MEDICAL APPLIANCE FOR A JOINT OF A PERSON AND METHOD FOR OPERATING A MEDICAL APPLIANCE

Abstract

Medical appliance (9, 9a, 9b, 9c) for a joint (1) of a person (10), which has at least two parts (11) which are to be placed on the joint (1) and can be moved with respect to one another by the joint (1) and at least one detection device (13) for detecting a relative movement of the parts (11), wherein the medical appliance (9, 9a, 9b, 9c) comprises an evaluation device (16), having: a determination unit (17) for determining, from detection data of the detection device (13), a range of movement (5) of the joint (1), which range of movement is actually used when the medical appliance (9, 9a, 9b, 9c) is worn, a comparison unit (18) for comparing the range of movement (5) used with a desired range of movement (6), and a support unit (19) for determining support information guiding the person (10) to the most extensive use possible of the desired range of movement (6), said support information being dependent on the result of the comparison.

The medical appliance (9, 9a, 9b, 9c) further has an output device (20) for outputting the support information to the person (10).

Claims

1. Medical appliance (9, 9a, 9b, 9c) for a joint (1) of a person (10), which has at least two parts (11) which are to be placed on the joint (1) and can be moved with respect to one another by the joint (1) and at least one detection device (13) for detecting a relative movement of the parts (11), characterized by an evaluation device (16), having: a determination unit (17) for determining, from detection data of the detection device (13), a range of movement (5) of the joint (1), which range of movement is actually used when the medical appliance (9, 9a, 9b, 9c) is worn, a comparison unit (18) for comparing the range of movement (5) used with a desired range of movement (6), and a support unit (19) for determining support information guiding the person (10) to the most extensive use possible of the desired range of movement (6), said support information being dependent on the result of the comparison, wherein the medical appliance (9, 9a, 9b, 9c) further has an output device (20) for outputting the support information to the person (10).

2. Medical appliance (9, 9a, 9b, 9c) according to claim 1, characterized in that the medical appliance (9, 9a, 9b, 9c) has at least one stocking-like enclosure section which is to be pulled over the joint (1) and/or wrapped around the joint (1) as a bandage and/or designed as a garment and/or as a belt system (44) and/or at least one articulated guide element (25), in particular at least two hinged, rigid articulated guide elements (25).

3. Medical appliance (9, 9a, 9b, 9c) according to claim 1, characterized in that the detection device (13) comprises at least one sensor (14) integrated into at least one part (11) or detachably or non-detachably attached or attachable to at least one part (11) and/or to a body region moving with a part (11), and/or is designed to measure a distance between two sensors (14) and/or sensor parts and/or a joint angle and/or at least one dynamic variable of the joint movement, in particular an angular velocity and/or an angular acceleration, and/or that the at least one sensor (14) has a measuring principle using magnetism and/or induction.

4. Medical appliance (9, 9a, 9b, 9c) according to claim 1, characterized in that the appliance (9, 9a, 9b, 9c) has a setting device (21) for setting the desired range of movement (6) of the joint (1) which the person (10) is to use when wearing the appliance (9, 9a, 9b, 9c).

5. Medical appliance (9, 9a, 9b, 9c) according to claim 4, characterized in that the setting device (21) has an electronic and/or mechanical setting means, in particular one that exists independently of a treatment device (22) formed by the parts (11), in particular a hand-held mobile device (36).

6. Medical appliance (9, 9a, 9b, 9c) according to claim 5, characterized in that the mobile device (36) additionally comprises a computing device (38) designed as at least one part of the evaluation device (16), on which computing device (38) an application (39) exists that configures the mobile device (36) as a setting means and as the part of the evaluation device (16).

7. Medical appliance (9, 9a, 9b, 9c) according to claim 4, characterized in that the setting device (21) is designed to at least partially automatically determine the desired range of movement (6) by evaluating user-defined default data and/or historical data detected with the detection device (13) and describing the joint movement of the joint (1) of the person (10) in a previous time period.

8. Medical appliance (9, 9a, 9b, 9c) according to claim 1, characterized in that a movement phase, in particular an approaching of the state of movement to an extreme position, and/or a movement history of the joint (1), can be taken into account by the support unit (19) for determining the support information and/or an output time for the support information.

9. Medical appliance (9, 9a, 9b, 9c) according to claim 1, characterized in that the evaluation device (16) is designed to control the output device (20) for outputting the at least one piece of support information during and/or after an assessed movement.

10. Medical appliance (9, 9a, 9b, 9c) according to claim 1, characterized in that the support unit (19) is designed for selecting at least one output parameter, in particular the intensity and/or volume and/or frequency of the repetition of a sound and/or of a light signal, at least one of the at least one piece of support information as a function of a usage measure, determined from the comparison result, of the desired range of movement (6) and/or approach measure to a limit (7) of the desired range of movement (6).

11. Medical appliance (9, 9a, 9b, 9c) according to claim 1, characterized in that it also comprises, in particular as part of the output device (20), at least one stimulation device controllable by the evaluation device (16) as a function of the comparison result for at least one muscle of the person (10) assigned to the joint (1) and/or at least one electrical and/or mechanical drive means (30) designed to change the relative position of the parts (11) and controllable by the evaluation device (16) as a function of the comparison result.

12. Medical appliance (9, 9a, 9b, 9c) according to claim 1, characterized in that the evaluation device (16) has a classification unit (45) that categorizes the current movement into a class of movement types based on the detection data of the detection device (13), the support information being output only if a class of movement types corresponding to the associated movement type is present.

13. Medical appliance (9, 9a, 9b, 9c) according to claim 1, characterized in that it comprises a limiting device (31) for limiting a range of movement (2) of the joint (1) to a permissible range of movement (4).

14. Method for operating a medical appliance (9, 9a, 9b, 9c) for a joint (1) of a person (10), comprising at least two parts (11) which are to be placed on the joint (1) and can be moved with respect to one another by the joint (1) and at least one detection device (13) for detecting a relative movement of the parts (11), the method comprising the following steps: determining, from detection data of the detection device (13), a range of movement (5) of the joint (1), which range of movement is actually used when the treatment device (22) is worn, comparing the range of movement (5) used with a desired range of movement (6), determining support information guiding the person (10) to the most extensive use possible of the desired range of movement (6), said support information being dependent on the result of the comparison, and outputting the support information to the person (10).

15. Method according to claim 14, characterized in that the desired range of movement (6) to be used by the person (10) when wearing the appliance (9, 9a, 9b, 9c) is set at a setting device (21), in particular based on a user input.

Description

[0063] FIG. 1 explains the underlying idea of the present invention based on various ranges of motion (ROM) of a joint 1 of a person, such as a knee joint, as indicated by the central point. In the present case, the maximum range of movement 2 of the joint 1 indicated by dashed lines is limited by a limiting device of a treatment device used, in particular an orthosis, so that a permissible range of movement 4 delimited by lines 3 results. Due to protective postures and protective movements during the therapy phase, patients or, in general, persons using the aforementioned treatment device use only a small part of the permissible range of movement 4, shown here as the range of movement 5 actually used when wearing the treatment device.

[0064] Furthermore, however, there is also a desired range of movement 6 which is therapeutically useful and which can be described by the limits 7. The basic idea of the present invention is now to design a medical appliance that can be assigned to or can comprise said treatment device such that the patient is specifically guided, based on support information symbolized by arrows 8, to use larger portions of the desired range of movement 6, starting from the currently used range of movement 5.

[0065] FIG. 2 shows a schematic diagram of such a medical appliance 9 according to the invention for a joint 1, here for example a knee joint or other single-axis joint, of a person 10 that has only been indicated. Parts 11 are evidently provided on the body of the person 10 adjacent to the joint 1 and are moved relative to one another by the movement of the joint 1 indicated by the arrow. A detection device 13 only indicated here, which may comprise, for example, two sensors 14 or parts of a sensor 14 that are designed to measure the relative position and/or relative orientation between them, measures the movement of the joint 1 actually taking place. Its detection data can be forwarded to an evaluation device 16 via a communication link 15 only indicated here. The evaluation device 16 comprises, first of all, a determination unit 17 that determines, from the detection data of the detection device 13, the range of movement 5 of the joint 1 actually used when wearing the medical appliance 9, in the case of a single-axis joint, as shown here for example, in particular by tracking the joint angle and determining the maximum angles. It should be noted already at this point that the detection device 13 also describes dynamic parameters in its detection data, i.e. an angular velocity in the present example.

[0066] A comparison unit 18 of the evaluation device 16 compares the range of movement 5 actually used with the desired range of movement 6. For example, the corresponding, in particular maximum joint angles describing the range of movement 5 used can be compared with the maximum and minimum joint angles describing the limits 7. Ultimately, at least one usage measure results which indicates the extent to which the desired range of movement 6 is actually being used, in particular in relation to each individual limit 7.

[0067] Finally, the evaluation device 16 also has a support unit 19 which determines a piece of support information as a function of the comparison result. The support information is thereby determined in such a way as to guide or lead the person 10 to the most extensive use possible of the desired range of movement 6, which will be explained in more detail below with regard to specific exemplary embodiments.

[0068] Support information does not have to be output at each point in time or in each situation, since at least one information criterion can be provided within the support unit, which evaluates at least the comparison result and upon the fulfillment of which a piece of or the support information is output, possibly after adequate parameterization. Furthermore, it can be generally said that, when it comes to guiding the person 10 to the most extensive use possible of the desired range of movement 6, it is expedient to take into account the current state of movement and at least the preceding movement history also in the design of the support information, especially during its specific parameterization, so that the support information contains an instruction that can be intuitively understood by the person 10, namely how to achieve a broader use of the desired range of movement 6.

[0069] The support information determined by the support unit 19 can be output via a corresponding output device 20. It may comprise, for example, corresponding output means for optical and/or acoustic and/or haptic output of the support information, as will be discussed in more detail in the specific example.

[0070] In preferred exemplary embodiments, the medical appliance 9 according to the invention furthermore also has an input device 21 with at least one input means via which the desired range of movement 6 may be defined manually and/or automatically, wherein it is preferred to take a user input as a basis. An input means can be provided in particular also in mechanical form at the parts 11 and/or a treatment device 22, which is shown in FIG. 2 and which may also belong to the medical appliance 9, as a mechanical input means, for example in the case of the limiting device already addressed with regard to FIG. 1, via which a desired range of movement 6 can also be defined mechanically. With regard to automatic determination, for example, a dynamic or defined therapy plan may be preset for the person 10 by a therapist as user, which, for example, extends the desired range of movement 6 in successive periods of time for different therapy progresses. The therapy progress may follow a defined chronological sequence; however, it is preferred to track the therapy progress via the detection data since, in particular, the aforementioned usage measure determined by the comparison unit 18 offers an excellent indication as it indicates the extent to which a desired range of movement 6 has already been used, so that this may optionally be considered in order to be able to progress to a next therapy level and thus to an extended desired range of movement 6.

[0071] In addition, such a therapy plan can also entail the use of different treatment devices 22 since, for example, first an orthosis, then a bandage, and finally a belt system or the like may be used. Since the parts and/or the at least one sensor are preferably releasably attachable to the treatment device 22, which may also include the parts 11, for example via hook-and-loop fasteners, which may also apply to other components of the medical implement 9, the medical implement 9 may thus also be used with different treatment devices 22 in certain embodiments.

[0072] Generally, it should also be noted at this point that the parts 11 may, but do not have to belong to the treatment device 22. If the treatment device 22 is an orthosis for example, the parts 11 may be rigid articulated guide elements which are coupled in an articulated manner; but it is also possible for the parts 11 to be formed by subregions of a flexible component of the treatment device 22 or medical appliance 9, for example made of compression material in the case of a bandage.

[0073] Furthermore, initially it also applies in general that the evaluation device 16, the output device 20 and the setting device 21 may be implemented at least partially on the treatment device 22, i.e. close to the joint, and/or at least partially external to the treatment device 22, in particular remote from the joint 1, wherein the communication link 15 is then preferably a wireless communication link. Specific embodiments will be explained in more detail below.

[0074] As was described, the sensor 14 preferably measures the relative position and orientation to the other sensor 14 or, in particular, the passive sensor component on the other part 11. Particularly preferably magnetic and/or inductive measuring principles can be used, for example the provision of magnetic material on one part and of a corresponding magnetic field sensor on the other part 11. Other conceivable embodiments include the provision of conductive material on one part 11 and of induction sensors on the other part 11.

[0075] FIG. 3 shows a first specific exemplary embodiment of a medical appliance 9a according to the invention comprising an orthosis 23 as treatment device 22, wherein only the components of the medical appliance 9a provided on the joint 1, here a knee joint, are shown in the present case. In the present case, the orthosis has two rigid articulated guide elements 25 coupled via a joint 24, which can be held on the upper leg or lower leg of the person 10 by belts 26. In the present case, the sensors 14 or sensor components of the sensor 14 are arranged on the inner belts 26 relative to the knee joint but may also be provided on the articulated guide elements 25. The sensor elements 14 that form the detection device 13 may be integrated, for example, into the belts 26.

[0076] FIG. 3 also shows various possible embodiments of output means of the output device 20. On the one hand, a scale-like output means 27 less preferably having optical output elements and preferably having haptic output elements is shown, the output elements of which output means can be switched on in succession for example, as the approaching of a complete use of the desired range of movement 6 increases, in order to indicate this to the person 10. As a further preferred acoustic output means, the output device 20 according to FIG. 3 also has a speaker 28 arranged on the orthosis 23, here on one of the rigid articulated guide elements 25, via which sounds, possibly also voice outputs, can be output as support information. Preferred is an embodiment with repeated sounds, the repetition frequency and/or volume and/or pitch of which can be changed depending on how well the desired range of movement 6 is actually being used by the person 10.

[0077] A design based on the parking assistant of a motor vehicle has proven to be a particularly intuitively conceivable embodiment, where, for example, a higher repetition frequency indicates a stronger approach to the limits 7 of the desired range of movement 6. The pitch can be used to inform the person 10 for example about the limit 7, i.e., for example, the flection direction or the extension direction. In this case, it is already expediently provided to make the output dependent on a current movement phase or a current state of movement, for example to output support information related to the flection when approaching the inflection point of the movement during extension and accordingly for flection.

[0078] Further preferred optional haptic output means are shown in FIG. 3 in the form of a vibration pad 29 provided in the present case on the upper leg, via which relevant muscle groups can be stimulated, for example as haptic information to maintain a movement direction longer, and of an electric drive means 30 in the present case at the articulation 24, which within a certain scope—preferably only as information—can somewhat force the movement in one direction, for example when it decelerates, in order to output a piece of information to the person 10 that there is still further room for desired movement here.

[0079] FIG. 3 further shows a limiting device 31 on the articulation 24, via which a permissible range of movement 4 can be set. As has already been explained, the limiting device 31 can also be understood as a mechanical setting means of the setting device 21, which in the present case can be supplemented by a setting button 32, for example a SET button. For example, initially a desired range of movement 6 can be set via the limiting device 31 by using the SET button 32, whereupon it is still possible to extend the permissible range of movement 4 relative to the desired range of movement 6 by subsequent adjustment of the limiting device 31. A further provided RESET button 33 may also be present. It can be used, for example, when reapplying the orthosis 23.

[0080] FIG. 4 shows the use of a medical appliance 9b in a bandage 34 as the treatment device 22, wherein the bandage 34 does not necessarily have to belong to the medical appliance 9b here. Shown thereof in the present case, and for the sake of clarity, are only the at least one sensor 14 and sensor-side components of a fastening means 35, here of a hook-and-loop means, which form the parts 11. By means of the fastening means 35, the at least one sensor 14 and the parts 11 can be thus releasably fastened to the bandage 34 at in particular predetermined positions, wherein the further components of the appliance 9b (evaluation device 16, output device 20 and input device 21) that are provided external to the joint are not shown.

[0081] In this respect, FIG. 5 shows a possible embodiment in which a hand-held mobile device 36, here a smartphone 37 or tablet, is used at least partially as an evaluation device 16, output device 20, and setting device 21. For this purpose, the mobile device 36 has a computing device 38 comprising in particular at least one processor, on which an application 39 (app), i.e., a computer program, is provided, which implements the corresponding parts or components of a medical appliance 9, 9a, 9b.

[0082] For example, a touchscreen 40 can be used as input means of the input device 21 via the application 39 in order to enter desired ranges of movement 6 or default data to be used for automatically determining the same. Furthermore, the display of the touchscreen 40, just like a speaker 41, can also be used as an output means of the output device 20. The computing device 38 can at least partially implement the determination unit 17, the comparison unit 18 and/or the support unit 19.

[0083] FIG. 6 shows the use of a medical appliance 9c in a treatment device 22 designed as a back orthosis 42. The back orthosis 42, which is associated with the spine as a joint or articulated group, has a back splint 43, which is held by a belt system 44. In this case, a larger number of sensors 14 are arranged along the back splint 43 as articulated guide element in order to measure the movement of the spine as precisely as possible. Ranges of movement 4, 5, and 6 can be described, for example, by local limits of movement or the like.

[0084] Further components of the medical appliance 9c are again not shown for the sake of clarity; the back orthosis 42 may, but does not have to be associated with the medical appliance 9c as a treatment device 22.

[0085] It should also be noted at this point that the belt system 44, the bandage 34 and the belts 26 ultimately form enclosure sections, which may serve as parts, at least in regions, when the treatment device 22 belongs to the corresponding medical appliances 9, 9a, 9b, 9c. It should also be noted that, similarly to the bandage 34, a stocking or other garment may also be used as treatment device 22 or part of the appliance 9, 9a, 9b, 9c.

[0086] Returning to FIG. 2, the evaluation device 16 may also additionally comprise a classification unit 45 which may categorize the current movement into a class of movement types based on the detection data of the detection device 13. In this case, it can be provided in particular that support information is output, that different support information or different desired ranges of movement 6 are defined for different types of movement and the like only in the case of at least one specific type of movement. For example, it may be desired to provide other desired ranges of movement 6 or other support information for a knee joint as joint 1 when climbing stairs and walking normally on a flat surface. In this case, the detection data, in particular over a defined previous time period, can indicate sufficiently clearly which class of movement types is currently being used.

[0087] With reference to FIGS. 7 and 8, exemplary embodiments of the method according to the invention that may be performed by the described medical appliances 9, 9a, 9b, 9c will now be explained in more detail.

[0088] In the exemplary embodiment according to FIG. 7, the detection data is recorded by means of the detection device 13 in a step S1.

[0089] In a step S2, the determination unit 17 of the evaluation device 16 is used to determine from the detection data the range of movement 5 of the joint 1 actually used when wearing the treatment device, wherein further analyses of the detection data are also carried out. Namely, in the case of the exemplary embodiment in FIG. 7 not only the current state of movement, but also the immediately preceding movement history and/or dynamic parameters, for example an angular velocity in the case of a single or multi-axis joint, is taken into account. In the present case, a knee should be considered more accurately during a cyclic movement. The latter usually consists of sequences of an extension process and a flection process, wherein these two processes each alternate at inflection points which represent limits of the range of movement 5 actually used. If the state of movement approaches the inflection point, this is expressed for example by a reduction in angular velocity. However, this makes it possible to already determine before reaching the inflection point that said inflection point is being approached, in particular also which inflection point, and also to predict up to where the current movement process is expected to be performed, in particular up to which joint angle.

[0090] Based on the information determined in step S2, a check is made in a step S3 as to whether a relevant movement phase or a relevant state of movement is present at all. This can be regarded as a first information criterion, since it is ultimately checked whether intuitively detectable and therefore reasonable support information would be possible at all in the current state of movement or the current movement phase. If this is not the case, step S1 is returned to or step S4 is proceeded with. In step S4, the comparison unit 18 of the evaluation device 16 checks to what extent in the specific example the predicted inflection point reaches the corresponding limit 7 of the desired range of movement 6. In the example of the knee as a single-axis joint, an angular distance between the limit 7 and the predicted inflection point can be determined, for example. Of course, more complex analyses/usages are also conceivable in other exemplary embodiments.

[0091] In a step S5, it can be checked as part of a further information criterion whether the deviation from the limit 7 determined in step S4 even requires support information. If this is not the case, for example because the limit 7 is reached (or even exceeded) anyway, step S1 is returned to. It should be noted, however, that it is also absolutely conceivable to output affirmative support information even in the event of complete or almost complete use of the range of movement 6.

[0092] In a step S6, the support information is then determined as a function of the comparison result of step S4 in order to be output in a step S7.

[0093] In step S6, the support information is in particular parameterized as a function of the information collected from the detection data and, in particular, of the comparison result. For example, the further the angular distance from the limit 7, the more the intensity of support information that intuitively promotes a further movement towards the limit 7 is increased. If, for example, a stimulation device, such as the vibration pad 29, and/or a drive means 30 is used, a stronger stimulation/stronger support information can take place if the person 10 is to be recommended a longer continuation of a current movement process, for example extension or flection. The same may apply to acoustic and/or optical support information; however, it may also be expedient to intuitively convey an approach to the limit 7 by higher intensity.

[0094] FIG. 8 shows a second, exemplary embodiment of the method according to the invention that may be used as an alternative or in combination with FIG. 7.

[0095] There as well, the movement is measured in a step S1 by recording detection data. In a step S2, however, a consideration over a plurality of movement cycles in the present case takes place in the determination unit, which means that detection data of the past that describe the movement history in a time period immediately before the current point in time, are used so that a more robust description of the actually used range of movement 5 can result. For example, averages—in particular also weighted averages—can be formed for extreme positions, and the like. Here, a continuous update with all new detection data is carried out, which means that a rolling time period is considered in order to be able to react as quickly as possible to changes, in particular improvements or deteriorations as regards the desired range of movement 6.

[0096] In a step S4′, the comparison takes place in the comparison unit 18 since in this exemplary embodiment continuous information, for guiding or leading the person, is desired anyway by means of support information.

[0097] Nevertheless, in a step S5′, which is in turn optional, information criteria may be checked as to whether support information is required at all. Especially in the event of an ultimately desired continuous guidance of the person 10 towards an improved utilization of the desired range of movement 6, it may also be desired to no longer output any support information if there is sufficient usage.

[0098] In a step S6′, analogous to step S6 in FIG. 7, the support information is determined and output in step S7. In this exemplary embodiment, it is preferred to use a tone sequence, the repetition frequency of which depends on the degree of usage, here in particular on the approaching of the limits 7.

[0099] FIG. 9 shows such an exemplary dependence of a repetition frequency f of a tone on the degree of usage N. The value 46 here indicates a substantially complete use of the desired range of movement 6. Obviously, there is first a low repetition frequency, which increases significantly as the use in the region 47 increases and thus intuitively conveys said approaching of the limits 7 similarly to a “parking assistant”. From value 46 upwards, region 48, for example a continuous tone can be output and/or the support information can be deactivated because use of the desired range of movement 6 to the greatest degree possible has been reached.

[0100] Finally, it should be noted that it is expedient not only in the exemplary embodiments according to FIG. 7 and FIG. 8 but generally in all embodiments of the invention to intuitively output the support information in a manner assignable to the movement during the movement itself, in particular immediately after the assessment. This improves the assignment, in particular when reacting to specific movement phases or predictions, and thus also the leading and guiding effect for improved utilization of the desired range of movement 6. It should also be noted in general that the support information preferably does not interfere with or interrupt the movement itself, but intuitively flows into the movement sequences thus leading the user to an improved utilization of the desired range of movement 6.