Patent Application
20250120836
The present application claims priority from Australian Patent Application No. 2021204640 filed on 1 Jul. 2021, the content of which is incorporated herein by reference.
The present disclosure relates to apparatus and methods for rehabilitating a joint of a body.
Joint Range of Motion (ROM) rehabilitation is typically carried out following knee arthroplasty, such as partial or full knee replacement, in an attempt to restore normal range of motion to a desirable extent. Certain pathologies of the knee may also require range of motion rehabilitation.
Other joints of the human body, such as the elbow, ankle, wrist, hip, and shoulder joints, etc., can also require joint range of motion rehabilitation following similar surgical procedures or due to certain pathologies.
While patients can perform their own ROM rehabilitation at home, regular visits from or to a physiotherapist is typically required, particularly when the patient is weaker or when more complex exercises are to be performed.
Time lost between visits from or to a physiotherapist to perform RoM exercises can significantly delay the time taken to restore the desired range of motion of a joint.
Any discussion of documents, acts, materials, devices, articles or the like which has been included in the present specification is not to be taken as an admission that any or all of these matters form part of the prior art base or were common general knowledge in the field relevant to the present disclosure as it existed before the priority date of each of the appended claims.
According to one aspect of the present disclosure, there is provided an apparatus for joint range of motion rehabilitation of a wearer of the apparatus, the apparatus comprising:
In some embodiments, the joint may be a knee joint, elbow joint or ankle joint, for example. Thus, the first and second limb portions may be upper and lower leg portions (knee joint), upper and lower arm portions (elbow joint) or lower leg and foot portions (ankle joint). Nevertheless, the apparatus may be used with a variety of other joints and limb portions such as hip, shoulder, wrist, finger joints or otherwise. In some embodiments, the apparatus may be generally configured as a brace, e.g. a knee brace, elbow brace or ankle brace, etc.
In some embodiments, the mechanical system may comprise an actuator configured to partially or entirely drive the flexion and extension movement of the second support relative to the first support. In some embodiments, the actuator may comprise a handle.
The actuator may be operable by the wearer of the apparatus. Additionally or alternatively, the actuator may be operable by a physiotherapist or other caregiver. In some embodiments, the actuator may be removable from the apparatus, e.g. to reduce the size of the apparatus for storage or otherwise. In some embodiments, the mechanical system may be entirely manually operable, although in other embodiments the actuator of the mechanical system may comprise a powered drive means such as a motor to partially or entirely drive the flexion and extension movement. Manual operation of the mechanical system may in some instances include the wearer partially or entirely driving the flexion and extension movement of the second support relative to the first support by carrying out native flexion and extension movement of the second limb portion relative to the first limb portion.
The arrangement of the apparatus may make it particularly suitable for self-administrable therapy, independent of a physiotherapist, and thus a desired ROM of a joint may be achieved in a significantly reduced time period and in a more efficient manner.
In some embodiments, the mechanical system may comprise a mechanism configured to control or enable the rotation and translation of the second support relative to the first support during the flexion and extension movement. The mechanical system may comprise a housing and the mechanism may be at least partly located in the housing.
In some embodiments, the mechanism may comprise a gear system and/or mechanical linkage, for example. The gear system may be a planetary gear system, for example. In some embodiments, to achieve both the rotational and translational movement, the mechanism may comprise a cam member or cam surface and/or may comprise asymmetrically configured gearing or mechanical linkage components. For example, a twin asymmetric planetary gear system may be utilised in some embodiments.
In some embodiments, the mechanical system may comprise first and second arms configured to be fixed to the first support and the second support, respectively. The arms may be elongate and substantially rigid (e.g. by being formed of rigid plastic or metal) and configured to extend partially or entirely along a length of the respective support. The first and second arms may rotate with the first and second supports, respectively, and generally assist in the transfer of forces between the mechanical system and the respective supports. In some embodiments, the first and second arms may rotate by being connected via a gear system as described above, or the first and second arms may rotate by being connected via a hinge, for example.
In some embodiments, at least one of the first and second arms may be adjustable in length. For example, at least one of the first and second arms may be adjustable in length by comprising first and second arm portions that are slidable relative to each other, e.g. by being configured in a telescoping arrangement or otherwise. The first arm portion may be fixed to a respective portion of the hinge and the second arm portion may be fixed to the respective support. Therefore, while the first and second supports rotate relative to each other by virtue of the hinge, the first and second supports can also translate relative to each other upon adjusting of the length of the second arm. During the flexion and extension movement of the second support relative to the first support, and therefore the rotation of the second arm relative to the first arm, an effective length of the at least one of the first and second arms having the adjustable length, e.g. the second arm fixed to the second support, may adjust to enable the translation of the second support relative to the first support. The adjustable arm may enable the translation of the second support relative to the first support as an addition to, or as an alternative to, use of other mechanism features such as the gear system and/or mechanical linkage described above.
The arrangement of the different embodiments of the mechanism may ensure that the first and second supports do not rotate about a uniform centre of rotation. For example, in some embodiments, a pivot point between the first and second supports may move along an arcuate path during the flexion and extension movement.
In some embodiments, the housing may be configured to be positioned substantially adjacent a centre of rotation of the joint when the first support and the second support are secured to the first limb portion and the second limb portion, respectively. In some embodiments, the actuator may form part of, or be configured to engage with, the housing.
In some embodiments, the translation of the second support relative to the first support may be configured to cause or enable an anterior-posterior translation of the second limb portion relative to the first limb portion. For example, the translation of the second support relative to the first support may be configured to cause or enable an anterior translation of the second limb portion relative to the first limb portion during extension movement of the second support relative to the first support and a posterior translation of the second limb portion relative to the first limb portion during flexion movement of the second support relative to the first support.
In addition to or as an alternative to the anterior-posterior translation, the translation of the second support relative to the first support may be configured to cause or enable an axial translation of the second limb portion relative to the first limb portion.
In some embodiments, the flexion and extension movement may comprise at least one phase wherein the rotation and the translation of the second support relative to the first support occurs simultaneously. In some embodiments, for example, the entire flexion and extension movement, between maximum degrees of flexion and extension, may comprise simultaneous rotation and translation of the second support relative to the first support. Alternatively, the flexion and extension movement may comprise at least one phase wherein the rotation of the second support relative to the first support occurs substantially without the translation of the second support relative to the first support.
The rate of translation of the second support relative to the first support may be non-uniform during the flexion and extension movement. For example, in some embodiments, during a full flexion movement of the second support relative to the first support, from a maximum degree of extension to a maximum degree of flexion, a highest rate of translation of the second support relative to the first support may occur during an intermediate phase of the full flexion movement. The intermediate phase may be between 20% and 60%, or 30% and 50%, of the full flexion movement, for example.
In some embodiments, during a full flexion movement of the second support relative to the first support, from a maximum degree of extension to a maximum degree of flexion, a lowest rate of translation, or substantially no translation, of the second support relative to the first support, may occur during a beginning and/or end phase of the full flexion movement. The beginning phase may be between 0% and 30%, or 0% and 20%, of the full flexion movement, for example. The end phase may be between 50% and 100%, or 60% and 100%, of the full flexion movement, for example.
In the above examples, while the rotation and translation of the second support relative to the first support during a full flexion movement is described, it will be recognised that the rotation and translation of the second support relative to the first support can occur in reverse for a full extension movement. In this regard, the first and second supports may move backwards and forwards along the same path during the flexion and extension movements, respectively. Nevertheless, it is conceived that the mechanical system may alternatively be configured so that the first and second support may move backwards and forwards along different paths during the flexion and extension movements, respectively.
By configuring the mechanical system so that, during the flexion and extension movements, the first support and the second support both rotate and translate relative to one another, the apparatus may provide for enhanced ROM rehabilitation. For example, the movement of the first and second supports of the present mechanical system may provide for a more natural or native movement of the first and second limb portions either side of the joint. Additionally or alternatively, the movement of the first and second supports may provide a more effective rehabilitation movement of the first and second limb portions.
In some embodiments, the apparatus may comprise one or more extension and/or flexion limiters configured to limit a maximum degree of extension and/or flexion of the second support relative to the first support. The extension and/or flexion limiter may ensure that the wearer does not over-extend, e.g. hyperextend, and/or over-flex, e.g. hyperflex, the limb portions when using the apparatus. In some embodiments, the extension and/or flexion limiter may be adjustable to change the maximum degree of extension and/or flexion of the second support relative to the first support. For example, the extension and/or flexion limiter may be a movable blocking element having an abutment surface that abuts one or more components of the mechanical system and the mechanism that controls or enables the rotation and translation of the second support relative to the first support, when a desired maximum degree of extension and/or flexion is reached.
In some embodiments, the apparatus may comprise one or more indicators configured to indicate a degree of flexion of the second support relative to the first support achieved during the flexion movement and/or a degree of extension of the second support relative to the first support achieved during the extension movement. In some embodiments, the indicators may indicate a maximum degree of flexion of the second support relative to the first support achieved during the flexion movement and/or a maximum degree of extension of the second support relative to the first support achieved during the extension movement. Each indicator may be in the form of a dial. Each indicator may comprise a selection element, and one or more indicia elements movable relative to the selection element during the flexion and/or extension movement. The selection element may be a window, line or pointer, for example. The one or more indicia elements may be a colour or shading gradient, a plurality of different numbers (e.g. indicating specific numerical degrees or angles of rotation), or symbols, for example. In this regard, any reference in the present specification to indication of the “degree” of flexion and/or extension need not necessarily require indication of a specific numerical degree (or angle) of rotation, but may include a more general indication of an extent to which flexion or extension has occurred, or is occurring. The alignment of a particular indicia element or portion of indicia element with the selection element may be indicative of the degree of flexion and/or extension movement at a particular point in time. In some embodiments, to indicate the maximum degree of flexion and/or extension achieved, an indicia element or portion of indicia element may be configured to remain aligned with the selection element until the maximum degree of flexion and/or extension is subsequently exceeded.
In some embodiments, the one or more indicators may be positioned to be directly observable by (e.g., in line of sight of) the wearer of the apparatus. For example, the one or more indicators may be positioned on or at a peripheral surface of the housing. The housing may be of a cylindrical or drum shape, for example, and the one or more indicators may be positioned on or at a curved peripheral wall of the housing. The peripheral surface or curved peripheral wall may be configured to face in a proximal or anterior direction or the limb on which the apparatus is worn, or a generally superior or anterior direction of the wearer's body.
In some embodiments, one or both of the first support and the second support may comprise one or more straps to be secured to the respective first limb portion or second limb portion. Additionally or alternatively, one or both of the first support and the second support may comprise one or more sleeve portions configured to be secured to the respective first limb portion or second limb portion. The sleeve portions may be elasticated for example, and may comprise elasticated rubber such as neoprene (polychloroprene), for example. In some embodiments, one or both of the first support and the second support may be secured to the respective first limb portion or second limb portion using one or more fasteners such as a hook and loop fastener; a buckle fastener; a snap fastener; and/or a hook-eye fastener. The fastener may be partially or entirely comprised in the straps, the sleeve portions or other components of the supports. In some embodiments, the first support and the second support may comprise one or more pads to ensure comfort for the wearer.
When the first and/or second supports comprise sleeve portions, the sleeve portions may have a rigid or semi-rigid section receiving section that is fixed to the respective first and second arm of the mechanical system. The receiving section may be fixed to the sleeve portion via an adhesive, for example, and the arm may be fixed to the receiving section using adhesive and/or screws for example.
According to another aspect of the present disclosure, there is provided a method of performing joint range of motion rehabilitation comprising:
In some embodiments, operation of the mechanical system may comprise use of an actuator to partially or entirely drive the flexion and extension movement of the second support relative to the first support. However, in other embodiments, operation of the mechanical system may comprise the wearer partially or entirely driving the flexion and extension movement of the second support relative to the first support by carrying out native flexion and extension movement of the second limb portion relative to the first limb portion.
In the present disclosure, while focus is given to apparatus having a mechanical system configured so that a first support and a second support rotate and translate relative to one another, it will be recognised that a variety of features disclosed herein may still be used advantageously without the first support and the second support necessarily rotating and translating relative to one another. For example, the configuration of the supports, the flexion or extension limiters, the housing, the arms, and/or indicators, etc., may be used advantageously within apparatus in which the first support and the second support rotate relative to one another but do not necessarily translate relative to one another.
Throughout this specification the word “comprise”, or variations such as “comprises” or “comprising”, will be understood to imply the inclusion of a stated element, integer or step, or group of elements, integers or steps, but not the exclusion of any other element, integer or step, or group of elements, integers or steps.
By way of example only, embodiments are now described with reference to the accompanying drawings, in which:
One or more embodiments of the present disclosure may provide, at least in part, an apparatus for joint range of motion rehabilitation.
In this embodiment, the apparatus 100 is in the form of a knee brace, and configured for rehabilitation of a knee. Thus, the first and second limb portions are the upper leg and lower leg portions, respectively, that are located either side of the knee. Nevertheless, the apparatus 100 may be configured for use with a variety of other joints and limb portions such as elbow, ankle or finger joints, or otherwise.
In this embodiment, the first support 110 and the second support 120 of the apparatus 100 each include attachment devices, in the form of straps 111, 121, that are spaced apart from each other and configured to extend around the limb portions to secure the supports 110, 120 to the limb portions. As illustrated in
To assist in transferring forces between the mechanical system 140 and the first and second supports 110, 120, the mechanical system 140 includes first and second arms 113, 123, each arm 113, 123 being generally elongate and substantially rigid. Each arm 113, 123 is fixed to portions of the supports 110, 120, such as the straps 111, 112. In this embodiment, with reference to
In an alternative embodiment, with reference to
Again, to assist in transferring forces between the mechanical system 240 and the first and second supports 210, 220, the mechanical system 240 includes first and second arms 213, 223, each arm 213, 223 being elongate and substantially rigid. Each arm 213, 223 is fixed to portions of the supports 210, 220, and in particular the sleeve portions 211, 221. The supports 210, 220 each have a rigid or semi-rigid receiving section 215, 225 that is fixed to the respective sleeve portion 211, 221 via an adhesive, for example, and the arm 213, 223 is received by and fixed to the receiving section 215, 225 using adhesive and/or screws or rivets 214, for example. In this embodiment, a proximal end region 2131, 2231 of each arm 213, 223 is engaged with a mechanism of the mechanical system 240, and an intermediate end region 2132, 2232 and distal end region 2133, 2233 of each arm 213, 223 is fixed to the receiving section 215, 225.
In any embodiment, the first and second supports 110, 120, 210, 220 including the straps or sleeve portions, can be fabricated from any suitable materials. The materials may be water resistant, breathable and/or at least partially elastic, for example. The materials may include an antibacterial material, to neutralize odour, a padding material, such as foam, to increase comfort and durability, and/or a gripping material to increase the grip of the apparatus against the first limb portion and the second limb portion to avoid migration of the apparatus during the flexion and extension movement.
The features and operation of the mechanical system 140 are now described in more detail with reference to the embodiment illustrated in
Advantageously, the handle 142a, 142b may be operable by the wearer of the apparatus 100. Additionally or alternatively, however, the handle 142a, 142b may be operable by a physiotherapist or other caregiver. In some embodiments, the handle 142a, 142b may be removable from the apparatus 100, e.g. to reduce the size of the apparatus 100 for storage, to enable use of the apparatus like a traditional brace (e.g. under clothing), or otherwise.
The mechanical system 140 of the present embodiment is manually operable, although in other embodiments the actuator of the mechanical system may comprise a powered drive means such as a motor to partially or entirely drive the flexion and extension movement. In the present embodiment, in addition to or instead of using the handle 142a, 142b, manual operation of the mechanical system may include the wearer partially or entirely driving the flexion and extension movement of the second support 120 relative to the first support 110 by carrying out native flexion and extension movement of the second limb portion relative to the first limb portion.
The arrangement of the apparatus 100 may make it particularly suitable to allow for self-administrable therapy, independent of a physiotherapist, and thus a desired range of motion of a joint may be achieved in a significantly reduced time period and in a more efficient manner.
In this embodiment, the mechanical system 140 includes a housing 141 and a mechanism 142 (see
The housing 141 is a substantially cylindrical or drum shaped housing in this embodiment, including a lateral wall 1411, which is substantially circular and flat in this embodiment, and a peripheral/side wall 1412, which is curved and extends around a peripheral edge of the lateral wall 1411 in this embodiment. The handle 142a, 142b engages the housing 141 via an opening in the lateral wall 1411.
With reference to
A mechanism 342 of a mechanical system 340 according to an alternative embodiment of the present disclosure is illustrated in
In the above-described embodiments, the mechanical system 140, 240, 340 is configured such that translation of the second support 120, 220 relative to the first support 110, 210 causes or enables an anterior-posterior translation of the second limb portion relative to the first limb portion. In particular, the translation of the second support 120, 220 relative to the first support 110, 210 causes or enables an anterior translation of the second limb portion relative to the first limb portion during extension movement of the second support 120, 220 relative to the first support 110, 210 and a posterior translation of the second limb portion relative to the first limb portion during flexion movement of the second support 120, 220 relative to the first support 110, 210. Additionally, the translation of the second support 120, 220 relative to the first support 110, 210 causes or enables a degree of axial translation of the second limb portion relative to the first limb portion.
The mechanical system 140, 240, 340 is configured so that the flexion and extension movement comprises one or more phases wherein the rotation and the translation of the second support 120, 220 relative to the first support 110, 210 occurs simultaneously, and optionally, one or more phases where rotation of the second support 120, 220 relative to the first support 110, 210 occurs substantially without the translation of the second support 120, 220 relative to the first support 110, 210.
The mechanical system 140, 240, 340 is configured so that the rate of translation, and particularly the rate of anterior-posterior translation, of the second support 120, 220 relative to the first support 110, 210, is non-uniform during the flexion and extension movement. During a full flexion movement of the second support 120, 220 relative to the first support 110, 210 from a maximum degree of extension to a maximum degree of flexion, a highest rate of translation of the second support 120, 220 relative to the first support 110, 210 occurs during an intermediate phase of the full flexion movement. The intermediate phase is between 20% and 60%, or 30% and 50%, of the full flexion movement, in this embodiment.
During a full flexion movement of the second support 120, 220 relative to the first support 110, 210 from a maximum degree of extension to a maximum degree of flexion, a lowest rate of translation, particularly anterior-posterior translation, or substantially no translation, of the second support 120, 220 relative to the first support 110, 210, occurs during the beginning and end phases of the full flexion movement. The beginning phase is between 0% and 30%, or 0% and 20%, of the full flexion movement, in this embodiment. The end phase is between 50% and 100%, or 60% and 100%, of the full flexion movement, in this embodiment.
A mechanical system 440 according to an alternative embodiment of the present disclosure is illustrated in
In this embodiment, the hinge 4420 is configured to be positioned substantially adjacent a centre of rotation of the joint when the first and second supports are secured to the first and second limb portions, respectively. The hinge 4420 may be configured to receive or connect to an actuator (not illustrated), such as a handle, the actuator configured to partially or entirely drive the flexion and extension movement of the second support relative to the first support.
At least one of the first and second arms 413, 423, and particularly the second arm 423 in this embodiment, is adjustable in length. The second arm 423 is adjustable in length by comprising first and second arm portions 4421, 4422 that are slidable relative to each other, e.g. by being configured in a telescoping arrangement. The first arm portion 4421 is fixed to the respective portion of the hinge 4420 and second arm portion 4422 is fixed to the second support. Therefore, while the first and second supports relative to each other by virtue of the hinge 4420, the first and second supports can also translate relative to each other upon adjusting of the length of the second arm 423. In general, the hinge 4420 and first and second arm portions 4421, 4422 of the second arm 423 of the mechanical system 440 are configured to work in conjunction to enable both the desired relative rotational and translational movements of first and second supports, and optionally to provide mechanical advantage to assist the user in manually operating the apparatus.
In this embodiment, while the first and second arms 413, 423 rotate about a uniform centre or rotation during the flexion and extension movement of the second support relative to the first support, the second support can be translated relative to the first support due to the adjusting of the length of the second arm 423 and such that such that a notional pivot point between the first and second supports moves along an arcuate path during the flexion and extension movement.
In this embodiment, the mechanical system 440 is configured such that, during the flexion and extension movement and therefore during the rotation of the second arm 423 relative to the first arm 413, translation of the second support relative to the first support is achieved through adjustment of the length of the second arm 423, thereby causing or enabling relative movement of respective limb portions that are secured to the first and second supports. The relative rotational and translational movements of the limb portions, including the rate of change of these movements, may be similar or identical to that described above with respect to previous embodiments.
In an alternative embodiment, the length adjustable arm as described above may be employed in conjunction with other mechanism features such as the gear system and/or mechanical linkage described in embodiments above, in order to assist in the translation of the second support relative to the first support.
In the above description of the mechanical system 140, 240, 340, 440, while the translation during a full flexion movement is described, the arrangement is substantially reversed for a full extension movement. In this regard, the first and second supports 110, 210, 120, 220 can move backwards and forwards along the same path during the flexion and extension movements, respectively. Nevertheless, it is conceived that the mechanical system 140, 240, 340, 440 may alternatively be configured so that the first and second supports 110, 210, 120, 220 may move backwards and forwards along different paths during the flexion and extension movements, respectively. In the above description, the specific nature of the rotation and translation may be particularly suited to rehabilitation of a knee joint, and may be adapted for other joints if necessary.
By configuring the mechanical system 140, 240, 340, 440 so that, during the flexion and extension movement, the first support 110, 210 and the second support 120, 220 both rotate and translate relative to one another (e.g., rather than rotate only), the apparatus 100, 200 provides for enhanced joint range of motion rehabilitation. For example, the movement of the first and second supports 110, 210, 120, 220 of the mechanical system 140, 240, 340, 440 provides for a more natural or native movement of the first and second limb portions either side of the joint.
In some embodiments, the apparatus 100, 200 includes one or more flexion and/or extension limiters configured to limit a maximum degree of extension and/or flexion of the second support 120, 220 relative to the first support 110, 210. A portion of a mechanical system 540, similar to those discussed above, but which includes a flexion limiter 545 and an extension limiter 546 is illustrated in
In some embodiments, the apparatus 100, 200 includes at least one indicator 147, 547 configured to indicate a degree of flexion of the second support 120, 220 relative to the first support 110, 210 achieved during the flexion movement and/or a degree of extension of the second support 120, 220 relative to the first support 110, 210 achieved during the extension movement. An indicator 147 is included in the mechanical system 140 illustrated in
The indicator 147, 547 may be generally in the form of a dial, and may include a selection element, which can be in the form of a window 5471, and one or more indicia elements 5472, which are movable relative to the selection element 5471 during the flexion and/or extension movement. An indicia element 5472 in this embodiment is provided by a colour or shading gradient. However, in alternative embodiments a sequences of numbers (e.g. numbers indicating a specific numerical value of angle and/or degree of rotation) or symbols representative of degrees of rotation may be used, which numbers or symbols sequentially align with the window 5471 during the flexion and extension movement. The alignment of the one or more indicia elements, or portions thereof, with the window 5471, is indicative of the degree of flexion and/or extension at a particular point in time. In some embodiments, to indicate the maximum degree of flexion and/or extension achieved, the indicia element or a portion of the indicia element may be configured to remain aligned with the selection element, until the maximum degree of flexion and/or extension is subsequently exceeded.
In these embodiments, the indicator 147, 547 is positioned so that it can be directly observed by the wearer of the apparatus. As seen in
It will be appreciated by persons skilled in the art that numerous variations and/or modifications may be made to the above-described embodiments, without departing from the broad general scope of the present disclosure. The present embodiments are, therefore, to be considered in all respects as illustrative and not restrictive.
| Number | Date | Country | Kind |
|---|---|---|---|
| 2021204640 | Jul 2021 | AU | national |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/AU2022/050656 | 6/27/2022 | WO |
