Patent Grant
10543144
An overground mobility aid is needed to enable continuation of gait training and ambulatory activities performed in stable railed environments such as parallel bars and treadmills for those requiring balance support as well as significant upper body support. Normal gait kinematics includes in part, erect posture, reciprocating UE movement (and UEs moving out of phase, and UE movement out of phase with reciprocating LE), and associated trunk rotation. Reciprocating gait also refers to those patterns which incorporate increasing amounts of UE support for the opposite LE (two and four point gait).
The goal when walking with mobility aids is to achieve stability and the most efficient gait pattern. It is understood that weight bearing through the upper limbs is unnatural and is preferentially minimized when using mobility aids.
It is well documented that arm movement when walking is advantageous mechanically to enhance gait efficiency and stability. Trunk rotation is needed for normal LE biomechanics. Neuromechanical connections between upper and lower limbs exist, suggesting neurologic benefit of UE movement during locomotor activities. In part, rhythmical repetitive reciprocating movement during repetitive stepping training is known to enhance recovery of LE function. Arm swing in neurologic gait rehab is recommended (Meyns et al, 2013). Reciprocating UE movement enhances gait velocity, an important indicator of ambulatory ability, a standard gait rehab goal, and often a primary concern of mobility aid users. Furthermore, walking and running with elbows flexed 90 degrees is known to be more efficient. It would be desirable to have a device offering forearm support and enablement of rhythmical reciprocating UE movement.
Arm swinging with mobile grip handle support has been shown to enhance velocity and reduce UE weight bearing on treadmills in comparison to walking with static grip support (Stephenson et al, 2010). Translation of this finding, mobile grips may provide the same benefits if introduced to another form of railed device, framed walking aids. Excessive gripping pressure is associated with UE weight bearing and is understood to create aberrant heart rate and other objective data during treadmill training (Berling et al, 2006). A means to minimize gripping pressure with use of all railed devices, including wheeled mobility aids, would be desirable.
Conclusions drawn from studies examining UE weight bearing and movement during walking on a treadmill may be applicable to railed wheeled devices. Stroke survivors exhibited enhanced gait velocity when walking on a treadmill using mobile grip handles (Umker et al, 2015). Subjects with traumatic brain injury, cerebro vascular accident (CVA) or stroke, and multiple sclerosis were able to walk faster when gripping a rail instead of walking without UE support (Williams et al, 2011). A walker with mobile grip handles on the upper rails is needed.
It has been shown that walking with mobility aids which enable reciprocating UE movement is correlated with enhanced UE movement when not using or when no longer needing to use the assistive device (Tester et al, 2011). It would be desirable if a wheeled device enabled more natural UE movement irregardless of the amount of support needed.
Crutch use enables reciprocating arm movement yet requires additional coordination and provides less support than a walker. Full shoulder and hip extension range of motion (ROM) are often not achieved with use, hence biomechanics are compromised. When minimal weight bearing support is needed, yet reciprocating gait pattern is desired, such as with exoskeleton use and body weight support, crutches do not enable rhythmical repetitive UE movement. Canes enable UE movement yet may not provide adequate support.
Carter (U.S. Pat. No. 2,362,466) discusses a walker which provides for active alternating rotational movement of the upper torso. The user statically grips the side rails and axillary supports (supports under armpits/axilla or ‘crutch-like’ support assemblies) oscillate about fixed points on the side frame. Movement of one side of the upper body does not create equal and opposite motion of the second side and good bilateral UE function is needed for use. Reciprocating movement of an UE upon the frame is not created. In addition, mobile grips/grip handles or mobile forearm supports are not mobile upon the side frame(s). Schultz (U.S. Pat. No. 4,748,994) describes a device with UE support assemblies which can be repositioned along the side rails prior to use yet assemblies are statically positioned during use and statically positioned UEs manage the device.
Pak (U.S. Pat. No. 8,726,922), Murcott (U.S. Pat. No. 3,098,651) and Edwards (U.S. Pat. No. 3,442,276) discuss walkers with hinged connections between the front and side frames. The application of these devices is limited to users with good bilateral UE function. Features do not facilitate alternating UE movement. LE movement which is in phase with reciprocating UE movement as opposed to out of phase, is facilitated with these devices related to the positioning of the front frame member when one side is advanced. Wheels must be introduced in order to perform more rhythmical UE movement. This presents stability concerns particularly with increased UE weight bearing.
Rollators are three or four wheeled devices increasingly being used by an aging population wishing to remain strong and active. Users often desire to walk with a gait pattern which is as natural as possible. Grip handles or forearm supports are typically statically and symmetrically positioned on these devices, which is unnatural. Stability is lacking compared to devices with two wheels. A stable device enabling more natural gait pattern is needed.
Devices requiring good bilateral UE function and advanced via reciprocating UE movement against resistance may have limited application to the fit, healthy population. Vangsgaard (WO 2017032376) presents a device with levers which drive front or rear wheels. Features do not provide constraint for slaloming. Kochs' (DE10201511748483) device provides levers pushed by the UEs against resistance and this causes forward movement of the device. Judjahn (DE 102007015106) and JP 2009106446) also present devices with levers gripped by the user to drive the wheels. A device is needed which enables a more natural gait pattern and does not rely on good upper body function to manage. A device is needed which could variably be used to enhance upper body strengthening by addition of resistance mechanism to the mobile component.
A common concern related to use of walkers and rollators is the flexed posture associated with use. UE forces can be directed horizontally parallel to the ground and erect posture achieved when used for balance support. Weight bearing through UEs necessitates anterior displacement of the center of gravity because the UEs simultaneously advance the device and this is accomplished by forward leaning or flexing the spine and/or hips. Forearm supports can be used to facilitate more erect posture and reduced UE weight bearing yet if used for more than light support, upper body forces are necessarily directed angled downward. A paradigm shift in how mobility aids are managed is needed. A walker and rollator is needed which is advanced via bodily contact instead of being managed by the UEs.
When light/balance support is needed, it would be desirable to have a wheeled mobility aid or rehab or therapeutic device which is advanced preferentially by bodily contact which could be used with statically positioned UEs as well as with mobile UEs.
Continuous stepping with a wheeled device involves more hip extensor activity yet hip extension range of motion is typically reduced and kinetics are altered. When discontinuous stepping patterns are performed, even when walking with light upper body support, the UEs may be used to provide bracing to facilitate hip flexion to advance a LE instead of activating hip extensors to a greater extent. Bateni et al. (2005) discuss the potential for variability in horizontally directed (propulsive or braking) forces with use of walkers. It would be desirable to have features which facilitate enhanced lower body propulsion to advance the device.
Static UE positioning does not enable performance of compensatory gait patterns which may be performed in parallel bars. This is unsafe and inefficient. A device is needed which enables gait patterns achievable in parallel bars for safety and efficiency. It would be desirable to have a wheeled walker with braking capability which enabled alternating UE movement and more vertically directed upper body forces for provision of support.
Suica et al (2016) and Maguire (2017) note that excessive compensatory use of UEs is common with rollator use and this may negatively impact LE strength over time. Alkjaer et al (2006) also found significant alterations in LE muscular function with rollator use. Rollator use is particularly desirable to those wishing to remain independent. LE strength is integral to functional independence. A rollator solution is needed which provides for more normalized LE function.
Walking ability with wheeled devices necessarily in part reflects upper body function. Also, adequate upper body function is needed to use wheeled devices. Minimization of UE management would be desirable in order to be able to more accurately assess lower body functional status. Such a device could be used as a screening tool for fall risk associated with use of a particular type of wheeled device.
Schulein et al (2017) discuss the importance of delineating the impact of walker use on gait parameters known to directly impact falls in the elderly population. Excessive UE management of these devices significantly impacts measures reviewed in these papers. UE management of mobility aids places additional cognitive demands and may be particularly detrimental in the presence of cognitive impairment.
For a given amount of physical work, energy expenditure is greater when the same amount of work is performed by UEs as compared to the LEs. It is well known that energy expenditure related to UE management of mobility aids is considerable. It would be desirable if a wheeled device could be advanced via bodily contact instead of by UE management.
Increased use of forearm supports on wheeled devices is needed as well as a device which enables improved ambulation with use of this type of UE support surface. Assemblies predominantly are available for attachment to standard devices, thereby introduced without hand brakes. Stability is often a concern related to need to be used on a wheeled device, and typically one with swivel wheels to enable steering. Support surfaces typically are not ergonomically designed to accommodate UE dysfunction. A mobility aid with various types of readily interchangeable grip and forearm support assemblies with hand brakes is needed. Other walkers and rollators which enable reciprocating UE incorporate gripping support. A device which enables all of the reciprocating gait patterns whilst one or both forearms is supported is needed. Training in proper biomechanics in all orthopedic gait rehabilitation including following total hip and total knee replacement is significantly compromised when using standard walkers and rollators. It would be desirable to have a gait training device which encouraged normal hip and knee function.
Prior art focused on devices for use in gait training includes devices propagated by work performed by the upper body [Lutz (U.S. Pat. No. 8,251,079). Albani et al (EP0624357) Katamoto (JP 2013116146)]. A device which normalizes upper and lower body movement whilst minimizing UE work is needed.
Pinero (U.S. Pat. No. 7,422,550) presents a training device which addresses the need for facilitation of reciprocating LE movement. A device which mechanically mobilizes the UEs in reciprocating manner is needed.
Exaggerated upper limb movement to improve locomotor ability following neurotrauma is discussed in the art (Zehr et al, 2016). Current solutions for creating exaggerated and/or repetitive reciprocating UE during repetitive stepping training over ground and on the treadmill includes holding and moving poles parallel to the ground. This requires adequate UE function and physical assistance. A mechanical means is needed to enable UE movement during long duration stepping activities is needed. This feature would enhance UE movement symmetry. It is well known that fall risk in the elderly is correlated with gait asymmetries. It would be desirable to have a device which could be used for daily training to enhance gait symmetry.
Specifically related to Parkinson's Disease (PD), incorporation of reciprocating UE movement and associated trunk rotation in rehab is advised. The UEs are statically positioned on current devices designed for the PD population. Decreased arm swing is one of first physical signs of the disease. A device which could be used throughout the course of this progressive disease would enable freely reciprocating UE movement as well as a means to potentiate this movement in later stages. The same device could be used in sitting and standing. It would be desirable to have locking wheels for stationary activities.
Warlop et al (2017) recommend incorporation of rhythmic external audible cuing to bypass the basal ganglia in PD. Audible cuing is also advised for spinal cord injury (SCI) gait rehab. Reciprocating UE movement would provide a functionally relevant means to accomplish this.
Stroke (CVA) gait rehab is the largest cause of gait dysfunction in the U.S. A device is needed which enables a stronger UE to mobilize a weaker UE in reciprocating fashion. A mechanical means to incorporate the upper body into gait rehab is needed. An adequately supportive device which facilitates work on upper and lower body symmetry is needed. Such a device could also be used for bilateral UE training in sitting.
Typically in the case of unilateral UE dysfunction, the involved UE is statically supported or unsupported and not mobilized when using a cane or hemiwalker. A mobility aid which does not require good upper body function, as well as enablement of walking similar to that performed in parallel bars would be desirable for CVA gait rehab (Allet et al, 2009). Klarner et al (2016) discuss the unmet need to incorporate UE movement in CVA gait rehab.
Suica et al (2016) write that current walkers and rollators which enable excessive stability provision by the UEs thereby diminishing physical challenge to the LEs may not be optimal devices to use for stroke (CVA) rehab. It would be desirable to have a training device and mobility aid which enabled UE movement and adjustability of this movement in order to alter stability.
Recent findings related to plasticity of the nervous system have expanded endeavors to improve gait function in those with neurologic disorders. Training involving repetitive stepping training is called locomotor training. Behrman et al (2000) list principles known to enhance locomotor training. This list includes: “(1) generating stepping speeds approximating normal walking speeds (0.75-1.25 m/s) (2) providing the maximum sustainable load on the stance limb (3) maintaining an upright and extended trunk and head (4) approximating normal hip, knee, and ankle kinematics for walking (5) synchronizing timing of extension of the hip in stance and unloading of limb with simultaneous loading of the contralateral limb (6) avoiding weight bearing on the arms and facilitating reciprocal arm swing (7) facilitating symmetrical interlimb coordination, and (8) minimizing sensory stimulation that would conflict with sensory information associated with locomotion.” Problems associated with walkers as related to adhering to these principles are addressed by Behrman et al (2005), which describe challenges adhering to these principles with currently available mobility aids.
Maguire et al (2017) present problems related to rollator use related to neurologic gait rehab. LE muscular activity, hip loading, and hip extension range of motion are reduced, excessive use of the UEs is predominant, and collision of rear wheels with feet serve as confusing cutaneous inputs. A device advanced by the body instead of by the UEs is advised.
Even in the presence of normal upper body function, performing repetitive stepping activities on treadmills and when standing, or walking over ground with body weight support, patients may tend to statically position UEs. It would be desirable to have a device which enabled, facilitated, and potentiated reciprocating UE movement for repetitive stepping activities over ground or when on the treadmill. It would be desirable to have a device which could also be used to perform reciprocating gait patterns involving heavier UE support, such as with forearm supports. Such a device could be used for training to minimize UE weight bearing when light support is needed and would enable the same biomechanics when heavier support is needed in the absence of deweighting devices.
Fulk et al. (U.S. Pat. No. 8,573,612) present a device to address the above principles. The device is managed by the UEs, with statically positioned grips on the frame; neither reciprocating movement of one UE or symmetrical out of phase UE movement can be facilitated; device is lacking in stability for safe use when more than light support is needed.
A device is needed which enables enhanced adherance to a greater number of principles known to enhance neurorecovery.
A need exists for an improved arrangement which provides solutions for the above problems as well as others.
The technical problem is how to reduce UE management of wheeled mobility aids and enable reciprocating UE movement.
Improved gait is achievable with mobile upper extremity (UE) support and related methods in other railed devices such as parallel bars and treadmills by altering upper body function, and an over ground mobility aid is needed which enables the same.
The solution is one or both UE support assemblies can be mobile upon the upper portions of side frames of a device with rigid interconnections between the frame panels. A mobile support assembly comprised of a mobile component and attached UE support assembly is able to reciprocate (move back and forth) along the upper part of one or both side frames along a straight or curvilinear path. UE support surfaces such as grip handles and forearm support assemblies or other can be incorporated in any combination. Brake levers are preferably provided on grip handles and handle portions of forearm support assemblies for use as needed to brake the wheels and/or movement of the assembly upon the rail. An interconnecting member (reverse motion linkage) creates equal and opposite movement of one support assembly relative to the second support assembly. Disconnection of this reverse motion linkage enables independent movement of support assemblies. Introduction of an external power source to movement of one assembly upon its rail or to the reciprocating linkage can readily be introduced. Positioning of motion stop blocks adjacent to mobile components enables one or both support assemblies to be statically positioned. Variable static positioning of assemblies in the sagittal plane can be accomplished. Positioning at other locations along the track provides a way to delimit excursion range of motion. One or more novel frame components identified as torso bar(s) are attached to the frame for contact with user's anterior torso. Vertical positioning of the torso bar (above or aligned with pelvis) is adjusted to optimize walking performance. Positioning at the level of the hip joint may encourage enhanced LE propulsion. A belt or other means of encouraging secure and consistent bodily positioning relative to the torso bar is provided and can be variably incorporated. The device is advanced via bodily contact. The device has two or more wheels. Wheel locks can be incorporated for use for static activities. A preferred embodiment introduces caster wheels to the rear legs.
A wheeled ambulatory aid (such as a walker/rollator) is provided which is advanced via contact with an advancing body (torso). This provides multiple advantages of reduced use of the UEs to manage a mobility aid. Good upper body function is not needed, posture is improved, UE physiological work and excessive upper body weight bearing are likely reduced, training to minimize UE weight bearing can be performed. When used for light support, UEs can be statically positioned or mobile. Static positioning can be accomplished by placement of motion stop blocks adjacent to the assembly(ies). When additional upper body support is needed and gait patterns performed with alternating UE movement, forward movement of the torso related to weight shifting advances the device. Horizontal force development and erect posture are encouraged. Enhanced LE muscular activity with rollator use may occur. Hip extension range of motion is increased. Assessment of ability to walk safely with a wheeled device is enhanced. Visual and physical cues are provided to encourage forward movement of the pelvis (or abdomen) and consistent positioning relative to the frame is accomplished.
Reciprocating movement of one or both support assemblies in the sagittal plane enables reciprocating UE movement of one or both UE as well as a means to achieve out of phase UE movement. An assembly is provided which can be mobile upon a track, rail, or any other configuration allowing back and forth movement on the upper surface of a wheeled device frame. Motion stop blocks prevent movement of assemblies off of tracks and can be used to delimit excursion range. Rhythmical movement can be accomplished when UEs are lightly supported and a more natural gait pattern can be achieved with the adequate support of a framed device, and particularly with a device with wheels on all legs to facilitate continuous stepping. Rhythmical movement can be accomplished with a mechanical linkage intact for consistently symmetrical movement, or with linkage disconnected which allows greater freedom of movement. Rollator users with mild age related gait impairment may selectively use the device with UE movement enabled when walking longer distances and statically position the support assemblies for walking shorter distances such as in the home.
Mobile gripping surfaces or grip handles or mobile forearm supports can be incorporated for UE positioning similar to arm swinging or with flexed elbow which may be desirable for training in faster walking. Horizontally directed UE forces when lightly supported may enhance forward propulsion. This device can be placed over treadmills, used at the edge of a chair or edge of a bed to enable training in functionally relevant upper body movement when standing or marching in place. Introduction of a resistance component provides additional UE training benefit.
UE movement in the sagittal plane enables reciprocating gait patterns incorporating additional UE support. Two and four point gait patterns, variations thereof depending on individual movement patterns which may include compensatory movement, can be performed. Hand braking can be incorporated on one or both sides as needed or desired. Advancing an UE concurrently with (two point gait) or before (four point gait) the opposite LE enables UE forces to be directed perpendicular to the ground. Connection of the reciprocating linkage results in equal and opposite movement of the UEs, with movement of one UE behind the plane of the body. Disconnection of the linkage when performing these gait patterns enables increased freedom and asymmetry of movement. For example, an UE can remain parallel to the torso instead of moving in the rearward direction when the opposite UE is advanced. Independent movement of the assemblies also enables three point gait patterns which will be described. Users with adequate cognition to use the device for this purpose may walk with improved posture and safety. A device is provided which enables a wide range of movement patterns and related UE support needs.
A device which provides a mechanical means to achieve symmetrical bilateral UE movement (via the reverse motion linkage) provides a way to incorporate a motor which might be particularly beneficial for training in longer duration repetitive stepping training when light support is needed as well as repetitive stepping training and movement facilitation when additional support is needed. Repetitive movement of lightly supported UEs may be used when LE function is adequate, or when any of various deweighting devices such as exoskeletons or body weight support is used. Mechanical facilitation of repetitive movement provides a way to adjust stepping cadence, velocity, excursion of movement, and may enable increased duration of walking activities related to decreased cognitive and physical demands to move the UEs for long durations. The reciprocating mechanism provides a way for a stronger UE to mobilize a weaker UE during walking, or for both UEs to be mobilized in the presence of bilateral UE dysfunction. This feature provides an effective tool for training symmetrical upper and lower body movement.
The reciprocating linkage and/or the movement of support assemblies provides a functionally relevant mechanism to integrate LE orthotic devices such as reciprocating gait orthoses as well as more advanced orthotic devices and to integrate various physical cuing mechanisms such as audible cuing or other.
The torso bar can be positioned for fit and function. Consistent bodily positioning relative to the frame provides for safer turning, and prevents foot contact with wheels. Connection of the torso bar to the frame could include spring loaded or other mechanisms in order to enable a selected amount of freedom of movement between the user with secured torso bar and the frame. This may be beneficial when using the device on uneven terrain or to accommodate gait patterns with excessive vertical displacement of the center of gravity.
A walker is provided with a preferred wheel configuration including standard wheels in the front to prevent side to side movement of the device when arms are moving. Swivel wheels in the rear enable turning. The device is turned by moving the rear frame away from the direction of the turn instead of moving the front end of the frame in the direction of the turn. Consistent improved positioning of the body relative to the device in conjunction with wheel configuration may reduce instability and associated fall risk related to traditional rollator use with excessive UE weight bearing and device too far away from the body. A device is provided which can be used with standard wheels in the front and legs without wheels in the rear. A device is provided which can be used with casters in the front and standard wheels in the rear. This configuration may be desirable when UE support assemblies are statically positioned. A device is provided which enables efficient integration of any combination of UE support surface (gripping surfaces, forearm support). The device provides for straight or curved rails. Curved rails enable rotatory shoulder motion and may be particularly useful with incorporation of forearm supports. A rollator with this configuration could be uniquely used for activities such as outdoor rollator walking similar to racewalking. Exaggerated UE movement when forearms are supported encourages enhanced trunk rotation when walking with a railed device. This type of training may be particularly beneficial for the PD population. A device with two forearm supports which enables movement of at least one UE provides a device which enables enhanced maneuverability and functionality when bilateral forearm support is desirable.
A device is provided which can be used with hand braking on one or both sides, and in combination with a grip handle or forearm support. Various configurations provide for various user needs and functional requirements. One lever can actuate one or both wheels and/or brake the movement of the mobile assembly along its path. A device is provided which may enhance neurorecovery as follows: walking at higher velocities is facilitated by UE movement, functionalities associated with the mechanical linkage, and other; enhanced LE weight bearing by enhanced symmetry related to reciprocating UE movement and reduced UE weight bearing; erect posture via incorporation of the torso bar; improved LE kinematics and hip extension range of motion via these same features; reduction of UE weight bearing facilitated by changing UE function related to management of the device; reciprocating UE motion and related work on interlimb coordination is mechanically enabled and can be variably facilitated or potentiated by movement of the opposite UE or by an external power source; and/or consistent positioning relative to the device reduces LE contact with the wheels when walking over ground.
A wheeled device is provided which can be used as a mobility aid by users such as the elderly who have mild age related gait impairment as well as by severely disabled users. A device is provided which can be used as a gait and general rehabilitation device in all patient populations. A device is provided which provides multiple ways to improve training in CVA, PD, and other neurologic disorders. A device is provided which provides therapeutic benefit for many types of users. A device is provided which can cost effectively be introduced into clinical and home settings for efficient and effective continuation of care.
A device is provided which can be folded for easier transport and storage. A walker is provided which can include a seat. A walker is provided into which instrumentation and mechanization components related to UE weight bearing and movement can be added. A walker is described which can be fabricated with various sizes, shapes, and weights of frame components. A device is provided to which additional weight could be added to the exterior of the frame for additional training benefit.
A device is provided which has two or more wheels. A device is provided with front wheels which could be variably positioned, aligned with rear legs/wheels of the device, or positioned in the midline of the device.
Another type of wheeled device, a standing frame, is provided which enables reciprocating UE movement and multiple benefits of UE movement during supported standing activities.
A walker is provided which offers still other features and benefits.
Two forearm support assemblies, two grip handles, or one grip handle and one forearm support assembly are selected for use. Brake levers may variably be used with a front wheeled embodiment of the device yet are preferably introduced to devices with more wheels for stability purposes. Appropriate braking configuration is selected. Resistance to glide of the mobile housing could be incorporated and selected. For use as a training device, incremental weight could be added to the frame. Walker height and positioning of support surfaces is adjusted for fit and function. Integration of grip handles which can be positioned horizontally, vertically, and in angled fashion is desirable in terms of accommodating a wide array of user needs. Curvilinear or straight rails/tracks can be incorporated, and may be interchangeably introduced on a single device. The torso bar is positioned fore/aft for optimal positioning of feet within the frame and positioned vertically to optimize contact location on anterior torso. A vertical position level with the hip joint may be desirable in terms of facilitating forward movement of each hemipelvis in turn. Positioning of each of the two support assemblies along the rail is selected for fit and function and the assembly is statically positioned by positioning motion stop blocks on or adjacent to the support assemblies. Walking can be performed with statically positioned UEs in this position. The reverse motion linkage mechanism is attached or engaged for use of the device with bilateral symmetrical reciprocating movement. With the linkage intact, the starting position of the assemblies reflects the mid position of each of the two assemblies during reciprocating movement. Typically, the upper arm will be aligned with the lateral trunk of the user in the starting position yet positioning could be more forward. Disconnection of the linkage enables one UE and associated support assembly to move independently of the second assembly. This allows for asymmetrical movement as well as static positioning of one limb while the other limb moves. The belt is variably secured around the user and provides enhanced management of the device. A quick release mechanism can be introduced to this feature for safety purposes.
The device advances as related to progression of the torso irregardless if UE support assemblies are statically positioned or if UE movement is enabled. Upper body forces directed downward and forward in order to advance the device are discouraged. A more rearwardly placed torso bar and/or more forwardly positioned UE supports would enable increased compensatory use of the upper body if indicated or desired for any reason.
Walking with light support can be performed with static or mobile UE support assemblies. The user is encouraged to rest UEs lightly on UE support assemblies while stepping. The need for additional upper body support necessitates enablement of movement of the support assemblies in alternating fashion or walking with two or four point gait pattern and in symmetrical fashion for walking with a three point gait pattern. The UEs can assist with steering when assemblies are statically positioned.
When light support is needed, UEs can be moved in repetitive reciprocating fashion.
Two and four point gait patterns can be performed with the mechanical linkage connected or disconnected. Hand braking can be used for added stability as needed. Three point step to gait pattern is performed by advancing both assemblies, braking, stepping with the first foot, releasing the brakes and advancing the second foot even with (step to) or past (step through) the first foot. Turning is accomplished by turning the rear of the device in a direction opposite the direction of the turn.
A standard aluminum walker frame has been incorporated in the first embodiment and is shown in
Along the upper surface of each of the side frames, a generally L-shaped member such as a piece of steel 400 is secured to the superior and lateral surfaces of the uppermost horizontal bar of the side frame in order to create a stable flat surface to accept a track 500—shown here as a ceramic-coated aluminum rail, forming a miniature linear guide. A similar length of rail is secured to the flat surface. Motion stops 600 (
A carriage such as a mobile anodized aluminum carriage 700 (
Multiple options exist for creation of a reverse motion or reciprocating motion coupling mechanism. This type of linkage causes symmetrical motion in opposite directions, of two assemblies resting upon parallel (or mirror images—as in curved tracks, tracks/railings, etc.). See
The first embodiment includes a cable push-pull linkage. Incorporation of a reverse motion/push pull linkage involves the following. A member such as a curved, firm plastic tube 800 (
Removal of the cable or disconnecting the carriages/support assemblies from the cable, would enable each of the two support assemblies to function independently. See
In the first embodiment, support surfaces are attached to the carriage as follows. An L-shaped adapter, for example a piece of steel 1000 (
The bolt 1020 or other stable vertical piece could also accept a hollow tube to which is attached a horizontal or angled grip 1330, 1340 (shown in
A torso bar 1100 shown here as a curved aluminum tube member (
The proper support surface for each of the two sides is selected and attached to each carriage. Note that any combination of grip handles and forearm support assemblies can be incorporated depending on a user's needs. A height of the forearm support can be adjusted as needed. Likewise, fore-aft position of the support surfaces along the rail are adjusted for optimal fit and function as described above. The height of the walker is adjusted via adjusting the snap pin location in the telescoping members at ends of all four legs of the walker.
Standard or caster wheels are selected for the front and rear legs. Legs without wheels can be introduced to the rear. Standard wheels in the front and caster wheels in the rear is the preferred combination and results in a device which more readily travels along a straight path. Turns are performed by turning the rear of the device opposite the direction of the turn. When UE supports are statically positioned, swivel wheels in the front and standard wheels in the rear could variably be incorporated. Caster wheels with locking mechanisms could be incorporated on all four legs which would enable altering wheel functionality as desired.
Orthoses can be incorporated as needed to secure the user's wrist and hand to the grip support or to the grip handle component of the forearm support assembly. This would be desirable for users with diminished UE function.
The torso bar 1100 is adjustably positioned such that when the anterior aspect of the user's torso contacts the torso bar, the feet of the user are positioned for optimal balance and function. Vertical adjustment of the torso bar is not possible in this embodiment yet this would be desirable. The belt strap length is adjusted for secure positioning of the body of the user relative to the torso bar 1100. The torso bar (with belt) serves to attenuate any forces related to arm movement of the user. Advancement of the walker is preferentially caused as a result of contact of the user with the torso bar as opposed to being managed by the UE. The torso bar also serves as a tool for consistent maintenance of optimal body positioning relative to the device.
It is contemplated that engaging the brakes could brake the mobile UE supports along the upper rail and/or actuate the wheels, depending on functionality desired.
The cable linkage can be connected to each of the two mobile assemblies or disconnected. When connected, equal and opposite motion of mobile assemblies results when one or both UEs moves. Disconnection enables one or both assemblies to reciprocate independently of the other, each upon its rail. Early active movement on an involved UE is allowed while the opposite UE moves in reciprocating fashion. Incorporation of an external power source to the mechanical linkage would potentiate repetitive, out of phase movement. Adjustment of frequency of movement could be done to effect changes in stepping cadence. Mechanization of the linkage would provide multiple additional training benefits including symmetrical repetitive motion, velocity adjustment (which in turn affects stepping frequency), enabling the user to focus on LE stepping, reduction in UE fatigue for longer duration training, and setting training session duration. Repetitive reciprocating motion can be accomplished with the linkage disconnected as follows: support assemblies positioned at opposite ends, and each side independently powered. Variably, one side could be externally powered for movement assistance in the case of asymmetric UE functioning.
One or both assemblies can be statically positioned. This may be desirable when walking shorter distances. It may be desirable when training or use of the device necessitates focus on lower body stepping. The embodiment incorporating statically positioned UE supports may be used as a screening tool for adequate lower body function to use the selected wheeled device, as related to the function of the torso bar discussed above. The torso bar can be left in place or removed in order to manage the device with the UEs if desired.
Turning the device with mobile UE supports (with the cable linkage intact or removed) is facilitated as follows. Arm support is moved in the rearward direction on the side the user is turning toward, and arm support is moved in the forward direction on the opposite side. With standard wheels in front and swivel wheels in the rear, the user sidesteps in the direction opposite the direction of the turn, thereby turning the rear end of the device opposite the direction of the turn instead of turning the front end in the direction of the turn when swivel wheels are on the front. The preferred wheel embodiment provides for a safety mechanism when turning: excessively distancing oneself from device moving forward and concurrently turning is often hazardous and is not possible.
Side braces 2020 extend between respective legs on each side of the wheeled walker 2000. For example, one of the side braces 2020 interconnects the front right leg 2002 with the rear right leg 2006. Likewise, the other side brace 2020 interconnects the front left leg 2004 with the rear left leg 2008. Moreover, one or more front braces 2022 may be provided between the front legs 2002, 2004.
The ability to support an upper extremity or upper extremities of a user (not shown) having various needs are particularly illustrated in
As described above, the carriages or support assemblies 2030 are mounted for sliding movement relative to a respective side, and also fore and aft relative to one another, i.e., one side advances forward while the other moves rearwardly, and vice versa. This coordinated action between the support assemblies 2030 employs a mechanical connection or link 2070 and when assembled together (connected), is referred to herein as a reverse motion linkage. The reverse motion linkage serves to move one carriage/support assembly in the forward direction at the same velocity and distance as the opposite carriage/support assembly moves in the opposite direction.
In the embodiments of
A handbrake 2080 is also conveniently positioned relative to the handle grip 2060. Actuating the handbrake 2080 as shown in
The carriages are positioned symmetrically, with fore-aft positioning such that when the support surface is engaged by the user, the shoulder is in a neutral position (i.e., even with midline of body when viewed laterally). As related to variable fore-aft contact location of the extremity with the support surface, when comparing grip support to forearm trough support, bilateral grip handle supports will be symmetrically placed slightly more forward along the rails, and bilateral forearm supports will be symmetrically placed farther back along the rails. This is due to the ability to vary the UE contact point with the rail depending on the elbow position of a particular user. One grip handle and one forearm support may be desirable, as well, for various clinical reasons. With the current embodiment with grip supports in place, the carriage can be mobilized anterior relative to the neutral position to a location approximately even with the front horizontal bar of walker (e.g. approximately seven inches anterior to the neutral position) and posterior relative to the neutral position to a location roughly even with the attachment of the torso bar to the side frame (e.g., approximately seven inches posterior to the neutral position), enabling symmetrical arm motion during gait. Of course one skilled in the art will recognize that the noted dimensions are exemplary only and the subject disclosure should not be unduly limited to these dimensions.
The carriages can be connected with the reverse motion linkage or can be unlinked simply by removing the coupling shaft. Removing the coupling shaft or unlinking the carriages from cooperating movement with one another would allow for independent movement of each of the two carriages along each of the two respective rails. As such, the direction of and the extent of glide of each of the two mobile assemblies, is independent of the other.
The carriages allow for very low resistance gliding along the tracks. Variable resistance to glide could be introduced in any of the embodiments. Adding resistance to upper body movement could be desirable for purposes of use of the device for upper body strengthening.
In the second embodiment, the device is unfolded by moving one side frame away from the other side until the joints between the two front legs and the two horizontal front frame members lock into place. The end plates of the torso bar are lowered into the pockets or recesses on the inner surfaces of the housing. The desired wheel type on front and rear wheels is selected for optimal functioning. Standard wheels in the front and casters in the rear are the preferred embodiment. The walker height for a particular user is adjusted for proper fit and function by adjusting the positions of the snap pins in the holes of the leg attachment pieces. The height of the forearm support trough(s) is likewise adjusted if this type of support surface is selected. It is also understood that a grip surface on one side and a forearm support assembly on the other side or two grip handle supports could be used. The desired support surfaces are selected and secured to the device.
The actuating arms (mounting members) are positioned for fit and function for a particular user. Motion of a support surface of, for example, up to 17.5 inches of total travel has been achieved with this embodiment, and again, a greater or lesser amount of travel is contemplated without departing from the scope and intent of the present disclosure. This disclosure accommodates variable introduction of grip supports or forearm supports and the variable neutral positioning associated with each. The coupling shaft is engaged to lock the support surfaces into the desired positions, which may be asymmetrically placed, for example, if both a grip and a forearm support are used. Otherwise, the supports would typically be symmetrically placed. In the mid-position, the same amount of travel fore and aft relative to the midline of the body results. Alternately, placement of the support or carriage more forward results in a greater percentage of the travel in front of the midline, and placement of the support or carriage closer to the rear of the device results in a greater percentage of the travel posterior to the midline of the body. The coupling shaft is left disengaged if independent movement of the arms is desired.
Testing of brake functionality is performed for safety purposes. Brakes can be engaged as needed, for purposes of arresting the movement of the support surface along the rail, and/or for arresting the movement of the device along the ground. When the coupling shaft is in place, braking one side will cause braking of both UE supports. One brake lever can be configured to brake both wheels of the device if this is desired, such as in cases of UE dysfunction unilaterally.
The torso bar could be made to be adjustable for fore-aft and vertical positioning. Adjustability of the torso bar is not specifically shown in this embodiment but it is well within the purview of one skilled in the art to provide an arrangement that permits such adjustment. The user addresses the walker, and with the current embodiment, maintains contact of the abdomen with the torso bar and secures a belt attached to each end of the torso bar, such that constant contact with the device through the torso bar is achieved. The arms of the user are placed on the support surfaces.
It will be recognized that the present disclosure is not limited to the physical structures and functions described herein, but is intended to encompass variations and modifications that are reasonable extensions of these teachings. For example, a glide on track; glide directly on rail; or any other device which stably glides along a track. Alternately, an undersurface of a forearm trough is equipped with rollers, bearings, or any of several other mechanisms to accomplish secure mobility (i.e., relative sliding) along a track.
The torso bar 3310 is positioned so that the user is positioned with feet in the rear half of the walker with the anterior torso contacting the arc-shaped bar (see
Wheels are secured to the front legs and casters on the rear. The seat has been removed yet it is understood that this feature would be desirable in many applications. The user would access the seat by removing the torso bar.
As explained, this linkage can be connected or disconnected, the latter enabling independent movement of each of the two support assemblies. The component which is mobile upon the rail is similar in function to a mobile device presented in
In
In
In
It is also understood that the walker frame itself could be fabricated with discontinuous (
A rollator particularly suited for fast walking training with flexed elbows is shown in
This application is a continuation-in-part of and claims the priority benefit of PCT/US2016/060411, international filing date of Nov. 3, 2016, which claims the priority benefit of U.S. provisional application Ser. No. 62/250,291, filed Nov. 3, 2015, and U.S. utility patent application Ser. No. 14/719,311, filed May 21, 2015, the disclosures of each of which are expressly incorporated herein by reference. This disclosure is directed to wheeled devices used for ambulatory support. Assistive devices such as walkers, rollators, and wheeled devices used for various forms of walking training are railed devices used as mobility aids to improve balance and to reduce lower extremity (LE) loading, for gait and other physical rehabilitation, as therapeutic devices, and for neurorecovery of locomotor function. The interest in physical, physiological, and functional effects of using walkers and rollators and the use of these devices for therapeutic purposes is increasing (O'Hare et al, 2013). The upper extremities (UEs) function abnormally in a postural support role when managing these devices. Multiple solutions for multiple user groups related to wheeled device use are provided for by altering the function of the upper body.
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| Number | Date | Country | |
|---|---|---|---|
| 20180250189 A1 | Sep 2018 | US |
| Number | Date | Country | |
|---|---|---|---|
| 62250291 | Nov 2015 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | PCT/US2016/060411 | Nov 2016 | US |
| Child | 15970538 | US | |
| Parent | 14719311 | May 2015 | US |
| Child | PCT/US2016/060411 | US |
