This invention relates generally to exoskeletal devices, and more particularly to load-bearing exoskeletons that can support weight.
Back pain is a common occupational injury, which can lead to lost productivity and significant expenditures of medical resources annually. Back pain is often associated with occupations requiring frequent bending and lifting maneuvers, which can impose considerable loads on the spine. While large loads increase the risk for injury, sustained static flexion of the spine while supporting the weight of the trunk alone can also lead to back pain as the extensor muscles of the lower back become fatigued. Similarly, prolonged awkward postures of the head and neck can produce discomfort.
During various treatment procedures, physicians are often required to adopt sustained static flexion of the spine. The performance of physicians in the operating room can be adversely affected by postural fatigue and discomfort, which are aggravated by the static postures frequently required during procedures. General surgeons, for example, can spend 65% of their operating time in static postures of the head and neck, with 14% of those in a flexed (forward bent) position. Physicians who perform minimally-invasive (e.g., laparoscopic, endoscopic, etc.) surgical procedures also experience long periods of static postures.
One subgroup of operating physicians that is believed to experience a higher-than-average incidence of back pain is interventionalists. These include neurosurgeons, radiologists, and cardiologists, for example, who operate using real-time radiography. The radiation levels in the operating room require the use of shielding garments (also called “leads”) for the full duration of procedures. The added weight of these garments on the trunk can potentially increase the risk for neck, shoulder, and/or back pain. One study showed that physicians who used shielding garments regularly (in this case, cardiologists who wore leads up to 8.5 hours per day) had the highest incidence of missed work days due to neck/back pain (21.3%) and required more treatment than other physicians who did not have to use shielding garments. The same study also showed a higher incidence of multiple-disc herniations of the cervical and lumbar spine among interventionalists. Approximately 20% of interventional cardiologists will develop symptoms of invertebral disc degeneration, and about 5% will require surgical intervention to treat the condition, which typically requires 22 days or more of recovery. Moreover, because the activity of the lower back muscles is known to directly correlate with lumbar intervertebral disc pressure, prolonged exposure to high intervertebral pressures, such as when a shielding garment is worn, can lead to discomfort as well as permanent structural damage of the intervertebral discs.
Physicians often employ a variety of creative methods to try and mitigate discomfort, including the use of spinal orthotics worn under shielding garments and surgical gowns. Spinal orthotics such as soft belts and semi-rigid corsets that are currently available can achieve some degree of spinal offloading by increasing intraabdominal pressure as well as serving as a kinesthetic reminder to the user to prevent excessive flexion. However, it has been shown that the use of such commercially-available back belts provides no reduction in the likelihood of injury, as quantified through compensation claims and reported lower back pain. Custom-made orthoses produced by a trained orthotist have been shown to be more biomechanically effective than common mass-produced, non-customized, or over-the-counter models, but have several drawbacks: the individual manufacturing and fitting required are prohibitively expensive for common usage, the restricted maneuverability such orthoses create could be disadvantageous in the workplace, and the increased back postural muscle activity that some orthoses can produce could actually promote muscle fatigue.
Aside from using over-the-counter back braces or one-off solutions created by individual clinicians, there have been a number of products that attempt to offload the weight of shielding garments. One includes a mobile scaffold that suspends the shielding garment over its user. The device must be wheeled about the operating room by two handles at waist level. Another suspended radiation protection system can carry the shielding garment and a face shielding window array via an overhead arm fixed to the ceiling of the room. Other repositionable shields can be rolled around or mounted to arms fixed to a wall of the operating room. These devices have not been widely adopted, may be obtrusive in a treatment room or prohibit the physician from certain types or directions of movement, or could be prohibitively expensive.
Shielding garments may also be used for chemical and radiation protection in non-medical scenarios such as nuclear leaks, chemical spills, etc. While most of the work in such scenarios is performed by robots or other machines, it may be desirable to have human participation. Providing a more mobile and low-profile shielding garment support could help facilitate such human contribution in those instances.
According to one embodiment, there is provided a load-bearing exoskeleton comprising a plurality of sagittally-extending load-bearing structures. At least one sagittally-extending load-bearing structure is an upper body support and at least one sagittally-extending load-bearing structure is a lower body support. A supportive force is provided to counteract at least some of the weight of a shielding garment. The supportive force is at least partially normal to an outer surface of at least one of the sagittally-extending load-bearing structures when an applied force from the shielding garment is encountered. The applied force from the shielding garment is at least partially transmitted to the floor through the at least one lower body support.
According to another embodiment, there is provided a load-bearing exoskeleton comprising at least one shielding garment attachment mechanism and a pelvis assembly including one or more hip joints. The attachment mechanism is connected to and supported by the pelvis assembly. The load-bearing exoskeleton further comprises one or more leg assemblies attached to the pelvis assembly via the one or more hip joints. The hip joint of the pelvis assembly is configured to allow for rotational movement of the leg assembly about a medial-lateral axis.
According to another embodiment, there is provided a load-bearing exoskeleton comprising at least one shielding garment attachment mechanism and a pelvis assembly. The load-bearing exoskeleton further comprises one or more leg assemblies attached to the pelvis assembly. Each leg assembly includes a rotational joint at a location generally corresponding to a greater trochanter of a user. The rotational joint includes a locking mechanism that is configured to inhibit rotational movement of the leg assembly when the exoskeleton is in a locked position.
Preferred exemplary embodiments will hereinafter be described in conjunction with the appended drawings, wherein like designations denote like elements, and wherein:
A load-bearing exoskeleton as described herein can help to offload the weight of a shielding garment, for example, from the body of a user. Preferably, the load-bearing exoskeleton can offload the entire weight of a shielding garment to help alleviate the risk of back injury and discomfort. The mass of a shielding garment may be borne entirely by the exoskeleton and conveyed down to the floor, with the user providing structural alignment. It is advantageous for the exoskeleton to have a low profile so as to not interfere with tight spaces in the operating room, while still affording sufficient mobility. Embodiments of the load-bearing exoskeleton may allow a user to rotate normally in place (e.g., turn about), walk, and tilt (e.g., flex) the trunk at the waist in one or more body planes. Some embodiments of the load-bearing exoskeleton allow a user to enter from behind, by simply walking into the device and then securing it to his or her body via an attachment mechanism such as adjustable straps or the like. In a preferred embodiment, the load-bearing exoskeleton is customized to a user's unique anthropometry. This customization may be facilitated by the use of easily-scalable computer aided design (CAD) models and three dimensional (3D) printing of complex parts. In another embodiment, each exoskeleton may be tailored to fit multiple end users of a similar body type, so that a customer (e.g., a hospital) does not need to necessarily purchase a unique exoskeleton for each end user.
Some load-bearing exoskeleton embodiments include at least one shielding garment attachment mechanism 12. In one embodiment, the shielding garment attachment mechanism 12 may be the thorax assembly 14 itself or parts thereof. In the embodiment illustrated in
The thorax assembly 14 in this embodiment includes shoulder extensions 20 and rib extensions 22 that radiate from the thoracic nexus 24. In a preferred embodiment, the thorax assembly is open in the back, which allows a user to simply walk into the device. The thoracic nexus 24 is attached to the pelvis assembly 16 via central beam 26. The thoracic nexus 24 can help to shunt weight from a shielding garment, or more particularly, from a trunk-worn portion of a shielding garment such as a discrete vest, into the central beam 26. The central beam 26 in this particular embodiment is a metal bar that is pivotally mounted with a rotational joint 34 to the pelvis assembly 16 to help facilitate lateral flexing of a user's torso. The shoulder extensions 20 or the central beam 26 may be considered a sagittally-extending load-bearing structure. “Sagittally-extending” refers to any position less than orthogonal to the sagittal plane of a user. Each rib extension may serve as a transversely-extending load-bearing structure, with “transversely-extending” referring to any position less than orthogonal to the transverse plane of a user. Sagittally-extending load-bearing structures and transversely-extending load-bearing structures that are part of the thorax assembly may be classified as upper body supports. Similarly, “coronally-extending” may refer to any position less than orthogonal to the coronal plane of a user. Thus, the rib extensions may also at least partially include coronally-extending load-bearing structures. The load-bearing structures can help to provide a supportive force when an applied force (e.g., weight) from a shielding garment is encountered, thereby offloading some of the force from the user. The supportive force may be at least partially normal to an outer surface of the load-bearing structure (e.g., in a direction away from the user), and is distinguishable from prior art devices that hold a shielding garment above a user, for example. In a preferred embodiment, as shown in
The pelvis assembly 16 is located between the thorax assembly 14 and the leg assemblies 18 in the embodiment illustrated in
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In a preferred embodiment, the leg assembly 18 is a modified hip knee ankle foot orthosis (HKAFO). A foot platform 54 may include straps or be a slide-on type shoe to help hold a user's foot in the exoskeleton. The foot platform 54 may be rubberized or coated with another high-friction “non-slip” material. Other designs for a foot platform are certainly possible. The foot platform 54 can be connected by a first rotational joint 56 to a first structural beam 58. Knee joint 60 can connect the first structural beam 58 to a second structural beam 62. The first and second structural beams 58, 62 may have adjustable lengths, if desired. The knee joint 60 which connects the first and second structural beams 58, 62 may be a single-pivot type joint that allows for nearly full knee flexion but has a hard stop to prevent hyperextension (e.g., motion of the knee past a vertical orientation in a forward direction).
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During use, the load-bearing exoskeleton 10 can vary between a plurality of states: unlocked and locked. During the unlocked state, the joints are free to rotate so that users may walk almost normally and assume whatever position they wish in order to perform procedures. Once users are in a desired posture, the device may be switched into a locked state, during which one or more joints would hold their rotational position, thereby providing a rigid support to convey most of the weight or all of the weight of the shielding garment down to the floor. In a preferred embodiment, all of the joints in the exoskeleton 10 would hold their rotational position while in the locked state. In another embodiment, only one or more leg joints (e.g., the knee joint) lock while the hip joint remains free to move so a user can flex and extend (i.e., lean forward and backward) if desired. The joints of the device could be switched between the two states through either mechanical or electromechanical means (e.g., pulleys, solenoids, etc). In one implementation, the rotational joints are passive joints with a spring powered button that would move into dents on each half of the joint once a predetermined position had been reached (i.e., vertical, full extension) and provide some resistance to movement in the joints. Motion could resume in the other direction in the joint with a higher applied torque from the leg. This implementation avoids hand actuation of buttons and/or electronics, making the exoskeleton easier to use during treatment procedures, for example.
It is to be understood that the foregoing description is of one or more preferred exemplary embodiments of the invention. The invention is not limited to the particular embodiment(s) disclosed herein, but rather is defined solely by the claims below. Furthermore, the statements contained in the foregoing description relate to particular embodiments and are not to be construed as limitations on the scope of the invention or on the definition of terms used in the claims, except where a term or phrase is expressly defined above. Various other embodiments and various changes and modifications to the disclosed embodiment(s) will become apparent to those skilled in the art. All such other embodiments, changes, and modifications are intended to come within the scope of the appended claims.
As used in this specification and claims, the terms “for example,” “e.g.,” “for instance,” and “such as,” and the verbs “comprising,” “having,” “including,” and their other verb forms, when used in conjunction with a listing of one or more components or other items, are each to be construed as open-ended, meaning that the listing is not to be considered as excluding other, additional components or items. Other terms are to be construed using their broadest reasonable meaning unless they are used in a context that requires a different interpretation.
This application claims the benefit of U.S. Provisional Application No. 62/214,401 filed Sep. 4, 2015, the entire contents of which are hereby incorporated by reference.
Filing Document | Filing Date | Country | Kind |
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PCT/US16/50077 | 9/2/2016 | WO | 00 |
Number | Date | Country | |
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62214401 | Sep 2015 | US |