The present disclosure generally relates to the field of devices and rehabilitation assistive technologies for persons with severe lower limb immobility, such as paraplegics. The present disclosure is particularly useful for a rehabilitation and a walk enablement of persons with spinal cord injuries.
This section provides background information related to the present disclosure which is not necessarily prior art.
Persons with spinal cord injuries who had a severe or a partial paralysis of the lower limbs need to start with exercise of the paralyzed body segments as soon as possible and verticalize themselves to prevent further health complications due to prolonged sitting such as for instance osteoporosis of the lower limbs, muscle atrophy or bedsores. Such additional health complication causes further discomfort and make the overall treatment very expensive and time consuming
Passive movement of the lower limbs during rehabilitation can be performed either with an assistance of another person or by a dedicated device. With approximately five hundred thousand spinal cord injuries worldwide each year, resulting in paraplegia in approximately 40% of the injuries, there is a significant need for a universal, inexpensive, easy-to-maintain, and easy-to-use device to allow verticalization of the injured person and his or her gait training with only a limited assistance or even without assistance from third person such as a healthcare professionals.
Currently available rehabilitation assistive technologies include parapodia and conventional lateral exoskeletons consisting of two orthoses, connecting the hips and ankles joints. Typical disadvantages of these assistive technologies are high weight, size and an amount of time it takes don and doff an assistive technology which in most cases requires a need for a third-party assistance. Further drawbacks of the current assistive technologies are time required to adjust an assistive technology to a specific person and importantly an affordability of an assistive technology as in many countries such assistive technologies are not covered by a health insurance and the current assistive technologies are price prohibitive.
Therefore, it would be advantageous to have an assistive technology that takes into account at least some of the issues discussed above as well as possibly other issues.
One objective of the present disclosure is to remedy at least part of the above identified drawbacks. An aspect of the present disclosure is directed to a medial unilateral exoskeleton having a medial hip joint. The medial hip joint comprising hip plates and hip pulleys, a plurality of actuation cables, orthoses suitable for a right and a left lower limb of a person, the orthoses being coupled to the hip joint and each of the orthoses comprising an ankle joint having a replaceable stirrup with a shoe or a shoe insert, an stirrup coupling, an ankle joint body and a guide pulley. Each of the hip pulleys is coupled to a respective ankle joint by at least one actuation cable of the plurality of actuation cables so that each actuation cable is on one end attached to one of the hip pulleys and on a second end attached to the stirrup coupling of the respective ankle joint, wherein the replaceable stirrup is pivotably connected to the ankle joint body via the stirrup coupling, wherein the guide pulley is coupled to the ankle joint body and configured to support and direct a respective actuation cable of the plurality of actuation cables to the stirrup coupling, wherein each of the actuation cables is configured to convey a movement of the hip pulley to the respective ankle joint and cause a pivot of the respective replaceable stirrup in a first direction.
In another aspect, each of the orthoses further comprises at least one elastic member having a one end coupled to the ankle joint body and a second end coupled to the stirrup coupling, wherein the at least one elastic member is adapted to act in a second direction opposite to the first direction caused by the movement conveyed by the respective actuation cable.
In another aspect, each of the actuation cable is either a pull cable or a push-pull cable and each of the actuation cable has a solid or wire rope core.
In another aspect, each of the plurality of actuation cables or at least one actuation cable of the plurality of actuation cables is a Bowden cable.
In another aspect, each of the orthoses further comprises a biasing cable and a moveable member. The one end of the elastic member is coupled to the ankle joint body via the moveable member. A one end of the biasing cable is coupled to the moveable member and a second end of the biasing cable is coupled to the hip pulley and the biasing cable is adapted to position the moveable member so that the distance between both ends of the elastic member remains constant.
In another aspect, wherein each of the orthoses further comprises a linear guide coupled with the moveable member.
In another aspect, the linear guide comprises at least one of a rail linear guide, a linear bearing slide, a ball bearing slide, a rack slide, a dovetail slide or a roller slide.
In another aspect, each of the orthoses further comprises a hollow first part having a slot and a second part. The hollow first part is coupled to the ankle joint body and a portion of the second part is inserted within the first part. A portion of the moveable member is guided within the slot and engages the portion of the second part within the hollow first part.
In another aspect, the first part is a first hollow profile extending in a longitudinal direction, the second part is a second hollow profile extending in the longitudinal direction and is slidably engaged into the first hollow profile, the slot extends in the longitudinal direction.
In another aspect, the moveable member comprises a roller configured to roll on a guiding profile formed in the portion of the second part within the first hollow part, the guiding profile extending along the longitudinal direction.
In another aspect, the elastic member is formed by one or more elastic elements shaped as a belt, a band, a string, a rope or a spring or a combination thereof.
In another aspect, the movable member extends between two ends perpendicular to the longitudinal direction, and the medial unilateral exoskeleton includes two elastic members which are attached to the ends of the moveable member.
In another aspect, each of the hip pulleys is coupled to a respective ankle joint by means of one actuation cable of the plurality of actuation cables.
In another aspect, each of the orthoses further comprises a unilateral medial thigh upright, a thigh cuff comprising one or more thigh bands, a knee joint, an unilateral medial lower leg upright and at least one lower leg cuff.
In another aspect, the knee joint is a self-locking joint. The self-locking knee joint may be configured to automatically lock when the exoskeleton is attached to a standing person or when the person stands up from a seating position. The self-locking knee join may be adapted to lock the medial thigh upright and the lower leg upright rigidly together.
In another aspect, each of the actuation cables is at least partially embedded within the medial lower leg upright and/or the medial thigh upright. The medial lower leg upright and the medial thigh upright are configured to enable an attachment of the exoskeleton to a person.
In another aspect, the medial thigh upright and/or the medial lower leg upright have an adjustable length.
In another aspect, the ankle joint is provided with at least one adjustable element formed by an ankle adjusting screw adapted to provide a tension to the actuation cable coupled to the ankle joint and impact the angle in the ankle joint.
In another aspect, the medial hip joint is provided with at least one adjustable element formed by a hip adjusting screw. The at least one adjustable element is adapted to secure a tension of the actuation cable and impact angle of the ankle joint.
In another aspect, the medial unilateral exoskeleton further comprising a lumbar orthosis coupled to the medial hip joint or a lateral hip joint.
A further aspect is directed to a use of the medial unilateral exoskeleton apparatus as defined above, where the orthoses are connected respectively to a right and a left lower limb of a person and the shoe or shoe insert is connected to a foot of the person.
Further areas of applicability will become apparent from the description herein. The description and specific examples in the summary are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure.
Other features and advantages of the invention appear from the following detailed description of some of its embodiments, given by way of non-limiting example, and with reference to the accompanying drawings, in which:
The foregoing summary, as well as the following detailed description of certain examples will be better understood when read in conjunction with the appended drawings. As used herein, an element or step recited in the singular and proceeded with the word “a” or “an” should be understood as not excluding plural of the elements or steps, unless such exclusion is explicitly stated. Further, references to “one embodiment” are not intended to be interpreted as excluding the existence of additional embodiments that also incorporate the recited features. Moreover, unless explicitly stated to the contrary, embodiments “comprising” or “having” an element or a plurality of elements having a particular property may include additional elements not having that property.
In the figures, the same references denote identical or similar elements, unless stated otherwise. In the drawings, the size of each element or a specific portion constituting the element is exaggerated, omitted, or schematically shown for convenience and clarity of description. Thus, the size of each component may not entirely reflect the actual size. In the case where it is judged that the detailed description of the related known functions or constructions may unnecessarily obscure the gist of the present disclosure, such explanation will be omitted.
The term medial unilateral exoskeleton relates to a one-sided exoskeleton for placement in the center of a body of a person. Such exoskeleton abuts the lower limbs only from the medial, i.e. the inner side of the limb. That way the medial unilateral exoskeleton ensures a more comfortable use of the exoskeleton for persons that suffer from swelling and/or skin problems where the use of bilateral orthoses that surround the limbs would be more complicated or even excluded.
The orthoses may include a right unilateral orthosis 3b, 114b and a left unilateral orthosis 3b, 114a. As shown in
Each of the unilateral orthoses may further comprises a unilateral medial thigh upright 4, a thigh cuff 5 comprising one or more thigh bands 9, a knee joint 6, an unilateral medial lower leg upright 7 and at least one lower leg cuff 8. The unilateral medial thigh upright 4 and unilateral medial lower leg upright 7 may be either solid or hollow and may have any suitable cross-section, with oval or round cross-sections being preferred, since they do not contain any potentially sharp edges. The unilateral medial thigh upright 4 and unilateral medial lower leg upright 7 may be made of any solid material.
For ease of maintenance and handling it advantageous when the material is as light as possible. Suitable materials may be light and/or solid metals or composite materials. The one or more thigh bands 9 and at least one lower leg cuff 8 may be made of any suitable material either that is either flexible or rigid. Suitable materials may be steel, Kevlar or a carbon composite. For fastening to the limb can be used e.g. Velcro or a buckle, or other means that allow tightening bands cuffs to the limb regardless of the size of the circumference of the limb. The one or more thigh cuffs 5 may be replaced by unlocking a locking pin, extending the one or more thigh cuffs and snapping in a different cuffs size. In the same way, the at least one lower leg cuff 8 may be replaced. The knee joint 6 may be a self-locking joint. Such self-locking joint may enable the medial unilateral exoskeleton handling as well as it simplifies the attachment of the exoskeleton to a seated person. The self-locking knee joint 6 may be adapted to lock the medial thigh upright 4 and the lower leg upright 7 rigidly together. One benefit of the self-locking knee joint is to automatically lock the joint whilst the exoskeleton is attached to a standing person.
At least one or each of the plurality of actuation cables may be at least partially embedded within the medial lower leg upright 7 and/or the medial thigh upright 4. At least one of the medial thigh upright 4 and/or the medial lower leg upright 7 may have an adjustable length. The adjustable length is controlled by a length adjusting member shown 103a, 103b shown in
As shown in
The medial hip joint 1 may connect a medial left and a medial right part of the medial unilateral exoskeleton 5, 100 so that a left ankle joint 2a may be connected to a right side of the medial hip joint and a right ankle joint 2b is connected to a left side of the medial hip joint. The medial hip joint 1 may be in the form of a module where the hip joint with pulleys 13a, 13b is attached to the hip plates 14a, 14b by one or more supporting rollers. This would advantageously enable a rehabilitation facility to easily exchange a hip joint for a more robust option for a person with a higher body weight.
As explained and further shown in
As depicted in
The medial hip joint 1 may connect the medial left and right parts of the medial unilateral exoskeleton so that the left ankle joint 2a may be connected to a right side of the hip joint and the right ankle joint 2b may be connected to the left side of the hip joint. The medial hip joint 1 may be delivered in the form of a module where the hip joint with pulleys may be attached to the hip plates by supporting rollers. One benefit would be to enable rehabilitation facilities to carry out a replacement of one hip joint for a more robust one in the case of person with a higher weight.
The left pulley 13a may be connected to the left ankle joint 2a by means of a first actuation cable 12a. When the first actuation cable 12a is actuated it may cause a plantar flexion of a respective left replaceable stirrup 31 and consequently a planar flexion of a shoe 41 that is connected to the left replaceable stirrup 31. Respective elastic member 26 that may connect a respective stirrup coupling 21 and the left ankle joint body 20 may be configured to hold the left replaceable stirrup in a constant dorsal flexion so that the first actuation cable 12a, when actuated, acts against the pull force imposed by the elastic member to the replaceable stirrup 31.
The right pulley 13b may be connected to the right ankle joint 2b by means of a second actuation cable 12b. When the second actuation cable 12b is actuated it may cause a plantar flexion of a respective right replaceable stirrup 31 and consequently a planar flexion of a shoe 41 that is connected to the right replaceable stirrup 31. Respective elastic member 26 that may connect a respective stirrup coupling 21 and the ankle joint body 20 may be configured to hold the right replaceable stirrup in a constant dorsal flexion so that the second actuation cable 12b, when actuated, acts against the pull force imposed by the elastic member to the replaceable stirrup 31.
Due to the contralateral interconnection of the right side of the medial hip joint 1 and a the left ankle joint 2a and the left side of the medial hip joint and the right ankle joint 2b, the ankle torque (in the direction of the dorsal flexion) may drive the contralateral (opposite) limb when attached to the orthosis to swing forward and propone a step forward.
Each ankle joint 2a, 2b may be interconnected with a replaceable shoe 41, 105 or a shoe insert. One of the following combinations may be used; a replaceable stirrup with a fixed shoe, a replaceable stirrup with a replaceable shoe or a replaceable stirrup with a fixed insert suitable for an insertion into any footwear. The replaceable stirrup 31 may be firmly integrated (for instance glued and/or secured by a fastener) with a central portion of the shoe sole. A shoe may also be temporarily attached to the stirrup, for instance via a conventional fastening means such as a tape or a Velcro. Alternatively, a shoe insert may be firmly attached to the replaceable stirrup and the insert may then be placed into any shoe and fixed to a foot of a person simply by tying up shoelaces or otherwise securing shoe. Replaceable inserts or shoes enable the medial unilateral exoskeleton to be adapted to an individual person, with respect to the foot size and/or to the preferred type of a footwear, possibly even to other specific requirements.
Each of the orthoses may further comprise a linear guide connected to the moveable member. The linear guide may comprise at least one of a rail linear guide, a linear bearing slide, a ball bearing slide, a rack slide, a dovetail slide or a roller slide. Each of the orthoses may further comprise a hollow first part 62 having a slot 63 and a second part 61. The hollow first part 62 may be coupled to the ankle joint body 20 and a portion of the second part 71 may be inserted within the first part 62. A portion of the moveable member may be guided within the slot 63. The portion of the moveable member may engage the portion 71 of the second part 61 within the hollow first part 62. The hollow first part may be a first hollow profile extending in a longitudinal direction and the second part may be a second hollow profile extending in the longitudinal direction. The second part may be slidably engaged into the first hollow profile. The slot 63 may extend in the longitudinal direction. As shown in
When using the medial unilateral exoskeleton and its variety as described above the orthoses 3a, 114a, 3b, 114b are connected respectively to a right and a left lower limb of a person and the shoe 41, 105 or a shoe insert 41 is connected to a foot of the person.
Such medial unilateral exoskeleton of the present disclosure may be used with crutches, walkers, or parallel walkways. The medial unilateral exoskeleton of the present disclosure is affordable, easy to assemble and maintain, and easy to use. The medial unilateral exoskeleton of the present invention also provides an increased stability and enables safer training of users. The medial unilateral exoskeleton of the present disclosure may be used in a home care because of its easy deployment and relatively simple control which does not require a special assistance from a third party.
In an example a medial unilateral exoskeleton as outlined in previous embodiments may be used as a user specific medial unilateral exoskeleton. Such user specific exoskeleton may comprise a medial hip joint 1 comprising hip plates 14a, 14b, a shaft 15 and pulleys 13a, 13b connected through a unilateral medial thigh upright 4 via the hip plates 14a, 14b to a right and a left lower orthosis. Each of the lower limb orthoses 3a, 3b may comprise, in addition to a metal hollow medial thigh upright 4 having an oval cross section, a thigh cuff 5 comprising two thigh bands 9 connected by a lateral support element 1. Each of the thigh cuffs 5 may be made of a steel thin flat plate provided with a padding and with a Velcro type fastening for an attachment of the thigh cuff to a user's leg. The skeleton may further comprise two self-locking knee joints 6 and two hollow unilateral medial lower leg upright 7 with an oval cross section. Each of the hollow unilateral medial lower leg uprights 7 may be provided with one lower leg cuff 8 in the form of an arc made of a steel thin flat plate provided with a padding and with a Velcro type fastening for an attachment to the user's leg. The length of the each of unilateral medial thigh uprights 4 and the unilateral medial lower leg uprights 7, the circumference of the thigh cuffs 5 and the lower leg cuffs 8 may be adapted to the body proportions of a particular person. Each of the lower limb orthoses 3a, 3b further comprises an ankle joint 2a 2b connected to the pulleys 13a, 13b of the hip joint 1 by means of actuation cables 12a, 12b. The actuation cables may be attached on one end to the respective pulley 13a, 13b of the hip joint 1 and on second end to the stirrup coupling 21 of the respective ankle joints 2a, 2b. The ankle joint body 20 may be further coupled to the stirrup coupling 21 by an elastic element 26. The stirrup coupling 21 of the respective ankle joint 2a, 2b may rotate on a pin 22 of the ankle joint body 2a, 2b. Each of the orthosis 3a, 3b may further comprise a replaceable stirrup 31 that may be connected to an orthopedic shoe 41 of a size corresponding to the leg size of the particular person. Each of the actuation cables 12a, 12b is a Bowden cable that may be attached to a Bowden holder 16 and may be guided partially inside the hollow medial thigh upright 4 and the hollow unilateral medial lower leg upright 7.
Such medial unilateral exoskeleton may be applied by a hip joint 1 between the legs of a seated user. The thigh cuffs 5 may be then attached to the particular user thighs via the thigh bands 9 and the lower leg uprights 7 may be attached to user's calf's via use of one or more lower leg cuffs 8. When the user reaches the vertical position, the thigh plate 4 and the lower leg uprights 7 may be locked at the knee joint 6 so as to hold the user in a vertical position without the possibility of a rotation in the knee joint. Due to the contralateral connection of the left ankle joint with a right hip joint and the right ankle joint with a left hip joint, one foot and associated dorsal flexion contralaterally swings the other limb, reducing effort and allowing the user to move reduced energy intensity and train walking and verticalization. After training in the rehabilitation facility, the user is able to use the medial unilateral exoskeleton using crutches or walkers without the assistance of medical staff.
In another example a medial unilateral exoskeleton as outlined in previous embodiments may be used in a healthcare and/or rehabilitation facility. Such universal medial unilateral exoskeleton may comprise a medial hip joint 1 comprising hip plates 14a, 14b, a shaft 15 and pulleys 13a, 13b that may be covered by pulley support covers 17a, 17b. The medial hip joint may be connected via hip plates 14a, 14b to orthoses 3a, 3b of a right and a left lower limb of a person, specifically through the unilateral medial thigh upright 4. Each of the lower limb orthoses 3a, 3b my include, a medial thigh upright 4 with an oval cross-section, a thigh cuff 5 that may comprise two thigh bands 9 interconnected by a lateral support element 10, the thigh cuff 5 that may be made of thin steel plate. The thigh cuff 5 may be provided with a padding and with a fastening for an attachment of the thigh cuff to a person leg. Each of the orthoses may be further provided with a self-locking knee joint 6, a unilateral medial lower leg upright 7 that may have an oval cross section provided with a one lower leg cuff 8 that may be in the form of a steel thin flat plate provided with a padding and with a Velcro type fastening for an attachment to the person's leg. The length of the medial lower leg upright 7 may be adjustable. The circumference of the thigh cuffs 5 and the lower leg cuff 8 may also be adjustable. Lateral hip joints 51 may be attached to the thigh cuffs 5, to which a lumbar brace 52 may be attached. Each of the lower limb orthoses 3a, 3b may further include an ankle joint 2a, 2b connected to the pulleys 13a, 13b of the hip joint 1 by means of actuation cables 12a 12b. The actuation cables may be attached on one end to the respective pulley 13a, 13b of the hip joint 1 and on second end to the stirrup coupling 21 of the respective ankle joints 2a, 2b.
The ankle joint body 20 may be further coupled to the stirrup coupling 21 by an elastic element 26. The stirrup coupling 21 of the respective ankle joints 2a, 2b rotates on a pin 22 of the ankle joint body 2a, 2b. Each of the orthoses 3a, 3b may further comprise a replaceable stirrup 31 connected to an orthopedic shoe 41. Each of the actuation cables 12a, 12b may be a Bowden cable that may be attached to a Bowden holder 16 and guided partially inside the hollow medial thigh upright 4 and the hollow unilateral medial lower leg uprights 7. The actuation cables 12a, 12b may be replaceable depending on the length required, which is influenced by the adjustment of the length of the medial lower leg upright 7. In the area of the ankle joints 2a, 2b may be located adjustment screws 23 of the actuation cable 12a, 12b that affect the angle in the ankle joint 2a, 2b. A sliding adjustable bar 27 may be formed on the stirrup coupling 21 to influence the transmission ratio between the hip and ankle, further influencing the walking style. In the region of the medial hip joint 2a, 2b, an adjustable element may be provided in the form of a hip adjusting screw 18a, 18b of the actuation cable 12a, 12b. The adjustable element may provide a tension to the actuation cable and affects the angle in the ankle joint 2a, 2b.
The universal medial unilateral exoskeleton may be applied by a hip joint 1 between the legs of a seated user, with the thigh cuffs 5 attached to the persons thighs via the thigh bands 9. The lower leg uprights 7 may be attached to the person calves via one or more lower leg cuffs 8. Next, the lateral hip joint 51 may be attached to the sides of the seated person and the lumbar brace 52 may be attached to the person's body. After the person reaches a vertical position, the medial thigh upright 4 and the lower leg upright 7 may be locked at the knee joint 6 so as to hold the user in a vertical position without the possibility of a rotation within the knee joint. Due to the contralateral connection of the left ankle joint with the right hip joint and the right ankle joint with the left hip joint, one foot and associated dorsal flexion contralaterally swings the other limb, reducing effort and allowing the user to move reduced energy intensity and train walking and verticalization.
While various spatial and directional terms, such as top, bottom, lower, mid, lateral, horizontal, vertical, front and the like may be used to describe embodiments of the present disclosure, it is understood that such terms are merely used with respect to the orientations shown in the drawings. The orientations may be inverted, rotated, or otherwise changed, such that an upper portion is a lower portion, and vice versa, horizontal becomes vertical, and the like.
It is to be understood that the above description is intended to be illustrative, and not restrictive. For example, the above-described embodiments (and/or aspects thereof) may be used in combination with each other. In addition, many modifications may be made to adapt a particular situation or material to the teachings of the various embodiments of the disclosure without departing from their scope. While the dimensions and types of materials described herein are intended to define the parameters of the various embodiments of the disclosure, the embodiments are by no means limiting and are exemplary embodiments. Many other embodiments will be apparent to those of skill in the art upon reviewing the above description. The scope of the various embodiments of the disclosure should, therefore, be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled. In the appended claims, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.” Moreover, the terms “first,” “second,” and “third,” etc. are used merely as labels, and are not intended to impose numerical requirements on their objects. Further, the limitations of the following claims are not written in means-plus-function format and are not intended to be interpreted based on 35 U.S.C. § 112(f), unless and until such claim limitations expressly use the phrase “means for” followed by a statement of function void of further structure.
This written description uses examples to disclose the various embodiments of the disclosure, including the best mode, and also to enable any person skilled in the art to practice the various embodiments of the disclosure, including making and using any devices or systems and performing any incorporated methods. The patentable scope of the various embodiments of the disclosure is defined by the claims, and may include other examples that occur to those skilled in the art. Such other examples are intended to be within the scope of the claims if the examples have structural elements that do not differ from the literal language of the claims, or if the examples include equivalent structural elements with insubstantial differences from the literal languages of the claims.
Number | Date | Country | Kind |
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PV 2019-334 | May 2019 | CZ | national |
Filing Document | Filing Date | Country | Kind |
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PCT/EP2020/065092 | 5/29/2020 | WO |