cannot take it back to the heart. Occlusion training provides benefits of positive physiological adaptations at lower muscle loads which can benefit postoperative patients or patients who are unable to sustain high muscle loads due to joint pain. Occlusion training produces muscle development by reducing the oxygen supply to the muscles which results in the development/adaptation of the large fast twitch muscle fibers to handle any muscle load and allows the accumulation of compounds in the blood that simulates other beneficial reactions such as the release of human growth hormones.
In some embodiments, the cable and tightening mechanism for the cross strap may be similar to the cable and tensioning mechanisms disclosed in U.S. Pat Pub. No. 2013/0184628, filed Jan. 11, 2013 to Ingimundarson et al.; the entire contents of which are herein incorporated by reference. In some embodiments, the cable and tightening mechanism for the cross strap may be similar to the cable and tightening devices disclosed in in U.S. Pat. Pub. No. 2014/0194801, filed Jul. 10, 2014 to Thorsteinsdottir et al.; the entire contents of which are herein incorporated by reference.
Some embodiments are capable of providing a dynamic elastic brace assembly that protects the knee by keeping it in an ‘athletic position’ protecting the ligaments and allowing the muscles around the knee to stabilize while protecting against muscle atrophy. These embodiments may be an alternative to taping the joint whereby there is no need to re-apply loose tape between events and no more costly continuous tape purchases. These embodiments provide an alternative to functional braces providing less slippage due to heavy, rigid structures and reduced skill limitations. Embodiments may provide extension prevention like a rigid brace but with the comfort and normal control of a taping procedure. Embodiments may be capable of being designed without metal and therefore may be used in sports that do not allow metal braces.
Some embodiments may be less costly, lighter weight, can be loosened between break times, intermissions and time-outs. Embodiments may control against knee hyperextension; a major cause of ACL tears and failure of ACL surgical repairs. Embodiments may control hyperextension by gradually increasing resistance such that the athlete experiences a “soft stop” which is more comfortable and doesn't shift the brace down the leg like a normal metal brace with hinges that creates a “hard stop”. Embodiments may mimic taping procedures that have been proven to outperform expensive functional braces. Embodiments may be less expensive and less irritating than repeatedly taping the knee or purchasing a custom fit or off-the shelf functional brace for sports, thereby increasing the number of athletes of all ages that can protect their knee during sports. Embodiments may be used as a training brace by adding a hip rotation strap that will teach athletes how to properly jump and land without tearing their ACL. Embodiments may be easily removed or partially released during short and long rest periods during athletic events, unlike functional braces that have to remain applied and often taped in place to prevent slippage. Embodiments may be applied to all leg shapes and sizes without losing its effectiveness. Many body types and heavy people cannot wear a functional knee brace. Embodiments may be used on both knees at the same time for training and preventative use.
Some embodiments may also increase quadriceps muscle strength because they provide resistance to extension. Embodiments may be light weight and easy to apply. Embodiments may allow the elastic/dynamic cross straps to be inexpensively replaced after multiple uses or breakage thus maintaining the active control of knee motions. Embodiments can act as the foundation to add accessory pieces that will protect against side blows (hinged lateral paddle), unstable knee caps (lateral buttress), or shin guards for soccer and motocross. Embodiments may be comfortably worn under pants or athletic gear. Embodiments may be worn during skiing without requiring shorter ski boots or shorter less effective braces.
In addition, some embodiments may further include additional features such as, but not limited to: side paddle with a hinge that can be added for lateral support, breathable over-sleeve, hip rotation training strap and different colors.
Some embodiments of the brace assembly may be utilized as a hyperextension prevention brace where it may prevent hyperextension of the knee during activity, they may be used as a training brace for practice or game keeping the knee in a “athletic” position, and they may be used in sports in which braces with any metal can't be used (e.g., soccer, etc.).
In some embodiments, the proximal and distal straps may be wider than shown, about three inches (3″) that wrap around the front and then attach to help hold the mounting facilities down. In some embodiments, the stabilizing straps also may be longer and wrap around the anterior of the limb and then attach to help hold the mounting facilities on the limb. In some embodiments, the elastic cross straps may be moved to the most distal position with the angle of the buckle changed to align with the direction of the strap. In some embodiments, conform tape may be used on the skin to enhance the interface with the brace.
Although not necessary, in some embodiments of the assembly, the assembly further includes a covering that can be decorative and/or can provide a sleek/smooth surface for the wearer.
One example embodiment of the disclosed inventions will be used to further illustrate the operational aspects of the invention. Although the embodiment discussed utilizes an assembly embodiment with a shin shell as the lower mounting facility, it is understood that embodiments of the invention may be applied to an assembly without a shin shell. For those other embodiments, such as shown in
One example embodiment of the invention, as shown in
Once secured on the thigh 104 and the tibia, the presence of the elastic straps in the X configuration provides resistance to knee extension and helps prevent the knee from hyperextension. Hyperextension is prevented by the cooperation of the secured ends of the straps with the positioning of the straps behind the knee. The elastic properties of the cross strap can provide resistive properties early in the motion arch of the joint thereby help control extension early in the motion arch. As the joint extends, the elastic straps stretch and provide progressively more resistance. When the knee reaches a desired limit, the elastic straps reach a significant resistance level that prevents further extension. This resistance does not provide a hard stop of the extension. By not having a hard stop, brace migration is minimized as well as the discomfort caused by sudden jerking of the brace when the hard stop if reached. Additionally, this resistance approach uniquely provides therapeutic benefits such as increasing neuromuscular control and causing the extensor muscles to gradually strengthen which is beneficial for joint stability.
The point of attachment, facility attachment points 142 and 122, of the elastic straps and the thigh and tibial pad respectively are such that the desired resistance provided by the anterior resistance points allow proper knee movement but prevents hyperextension. Additionally, if the brace assembly 100 has good frictional contact with the skin, rotational support of the knee joint is also provided. As the wearer uses the brace assembly, and as their need for support and/or comfort changes, the elastic straps can be tightened or loosened to change the elastic tension on the system by simply removing and reattaching the straps with the Velcro attaching means.
The embodiment of
The embodiment of
The embodiments of
The embodiments of
The example embodiments illustrated in
The embodiments of
The embodiments of
The example embodiments of
The embodiment shown in
The embodiments shown in
The embodiments shown in
The embodiments shown in
For some embodiments, the length of the strap, and the tension put on the strap when attaching to the attachment points, can be varied to vary the resisting force on the joint utilizing attachment means described earlier.
With respect to the above description then, it is to be realized that the optimum dimensional relationships for the parts of the invention, to include variations in size, materials, shape, form, function and manner of operation, assembly and use, are deemed readily apparent and obvious to one skilled in the art, and all equivalent relationships to those illustrated in the drawings and described in the specification are intended to be encompassed by the present invention.
Therefore, the foregoing is considered as illustrative only of the principles of the invention. Further, since numerous modifications and changes will readily occur to those skilled in the art, it is not desired to limit the invention to the exact construction and operation shown and described, and accordingly, all suitable modifications and equivalents may be resorted to, falling within the scope of the invention. Although this invention has been described in the above forms with a certain degree of particularity, it is understood that the present disclosure has been made only by way of example and numerous changes in the details of construction and combination and arrangement of parts may be resorted to without departing from the spirit and scope of the invention.
This application claims benefit of U.S. Pat. App. No. 62/186,192 filed Jun. 29, 2015; this application also claims benefit of U.S. Pat. App. No. 62/300,131 filed Feb. 26, 2016; this application is also a Continuation in Part App. of U.S. patent application Ser. No. 14/447,703 filed Jul. 31, 2014; U.S. patent application Ser. No. 14/447,703 claims benefit of U.S. Pat. App. No. 61/864,674 filed Aug. 12, 2013; U.S. patent application Ser. No. 14/447,703 is a Continuation in Part App. of U.S. patent application Ser. No. 12/993,258 filed Nov. 18, 2010 now U.S. Pat. No. 8,852,133 issued Oct. 7, 2014, U.S. patent application Ser. No. 12/993,258 is the U.S. National Stage App. of International App. No. PCT/US09/46183 filed Jun. 3, 2009, International App. No. PCT/US09/46183 claims benefit of U.S. Pat. App. No. 61/148,973 filed Feb. 1, 2009 and International App. No. PCT/US09/46183 claims benefit of U.S. Pat. App. No. 61/058,555 filed Jun. 3, 2008; U.S. patent application Ser. No. 14/447,703 is also a Continuation in Part App. of U.S. patent application Ser. No. 13/188,506 filed Jul. 22, 2011 now U.S. Pat. No. 8,808,211 issued Aug. 19, 2014, U.S. patent application Ser. No. 13/188,506 claims benefit of U.S. Pat. App. No. 61/466,909 filed Mar. 23, 2011, U.S. patent application Ser. No. 12/188,506 is a Continuation in Part App. of International App. No. PCT/US09/67152 filed Dec. 8, 2009, International App. No. PCT/US09/67152 claims benefit of U.S. Pat. App. No. 61/262,723 filed Nov. 19, 2009, International App. No. PCT/US09/67152 claims benefit of U.S. Pat. App. No. 61/263,737 filed Nov. 23, 2009, International App. No. PCT/US09/67152 is a Continuation in Part App. of International App. No. PCT/US09/46183 filed Jun. 3, 2009, International App. No. PCT/US09/46183 claims benefit of U.S. Pat. App. No. 61/058,555 filed Jun. 3, 2008, International App. No. PCT/US09/46183 claims benefit of U.S. Pat. App. No. 61/148,973 filed Feb. 1, 2009, U.S. patent application Ser. No. 12/188,506 is a Continuation in Part App. of U.S. patent application Ser. No. 12/993,258 filed Nov. 18, 2010 now U.S. Pat. No. 8,852,133 issued Oct. 7, 2014, U.S. patent application Ser. No. 12/993,258 is the U.S. National Stage App. of International App. No. PCT/US09/46183, International App. No. PCT/US09/46183 claims benefit of U.S. Pat. App. No. 61/058,555 filed Jun. 3, 2008 and International App. No. PCT/US09/46183 claims benefit of U.S. Pat. App. No. 61/148,973 filed Feb. 1, 2009; U.S. patent application Ser. No. 14/447,703 is also a Continuation in Part App. of U.S. patent application Ser. No. 13/541,796 filed Jul. 5, 2012 now U.S. Pat. No. 9,320,634 issued Apr. 26, 2016, U.S. patent application Ser. No. 13/541,796 claims benefit of U.S. Pat. App. No. 61/504,341 filed Jul. 5, 2011, U.S. patent application Ser. No. 13/541,796 is a Continuation in Part App. of U.S. patent application Ser. No. 13/188,506 filed Jul. 22, 2011 now U.S. Pat. No. 8,808,211 issued Aug. 19, 2014, U.S. patent application Ser. No. 13/188,506 is a Continuation in Part App. of International App. No. PCT/US09/67152 filed Dec. 8, 2009, U.S. patent application Ser. No. 13/188,506 claims benefit of U.S. Pat. App. No. 61/466,909 filed Mar. 23, 2011, International App. No. PCT/US09/67152 claims benefit of U.S. Pat. App. No. 61/262,723 filed Nov. 19, 2009, International App. No. PCT/US09/67152 claims benefit of U.S. Pat. App. No. 61/263,737 filed Nov. 23, 2009, International App. No. PCT/US09/67152 is a Continuation in Part App. of International App. No. PCT/US09/46183 filed Jun. 3, 2009, International App. No. PCT/US09/46183 claims benefit of U.S. Pat. App. No. 61/058,555 filed Jun. 3, 2008, International App. No. PCT/US09/46183 claims benefit of U.S. Pat. App. No. 61/148,973 filed Feb. 1, 2009, U.S. patent application Ser. No. 13/541,796 is a Continuation in Part App. of U.S. patent application Ser. No. 12/993,258 filed Nov. 18, 2010 now U.S. Pat. No. 8,852,133 issued Oct. 7, 2014, U.S. patent application Ser. No. 12/993,258 is the U.S. National Stage App. of International App. No. PCT/US09/46183, International App. No. PCT/US09/46183 claims benefit of U.S. Pat. App. No. 61/058,555 filed Jun. 3, 2008 and International App. No. PCT/US09/46183 claims benefit of U.S. Pat. App. No. 61/148,973 filed Feb. 1, 2009; and this application incorporates by reference all of the above referenced applications in their entirety.
| Number | Date | Country | |
|---|---|---|---|
| 62186192 | Jun 2015 | US | |
| 62300131 | Feb 2016 | US | |
| 61864674 | Aug 2013 | US | |
| 61148973 | Feb 2009 | US | |
| 61058555 | Jun 2008 | US | |
| 61262723 | Nov 2009 | US | |
| 61263737 | Nov 2009 | US | |
| 61058555 | Jun 2008 | US | |
| 61148973 | Feb 2009 | US | |
| 61504341 | Jul 2011 | US | |
| 61466909 | Mar 2011 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 14447703 | Jul 2014 | US |
| Child | 15195618 | US | |
| Parent | 13188506 | Jul 2011 | US |
| Child | 14447703 | US | |
| Parent | 12993258 | Nov 2010 | US |
| Child | 13188506 | US | |
| Parent | 13541796 | Jul 2012 | US |
| Child | 12993258 | US | |
| Parent | PCT/US09/67152 | Dec 2009 | US |
| Child | 13541796 | US | |
| Parent | PCT/US09/46183 | Jun 2009 | US |
| Child | PCT/US09/67152 | US | |
| Parent | 12993258 | Nov 2010 | US |
| Child | 13188506 | US | |
| Parent | 12993258 | Nov 2010 | US |
| Child | 13541796 | US | |
| Parent | 13188506 | Jul 2011 | US |
| Child | 12993258 | US | |
| Parent | PCT/US09/67152 | Dec 2009 | US |
| Child | 13188506 | US |
