This disclosure is directed to assistive devices for mobility, specifically wheeled devices used for ambulatory support.
Mobility aids used for ambulatory support are typically managed by one or both of a user's upper extremities (UE). Users maintain bodily contact with devices by gripping one or two gripping surfaces and/or by placing one or both forearms on forearm supports. Walkers without wheels are called pick up walkers (PUW). PUW are necessarily managed by the UEs as they are lifted off of the ground by the user and subsequently advanced in order to enable stepping. Walkers with wheels on the front legs are called front wheeled walkers (FWW).
Rollators are devices with three or four (4) wheels. Typically, caster wheels are fit on the front legs and standard wheels on the rear. Rollators are inherently less stable than FWW.
Gait trainers are wheeled devices prescribed for children and adults with physical disabilities to enable independent walking or for training in safe and efficient gait. Positioning and supportive components can often be incrementally added to the frames as needed for postural support and LE deweighting to enable stepping. Frames which incorporate upper extremity support surfaces/assemblies, used for walking without deweighting components, are frequently excessively managed by the upper body. Forward leaning and excessive weight bearing through the hands or forearms to advance these devices frequently occurs when the devices are configured to be managed by the UEs.
Devices with wheels are advanced by rolling the device with all legs and/or wheels remaining in contact with the ground. When needed for light support and when used properly, the user maintains consistent positioning relative to the device with erect posture and with UEs supported lightly. The device advances as the user takes steps and UEs are in contact with the device.
Use of devices such as walkers managed by the UE is particularly problematic related to the prevalent problem of excessive compensatory use of the UE for control and stability and associated flexed posturing, device positioned excessively forward relative to user, excessive upper body weight bearing and associated abnormal lower body functioning. Abnormal biomechanics impacts safety when walking, impairs gait rehabilitation efforts, is known to negatively impact neurologic recovery of locomotor function, and results in decline of lower body function. The goal when walking is to generate lower extremity (LE) propulsive forces. This would be enhanced in presence of a frame member optimally positioned for anterior pelvic contact.
Incorporation of bilateral forearm support assemblies facilitates improved posture when used correctly and when light UE support is needed, yet does not provide a solution for flexed posture and safety when increased upper body support is needed. When light support is needed, the prevalent tendency remains to excessively manage wheeled devices with the upper body and to excessively bear weight through forearm supports. Advancement of the device via torso contact is needed.
There are several reasons that poor technique with walker use may occur.
LE function may be inadequate to take steps with erect posture and normal LE biomechanics.
Users may conceive that UE weight bearing is advisable when using wheeled devices. Users may excessively consider that these devices are meant to provide considerable support.
Other users may be accustomed to observing the prevalent poor posturing of walker and rollator users and consider this unavoidable. In addition, users may not understand the detrimental effects of using devices in this way.
Many people inaccurately consider that weakening of the body necessarily occurs as one ages and accept that posture and gait quality deteriorate, particularly when a walker is deemed needed.
From an early age, humans are taught to push wheeled devices equipped with handles. Management style with wheeled devices is typically to push downward and excessively bear weight with the UEs.
Education in proper technique by those recommending the use of these devices may be lacking.
Users yield to the forces of gravity and fail to exert the effort required to counteract this.
Device designs may encourage less than optimal biomechanics.
Excessive upper body weight bearing is associated with UE overuse injuries.
Flexed posture is associated with spinal dysfunction, impaired balance, disruption of gait biomechanics, compression of the cardiorespiratory system, decreased visual interaction with the environment, and more.
Orthopedic patients need a simple training device which encourages increased hip and knee range of motion and optimal LE functional strengthening with use. Current devices are inadequate in this regard.
Established locomotor training principles known to enhance neurologic recovery include, in part, normalizing lower body function, improving spinal posture, reducing upper body weight bearing. Adhering to these and other principles is challenging with currently available overground mobility aids. This invention and Johnson's device provide solutions.
For a similar power output or similar volume of work performed, demands on the cardiorespiratory system are greater when the work is performed by the UEs compared to that when performed by the LEs. Excessive upper body work is undesirable in terms of gait efficiency as well as in the presence of various disease states. Conservation of energy and efficiency of movement are desirable and are negatively impacted with excessive, unnecessary upper body work. A simple mechanical means to reduce excessive UE work during walking is needed.
Walking with outstretched UEs and flexed posture with a mobility aid displaces the body's center of gravity (COG) anteriorly and displaces laterally when turning. Stability and safety are decreased when the COG falls outside of the base of support, particularly when the device has wheels.
Users often demonstrate unsafe turning technique with walkers and rollators. Feet can become positioned too far forward or back within the frame, and base of support can narrow. It would be desirable to have a mechanical means for consistent bodily positioning to enhance safety while turning.
Currently, ambulatory ability with a wheeled device in part reflects upper body functional status. It would be desirable for several reasons to have a device which when used primarily reflects lower body functional status.
Walkers and rollators managed by the upper body require good and symmetrical upper body function for safe and effective use. It would be desirable to have a device advanced via contact with the torso.
Management of wheeled mobility aids by the upper body represents dual tasking while walking and thus increases cognitive demands. For some, this may distract from necessary focus on lower body function, that which is necessary to walk safely or to improve gait. It may add confusion and increase fall risk. It would be desirable to be able to reduce these demands.
Falls present a major problem in our society and associated injuries are responsible for vast amounts of medical spending. It is commonly known that the majority of falls occurs with walkers. This invention may assist in reducing fall risk for reasons associated with above factors.
Gait quality and safety are increasingly compromised when additional upper body weight bearing is needed when using wheeled devices. Upper body forces are necessarily angled downwards in order to simultaneously advance the device. Posture typically becomes excessively flexed as upper body weight bearing is increased. Both UE provide support for each of the lower extremities (LE) as opposed to an UE supporting the opposite LE as can be performed with crutches. Solutions are needed to enable improved biomechanics when walking with walkers in the presence of need for additional upper body support.
Johnson's Reciprocating Arm Motion Walker U.S. Ser. No. 15/970,538, filed May 3, 2018, and WO 2017079491 (PCT/US2016/060411 that claims the priority benefit of U.S. provisional application Ser. No. 62/250,291, filed Nov. 3, 2015)(‘the '538 application), provides such a solution. UE support assemblies are mobile upon a fixed frame. Each UE can be advanced in turn, simultaneously with the opposite LE (2 point gait) or in advance of the opposite LE (4 point gait; 4 distinct points of contact with the ground) such as can be performed with crutches. The device is advanced via contact of the moving body with a novel horizontal frame member. Gait biomechanics are significantly normalized compared to walking with a wheeled device managed by the upper body. UE forces can be directed vertically, supporting the opposite LE to the extent needed, whilst maintaining erect posture. Improved 3 point step to and step through gait patterns can also be performed with this device, when simultaneous support of both UEs is desirable.
The device described in the '538 application also enables freely reciprocating UE movement such as can be performed, and is desirable, when a wheeled device is introduced for light support. Propagation of the device is independent of UE movement. The device is advanced via bodily contact with the horizontal frame member. Upper and lower body gait biomechanics are thus improved. UE support assemblies can variably be statically positioned when this is appropriate.
Bilateral torso bar designs such as presented in this invention could be integrated into the reciprocating arm motion walker of the '538 application in place of the one piece torso bar incorporated into the original designs.
Several different design options for a feature and related method is provided for various types of wheeled mobility aids to enable the selected device to be advanced preferentially via contact with the torso instead of by the upper extremities.
This invention provides a more effective way to walk with a wheeled device, particularly when the device is needed for light support.
The invention will be used as a gait training device and as a mobility aid to be used intermittently or on a permanent basis.
Falls present a major problem in our society and associated injuries are responsible for vast amounts of medical spending. It is commonly known that the majority of falls occurs with walkers. This invention may assist in reducing fall risk. It may be useful to screen for adequate lower body function as needed to walk safely with a selected type of wheeled device. Sufficient lower body function is required to propagate a torso bar walker. An individual who is able to walk by excessively managing a device with the upper body, yet is unable to walk with this invention, may be deemed to be at greater risk for falling.
This invention provides for the following benefits: reduction of excessive upper body management of the device and associated problems; facilitation of improved lower body function with implications for LE strengthening, gait quality, neuro-recovery, stability, safety.
This invention describes features which can be permanent or removable, and added to wheeled device frames with minor design modifications or incorporated into new designs. The invention is functional on wheeled mobility aids with two, three, or four wheels. Surfaces which facilitate gliding can selectively be introduced to the rear legs of two wheeled devices as needed or desired. It is also understood that the invention is applicable to a pick-up walker (i.e., no wheels) where the torso bar is not used for advancing the mobility aid but the torso bar is particularly useful to provide proper positioning of the associated user when using the pick-up mobility aid/walker.
One or more components (‘bars’) are securely fastened to any of various locations on the frame for purposes of providing contact points with the user's torso, preferably at the level of the pelvis. Bars presented in the drawings are attached to the side frames. Several different attachment mechanisms can be conceived and are not presented in detail here. Contact with the upper torso progressively may encourage forward flexion of the trunk and therefore would not be desirable.
Components could be made of any of several different types of material and in any of several different forms. Padding can be variably introduced to the bars, and conceivably incrementally added for comfort and to accommodate a range of body shapes and sizes.
Bar(s) contacting the anterior torso can be used with or without a belt or some other component contacting the posterior torso (‘posterior components’). Posterior components facilitate keeping body in contact with the bar(s) and offer a surface to push against for steering and walking backwards.
One piece torso bars span the frame of the device, are positioned parallel to the ground, and can be curvilinear or straight. Circular tubing with or without padding is incorporated in the one piece torso bar walkers illustrated. Steering of the device is enhanced when bar is more congruent with shape of the torso. Fore-aft and vertical adjustability would be desirable. Designs with fixed fore-aft positioning will strive for optimal fit for the majority of users.
Variably, a torso bar can project from each of the two side frames for contact with each side of the torso. Multiple positioning options of the bars can be conceived of. These are referred to as bilateral torso bar designs. An anterior member/component of each bar can be used with or without a posterior member, depending on user's needs or desires. Posterior members function similarly to that described above for the unilateral bar design. Preferably, the two torso bars are at the same height and extend the same dimension from the respective side frame, although it is recognized that the two torso bars could be offset in height or could extend different lengths from the side frames as needed for specific patient/user situations without departing from the scope and intent of the present invention.
Ideal positioning of the feet within a walker varies, depending on physical and functional characteristics of the user. Fore-aft adjustability of the bar(s) is desirable to accommodate this. One could consider torso bar walker designs in which bar(s) could be positioned excessively posterior in order to accommodate users accustomed to standing excessively far from the walker. The bar could be progressively moved forward as training progressed and UE weight bearing was reduced.
Vertical adjustability enables positioning at the preferred level of the torso. Again, contact with the pelvis is most desirable as described below related to functionality.
Bilateral designs such as a U- or V-shaped or caliper design could be created which enable adjustment for variable pelvic width.
Varying degrees of freedom of movement at the connections between torso bar(s) and the frame could be integrated. A rigid connection would serve to immediately cause the device to advance, when in contact with a moving body. Torso bar(s) with nonrigid connections may be useful for accommodating movement of the body relative to the device, such as with terrain changes, gait variations, and other.
Wheel configuration of four wheeled devices typically includes placement of swivel wheels on the front legs to facilitate turning. Users are heretofore accustomed to steering a device whilst pushing it excessively with the UEs. Turning with caster wheels on the rear is performed by turning the rear end of the device and this may be facilitated when movement of the body is more involved with managing the device. In terms of forward progression, standard wheels on the front may also create a more stable device.
Weights could be incrementally added to the frame for adding resistance to forward progression. Adding weight increases the force production required of the lower body to advance the device and therefore provides for a unique training option.
Auditory cuing devices could be integrated into the torso bar(s) for biofeedback to encourage contact, and to enhance contact forces.
The features serve to enable propagation and steering of the device via torso contact to the extent the user remains in contact with the features while walking.
The position of the bar(s) relative to the frame determines foot positioning and where bar(s) contact the body. Adjustment of position enables optimizing for comfort, fit, and function.
Consistent foot and bodily positioning is accomplished by keeping body in contact with the anterior bar.
The objective is to push the body forward against the bar(s) and to rest the UEs on the UE supports (grips and/or forearm supports) when walking. Generation of lower body propulsive force is required to advance the device. Horizontally-directed forces cause the device to advance.
Vertical positioning of the bar(s) is most desirable at the level of the pelvis. Forward leaning of the body or spinal flexion may be encouraged when positioned above the pelvis, as the upper trunk is pushing against the bar.
Vertical positioning close to the level of the hip joints may be optimal. During mid to late stance phase in the gait cycle, verbal and proprioceptive feedback provided to the user encourage pushing the pelvis forward against the bar in order to advance the device. In part, hip extension range of motion and muscular activity is thereby enhanced.
Presence of a left and right torso bar (as opposed to a one piece bar) may encourage enhanced pelvic rotation, that which increases gait efficiency and that which may be somewhat restricted related to static positioning of UEs on these devices. Training can include cuing to exaggerate pushing each hemipelvis forward during mid to late stance phase, in reciprocating fashion, as one takes steps.
The need for excessive UE support will prohibit use of the device as described, as this entails standing further away from the device in order to direct significant upper body forces in an angled direction to advance the device.
Sufficient lower body function is required in order to take steps while maintaining bodily contact with a wheeled device with the torso bar. If one can not walk in this manner, and can only walk via excessive UE management, walking with a standard device may not be safe. Related to this, it is proposed that the incorporation of torso bar features will render a device a screening tool for safe walking with the selected type of wheeled device.
The features can be kept in place long term, used for short term gait rehabilitation, or integrated intermittently as needed.
Managing wheeled devices by the UEs requires dual tasking which can be challenging for users with cognitive impairment. This device may reduce cognitive demands. The UEs can rest on the device while the lower body performs habitual stepping.
In
As is well known, and associated user (not shown) typically places the right and left hands and gripping relation with a hand grip bar 124 associated with the side frame portion. As noted above, if the height is not properly set, or the associated user hunches over while using the walker 100, safety, rehabilitation, locomotor function, muscle strength, etc., may be adversely impacted.
A torso bar 150 is incorporated into the structure in accordance with the present disclosure. The torso bar in this embodiment is a single structural component that has a slight curvature where a central portion is disposed forwardly (in a fore/aft direction) of first and second is 152, 154. Each end 152, 154 of the torso bar 150 is attached to a side frame 104, 106, particularly a rectangular plate 156 in the preferred embodiment, which slides into a holder 158 affixed to the inner surface of top portion of side frame. Adjustment of positioning is not possible with this design, although other mounting arrangements that are either fixed or adjustable or contemplated and not deemed to be outside the scope of the present disclosure. Adjustment of the height of the walker is required for adjusting where the torso bar 150 contacts the anterior torso of an associated user. The torso bar 150 can be removed for use of the device as a standard walker 100. The associated user grips the grip handles 124 and positions the body such that the torso bar 150 contacts the anterior torso. Erect posture and proper positioning of the feet is thus achieved.
Swivel wheels 128 are on the rear legs 122 and standard wheels 128 are attached to the front legs 120. This is the configuration incorporated in the '538 application. It creates a more stable device in the presence of reciprocating UE movement. This arrangement also creates a more stable device for forward progression. Turns are performed by stepping in the direction opposite the desired direction of the turn.
Another assistive walking device such as a four wheeled walker embodiment of the torso bar walker is shown in
An assistive walking device such as rollator 200 is shown in
A schematic illustration in
Rollators 200 are typically less stable than walkers related to the presence of four wheels 128 with swivel wheels in the front, and the tendency is to push these devices too far from the body. Stability is enhanced with the torso bar 150 due to consistent proximal positioning of the user to, or contact with, the torso bar along the torso region of the user. Fore-aft bar positioning of the torso bar 150 may be adjusted along frame members 214 for walking up and down inclines and may further optimize rollator walking. Variably, a device may be managed better on hills and uneven terrain by the UEs. LE strengthening may eventually be found to be enhanced with the torso bar rollator 200 as discussed above, hence stability improved.
An assistive walking device such as three wheeled rollator 250 with a basket 252 is shown in
An assistive walking device such as front wheeled torso bar prototype walker 100 is presented in
A design of a uniquely shaped torso bar 150 for enhanced conformity to the anterior torso and that also includes first and second anterior engaging portions 260 of the torso bar are illustrated in
An assistive walking device such as anterior gait trainer 300 is shown in
Illustrations of bilateral torso bar 150 designs are shown in
In
In
In
In
Design of U-shaped padded torso bars 450, 452 superimposed on a rollator is shown in
An assistive walking device such as a rollator frame 460 with unique design is presented in
The grip handle designs 462 may offer enhanced functionality compared to designs which involve gripping the upper rail of the frame. These novel designs may further reduce the tendency to manage the device with the UEs.
Straight or curved rails 470 comprise the top portion of the frame. The torso bar 150 is situated between the top rails and could be adjusted vertically and fore-aft.
A vertical extension 470 is attached to the upper rail of the frame in
A U-shaped wrist support 472 is provided on the device illustrated in
In
A torso bar rollator with forearm support assemblies 466 is illustrated in
All of the terms used herein including technical or scientific terms have the same meanings as those generally understood by an ordinary skilled person in the related art unless they are defined otherwise. The terms defined in a generally used dictionary should be interpreted as having the same meanings as the contextual meanings of the relevant technology and should not be interpreted as having inconsistent or exaggerated meanings unless they are clearly defined in the various exemplary embodiments.
This written description uses examples to describe the disclosure, including the best mode, and also to enable any person skilled in the art to make and use the disclosure. Other examples that occur to those skilled in the art are intended to be within the scope of the invention if they have structural elements that do not differ from the same concept or that do not differ from the literal language of the claims, or if they include equivalent structural elements with insubstantial differences from the same concept or from the literal language of the claims. Moreover, this disclosure is intended to seek protection for a combination of components and/or steps and a combination of claims as originally presented for examination, as well as seek potential protection for other combinations of components and/or steps and combinations of claims during prosecution.
Although specific advantages have been enumerated above, various embodiments may include some, none, or all of the enumerated advantages. Although exemplary embodiments are illustrated in the figures and description herein, the principles of the present disclosure may be implemented using any number of techniques, whether currently known or not. Moreover, the operations of the systems and apparatuses disclosed herein may be performed by more, fewer, or other components, and the methods described herein may include more, fewer, or other steps. Additionally, steps may be performed in any suitable order.
To aid the Patent Office and any readers of this application and any resulting patent in interpreting the claims appended hereto, applicants do not intend any of the appended claims or claim elements to invoke 35 USC 112 (f) unless the words “means for” or “step for” are explicitly used in the particular claim.
This application claims the priority benefit of U.S. provisional application Ser. No. 62/650,793, filed Mar. 30, 2018, and is a continuation-in-part of pending U.S. application Ser. No. 15/970,538, filed May 3, 2018, which is the national entry filing of PCT/US2016/060411, filed Nov. 3, 2016, which claims the priority benefit of U.S. provisional application Ser. No. 62/250,291, filed Nov. 3, 2015, the entire disclosures of each of which are expressly incorporated herein by reference.
Number | Date | Country | |
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62650793 | Mar 2018 | US | |
62250291 | Nov 2015 | US |
Number | Date | Country | |
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Parent | 15970538 | May 2018 | US |
Child | 16371707 | US | |
Parent | PCT/US2016/060411 | Nov 2016 | US |
Child | 15970538 | US |