Abstract
An orthesis, which has an upper part and a lower part, which are coupled to each other with a first joint device in such a way that the upper part and the lower part can pivot about a pivot axis, wherein devices for receiving a body part or a limb or for fastening the orthesis to a body part or a limb are arranged on the upper part and/or the lower part, and wherein an upper support element is fastened to the upper part on one side and a lower support element is fastened to the lower part on one side, which support elements are connected to each other with a second joint device in such a way that said support elements can pivot about the pivot axis. A bearing plate having at least one fastening device for fastening the second joint device is fastened to or formed on the upper part and/or the lower part.
Claims
1. An orthosis comprising: an upper part; a lower part; a first joint device coupling the upper and lower parts to each other in such a way as to be pivotable about a pivot axis; devices for receiving a body part or a limb or for securing the orthosis to a body part or a limb are arranged on at least one of the upper part and the lower part; an upper support element secured to the upper part on one side; a lower support element secured to the lower part on one side; a second joint device connecting the upper and lower support elements to each other in such a way as to be pivotable about the pivot axis; a bearing plate having at least one fastening device for securing the second joint device, the bearing plate being fastened to or formed on at least one of the upper part and the lower part.
2. The orthosis as claimed in claim 1, wherein the first joint device and the second joint device are arranged laterally and spaced apart from each other.
3. The orthosis as claimed in claim 1, wherein the support elements are connected to each other releasably via the second joint device.
4. The orthosis as claimed in claim 1, further comprising fastening devices for the releasable fastening of rails or devices for receiving a body part or a limb, the fastening devices being formed or arranged on the upper part and the lower part.
5. The orthosis as claimed in claim 1, further comprising receptacles for at least one of a damper, an enabling and locking device, a drive, a control device, a spring store, an extension assist and a sensor are arranged or formed on the upper support element and the lower support element.
6. The orthosis as claimed in claim 1, wherein the support elements are fastened releasably to the upper part and the lower part via the bearing plate.
7. The orthosis as claimed in claim 1, wherein at least one of the upper support element and the lower support element is designed to be adjustable in terms of angle to the pivot axis.
8. The orthosis as claimed in claim 1, wherein the orthosis is designed as a cross-knee orthosis, knee-ankle-foot orthosis (KAFO), or ankle-foot orthosis.
9. The orthosis as claimed in claim 1, wherein the support elements are secured to the upper part and the lower part to transmit force and moment.
10. The orthosis as claimed in claim 1, wherein the support elements are made from metal or a fiber-reinforced plastic.
11. The orthosis as claimed in claim 1, wherein at least one of the support elements is designed as a functional element, and such a functional element is fastened to at least one support element.
12. A system composed of an orthosis as claimed in claim 1 and of a plurality of different functional elements, which can be secured to the bearing plate at the same fastening devices.
13. The system as claimed in claim 12, wherein the functional elements or the support elements have fastening locations which are arranged corresponding to a fastening device for the fastening locations for fastening to the upper part and the lower part.
14. The system as claimed in claim 12, further comprising at least one spacer element is arranged between the respective functional element and at least one of the upper part and the lower part or the bearing plate.
15. The system as claimed in claim 12, wherein the functional element is secured exchangeably to the bearing plate.
16. The system as claimed in claim 12, wherein the upper support element and the lower support element are assembled to form a module.
17. A method for adapting an orthosis as claimed in claim 1 to a patient, on whom the orthosis is fastened to a body part or limb via the devices for receiving or for securing a body part or a limb, said method having the steps of: selecting a second joint device from a multiplicity of different second joint devices, and connecting an upper and lower support element, which are connected to each other via the selected second joint device, to the upper part and the lower part of the first joint device.
18. The method as claimed in claim 17, wherein a first joint device is selected from a plurality of different first joint devices and is connected to the devices for receiving or securing a body part or limb.
19. An orthosis comprising: an upper part; a lower part; a first joint device pivotally coupling the upper part to the lower part about a first pivot axis; receiving devices configured to receive a body part or a limb or for securing the orthosis to a body part or a limb, the receiving devices being arranged on at least one of the upper part and the lower part; an upper support element secured to the upper part; a lower support element secured to the lower part; a second joint device pivotally connecting the upper support element to the lower support element about a second pivot axis; a bearing plate having at least one fastening device and being fastened to or formed on at least one of the upper part and the lower part.
20. The orthosis as claimed in claim 19, wherein the first joint device and the second joint device are arranged laterally and spaced apart from each other.
Description
[0022] Illustrative embodiments are explained in more detail below with reference to the accompanying figures, in which:
[0023] FIGS. 1-3 show a KAFO in a frontal view, a medial view and a lateral view;
[0024] FIGS. 4-8 show a first variant of the invention in a sectional view, a frontal view, a lateral view, a rear view and a medial view;
[0025] FIGS. 9-13 show a second variant in a sectional view, a frontal view, a lateral view, a rear view and a medial view;
[0026] FIGS. 14-18 show a third variant in a sectional view, a frontal view, a lateral view, a rear view and a medial view;
[0027] FIGS. 19-21 show side views of an orthosis system; and
[0028] FIGS. 19a-21a show medial side views of FIGS. 19 to 21.
[0029] FIG. 1 shows a frontal view of what is called a KAFO (knee-ankle-foot orthosis) for placing on a leg. The orthosis is secured on the leg via receiving devices 50, 52 and 54, if appropriate together with additional straps (not shown). The thigh is received in a thigh shell 50, the lower leg is received in a lower-leg shell 52, and the foot is placed on a foot plate 54. The devices 50, 52, 54 for receiving body parts are fastened to rails 60 which run along the respective limb, in the illustrative embodiment shown laterally with respect to the leg (not shown). From the thigh shell 50, a thigh rail 60 extends to an upper part 10 and is secured there with form-fit engagement, in what is called a rail box, via screws. The upper part 10 thus forms the distal endpiece of the thigh rail 60. A lower part 20 is fastened to the upper part 10 about a pivot axis 40, such that the upper part 10 together with the lower part 20 forms a joint device 30 which is arranged at the height of a natural knee joint. A lower-leg rail 60 is fastened to the lower part 20; the lower part 20 thus forms the proximal termination of the lower-leg rail 60. At the distal end of the lower-leg rail 60, an ankle joint 230 is arranged at the height of a natural ankle joint and is adjoined by a rail component 60 which connects the foot plate 54 to the orthosis ankle joint 230. The foot plate 54 is connected pivotably to the lower-leg rail 60 via the orthosis ankle joint 230.
[0030] Support elements 110, 120, arranged laterally with respect to the rails 60, are fastened to the orthosis knee joint by the joint device 30. An upper support element 110 is fastened to the upper part 10 and, if appropriate, to the thigh rail 60 so as to transmit moment and force. Correspondingly, a lower support element 120 is fastened to the lower part 20 so as to transmit force and moment, in particular by being screwed on or being secured via form-fit elements. The upper support element 110 is connected pivotably to the lower support element 120 to form a second joint device 130 pivotably, such that, spaced laterally apart from the first joint device 30 between the upper part 10 and the lower part 20, a second, parallel second joint device 130, pivotable coaxially about the pivot axis 40, is formed in the region of the orthosis knee joint. A corresponding configuration can be provided at an orthosis ankle joint or also at an orthosis hip joint.
[0031] The two support elements 110, 120 can in particular be fastened releasably to the upper part 10 and lower part 20, in order to permit easy adaptation of a base orthosis to an alternatively configured, laterally arranged second joint device 120.
[0032] A receptacle 112 for further components, for example drives, damper devices, control devices, sensors or the like, is provided in the upper support element 110.
[0033] FIG. 2 shows a medial view of the KAFO shown in FIG. 1. A rail box 15 with screws is formed on the upper part 10, in which rail box 15 the thigh rail 60 is inserted and secured with form-fit engagement. The thigh shell 50 is fastened to the thigh rail 60. Distally from the upper part 10, the lower part 20 is secured pivotably about the pivot axis 40. The lower-leg rail 60 is screwed to the lower part 20 in the rail box 25. In the medial view, the receptacle 122 can be seen in the form of a through-opening for receiving, for example, a bolt for securing a piston rod; the receiving device in the upper support element 110 cannot be seen, and the lower support element 120 can be seen only partially. Arranged on the upper part 10 is a bearing plate 200, which extends in the proximal direction past the upper part 10 and is substantially wider than the upper part 10. The upper support element 110 is secured on the bearing plate 200; the fastening of the upper support element 110 to the bearing plate 200 will later be described in detail. The lower support element 120 is releasably fastened directly on the lower part 20.
[0034] FIG. 3 shows the orthosis according to FIG. 1 in a lateral view, in which both the upper support element 100 and the lower support element 120 can be better seen. The receiving device 112 in the upper support element 110 and the receiving device 122 in the lower support element 120 can likewise be seen, also the pivotable configuration of the second joint device 130 and the coaxial configuration of the pivot axis 40 of the second joint device 130 relative to the pivot axis of the first joint device 30 of the upper part 10 and of the lower part 20. The receiving device 112, which can be a housing, completely conceals the bearing plate 200, which is located between the upper part 10 and the upper support element 110.
[0035] FIGS. 4 to 8 show individual illustrations of the configuration of the joint devices without the rails 60 and the devices 50, 52, 54 for receiving the thigh, the lower leg and the foot, in a frontal sectional view, in a front view, in a lateral view, in a rear view and in a medial view.
[0036] FIG. 4 shows a partial view of an orthosis, in section, with the upper part 10, the lower part 20, and the fastening devices 15, 25 formed respectively thereon for releasably fastening the rails. The rails are placed in the fastening devices 15, 25 are fastened to the latter by screws. The screws are screwed into threaded bores inside the upper part 10 and the lower part 20.
[0037] The upper part 10 and the lower part 20 are connected to each other about a pivot axis 40 to form a joint device 30. Laterally with respect to the rails (not shown) and to the upper part 10 and lower part 20, two support elements 110, 120 are fastened, in the illustrative embodiment shown screwed, onto the upper part 10 and lower part 20. An upper support element 110 is fastened by screws to the upper part 10 via the bearing plate 200 so as to transmit force and moment. The bearing plate 200 is configured as a separate component and is fastened releasably to the upper part. Correspondingly, a lower support element 120 is fastened to the lower part 20 to transmit force and moment, here with a spacer 90 placed in between. Both support elements 110, 120 are connected pivotably to each other and form a second joint device 130, of which the pivot axis runs coaxially with respect to the pivot axis of the first joint device 30. It is thereby possible that pivoting of the orthosis components about the pivot axis 40 can take place without twisting or jamming.
[0038] The two joint devices 30, 130 are arranged laterally and spaced apart from each other, such that a clearance 80 is formed between the joint devices 30, 130. By the doubling of the joint in the region of the rail holders, it is possible, in highly loaded regions of an orthosis, for forces and moments to be effectively taken up and forwarded. The forces occurring in the orthosis are advantageously taken up and forwarded by the frame-like structure in the orthosis joint with the two joint devices 30, 130. The force lines in the longitudinal extent, i.e. from proximal to distal in the extended position, are divided up and run through both the upper part 10 and the lower part 20 with, between these two structural parts, the first joint device 30 and the upper support element 110, the lower support element 120 and, formed therebetween, the second joint device 130. In the region where the support elements 110, 120 are coupled to the upper part 10 and lower part 20, the forces and moments are divided up and brought together, resulting in a closed force train. The laterally arranged joint device 30 thus works as a medial support joint. The distance between the two joint devices 30, 130 corresponds to twice the thickness of the rails. The greater the distance of the joint devices 30, 130 from each other, the more stable the overall orthosis joint, although a very large distance brings disadvantages as regards wearing comfort.
[0039] FIG. 5 shows the detail of the orthosis according to FIG. 4 in a plan view from the front. Both the upper part 10 and the lower part 20 and also the upper and lower support elements 110, 120 can be seen with the joint devices 30, 130 laterally spaced apart from each other, i.e. spaced apart from each other along the pivot axis 40. The clearance 80 can be seen between the joint devices 30, 130. To be able to form the clearance 80 and the distance between the joint devices 30, 130 despite a flat configuration of the lower support element 120, a spacer 90 is arranged between the lower part 20 and the lower support element 120, which spacer 90 corresponds to the clearance 80 between the two joint devices 30, 130. Instead of a separate spacer element 90, a clearance 80 can be provided by a corresponding shoulder integrally formed on the lower support element 120. On the upper support element 110, the distance is compensated by the spacer element 95, shown in FIG. 4, in relation to the bearing plate 200.
[0040] FIG. 6 shows the embodiment according to FIGS. 4 and 5 in an external view, i.e. in a lateral plan view. Beside the upper support element 110, behind a lining and the lower support element 120, the lower part 20 can be seen only partially in the background. Receptacles 112 for further components, for example control devices, sensors or actuators, are formed on the upper support element 110. On the lower support element 120, a kind of rail box is formed, similar to the one in the lower part 20. A fastening strut 140 is inserted in the rail box and connected by screws to the lower support element 120. The strut 140 is connected to the lower part 20 by further screws via the spacer 90 so as to transmit force and moment. By the connection of the lower support element 120 to the lower part 20 via a strut 140 and a spacer element 90, it is possible to achieve easy adaptability to different conditions of use or to different orthoses with an upper part 10 and a lower part 20. The bearing plate 200 is arranged on the upper part 10 (not shown), and the upper support element 110 is in turn fastened to the bearing plate 200. A multiplicity of fastening devices 160 are arranged or formed on the bearing plate 200, which fastening devices 160 make it possible to fasten the upper support element 110 in different orientations and at different positions on the bearing plate 200. Besides a positioning of the upper support element 110 at different locations, it is possible to fasten different upper support elements 110 to the orthosis in order to form a second, parallel joint device 130 and to easily try out or even permanently establish variations in design. In addition, the bearing plate 200 and the multiplicity of fastening devices 160 afford the possibility of add-on components, such as energy stores, control devices, operating elements and the like, being arranged on the orthosis and being coupled to the upper part 10. If the bearing plate 200 is arranged on the lower part 20, a corresponding arrangement of add-on components can be provided on the lower part 20.
[0041] FIG. 7 shows a rear view of the orthosis component. The spacers 90, 95 can also be seen, likewise the upper and lower parts 10, 20, the joint devices 30, 130 and the upper and lower support elements 110, 120. The fastening rail 140 and the receptacle 15 for a thigh rail are also shown, likewise the coaxial pivot axis 40 for the two joint devices 30, 130.
[0042] FIG. 8 shows the embodiments according to FIGS. 4 to 7 in a medial view, in which the fastening devices 15, 25 are shown in the form of rail boxes for the rails 60 (not shown), and also the pivot axis 40 running perpendicularly with respect to the plane of the drawing, while the receiving device 112 of the upper support element 110 can be seen in the background. The medial view shows the bearing plate 200 with the multiplicity of fastening devices 160, which bearing plate 200 is fastened to the upper part 10. On the bearing plate 200, which is provided with passages, for example for being able to arrange displaceable fastening elements or for being able to secure further components on the bearing plate, a multiplicity of fastening devices 160 are formed via which different second joint devices 130 can be secured at different locations.
[0043] A variant of the invention is shown in FIGS. 9 to 13. The basic set-up corresponds to that of FIGS. 4 to 8, and therefore only the differences will be discussed here. In contrast to the embodiment according to FIGS. 4 to 8, the upper support element 110 is not oriented substantially parallel to the upper part 10 but instead has a slight lateral inclination, which is compensated by the proximal spacer element 95 between the receptacle 112 and the bearing plate 200. The inclination in the medial-lateral direction can be adjusted, for which purpose the joint device 130 can be designed to be adjustable, for example via a pivot joint that permits a medial-lateral pivoting movement, without modifying the orientation of the pivot axis 40 of the second joint device 130. For this purpose, for example, a joint would be provided proximally from the pivot axis 40, namely a joint which in the extended position of the orthosis has a pivot axis that points in the usual walking direction, i.e. runs from anterior to posterior perpendicularly with respect to the plane of the drawing. With such angle adjustability, in which the support is effected via the spacer element 95 or is also adjustable via a thread, an adaptation can be made to the components arranged respectively in the receiving device 112, for example drives, dampers or control devices. In the sectional view according to FIG. 9, the receptacle 112 is configured as a cavity in which, for example, a hydraulic damper or an electromotive drive can be inserted and can be secured therein.
[0044] FIG. 10 shows the upper support element configured as a housing in which the receptacle 112 is formed. The upper support element 110 is exchangeably coupled to the upper part 10 at two fastening locations 114, 116 via the bearing plate 200 and via screws or bolts, so as to transmit force.
[0045] FIG. 11 is a lateral view showing the receptacle 112 on the upper support element 110 and the receptacle 122 on the lower support element 120. The lower support element 120 does not have a rail box as in the illustrative embodiment in FIGS. 4 to 8, but instead is screwed directly onto the lower part 20 via the spacer element 90. The receptacle 122 on the lower support element 120 is an annular bearing receptacle in which, for example, a bolt of a piston rod for a drive or a damper can be secured, in order to effect or dampen a pivoting of the lower part 20 to the upper part 10 about the pivot axis 40.
[0046] The rear view according to FIG. 12 shows the hollow configuration of the upper support element 110 with the receptacle 112, likewise the annular shape of the lower receptacle 122.
[0047] FIG. 13 shows a medial view of the orthosis knee joint with upper part 10 and rail box 15, lower part 20 with rail box 25, and the first joint device 30 for pivoting about the pivot axis 40. The fastening locations 114, 116 and fastening devices 160 for securing the upper support element 110 can be seen on the bearing plate 200.
[0048] A third variant of the invention is shown in FIGS. 14 to 18. The set-up of the orthosis joint, which can be configured as a hip joint, knee joint or ankle joint, but also as an elbow joint, basically corresponds to the variant in FIGS. 9 to 13, but with an upper support element 110 oriented substantially parallel to the upper part 10 and the bearing plate 200. On account of the housing-like configuration of the upper support element 110, an arrangement of an upper spacer element is not needed. Furthermore, a clearance 80 between the two joint devices 30, 130 is formed, such that the force lines can run through the first joint device 30 and the second joint device 130 spaced apart from each other in the longitudinal extent of the orthosis. The upper fastening point 116 is relatively far from the pivot axis 40 in order to achieve a high degree of stability of the overall construction. A spacer element 90 is in turn arranged between the lower support element 120 and the lower part 20.
[0049] The frontal view according to FIG. 15 shows the compact set-up of the orthosis joint and the shell-like configuration of the upper support element 110. The lateral view according to FIG. 16 shows the upper and lower fastening locations 116, 114 and the receiving device 122 in the form of a bearing ring on the lower support element 120. The rear view according to FIG. 17 illustrates the hollow, housing-like configuration of the upper support element 110, wherein the upper support element 110 is so dimensionally stable that sufficient force transmission and force uptake can take place. The internal view according to FIG. 18 shows the upper part 10 with, adjoining the latter proximally, a plate-shaped enlargement, in order to permit a sufficient contact surface for the fastening of the upper support element 110. The lower part 20 with the rail box 25 is connected with form-fit engagement, and reversibly, by screws to the lower support element 120 and to the receptacle 122 for a bearing pin.
[0050] FIGS. 19 to 21 each show side views of an orthosis system with an identical basic set-up, which corresponds substantially to the set-up of an orthosis according to FIGS. 1, 2 and 3. FIG. 19 shows a variant of the embodiment according to FIG. 3, FIG. 20 shows a variant of the embodiment according to FIG. 6, and FIG. 21 shows a variant of the embodiment according to FIG. 11. Common to all the orthoses is the basic set-up with receiving devices 50, 52 and 54, as has been described with reference to FIG. 3, wherein straps 56 have been added in each case in order to fasten and secure the foot on the foot plate 54. In addition, a heel bracket 55 is arranged on the foot part, such that a foot placed on the foot plate 54 is pressed onto or held on the foot plate 54 and also against the heel bracket 55 via the two fastening straps 56. The ankle joint 230, on which functional elements such as adjustable stops or springs can be arranged, is adjoined in the proximal direction by the lower-leg rail 60, on which a lower-leg shell 62 is secured so as to be adjustable both in height and also in the anterior-posterior direction and in an angle position relative to the longitudinal extent of the lower-leg rail 60. The upper part 10 is designed to be pivotable relative to the lower part 20 about the knee joint axis 40. The thigh rail 60, on which the thigh shell 50 is fastened, extends proximally with respect to the upper part 10. The fastening of the thigh shell 50 to the thigh rail 60 is effected, in a manner corresponding to the fastening of the lower-leg shell 52 to the lower-leg rail 60, in an adapter which is displaceable along the longitudinal extent of the thigh rail 60 and via which an adjustment is permitted both of the angle position and also in the anterior-posterior direction and in the medial-lateral direction, i.e. from or toward the thigh rail.
[0051] This basic set-up is identical in the system shown in FIGS. 19 to 21. The orthoses differ in terms of different functional elements 150, of which only one is visible. In the embodiment according to FIG. 19, a hydraulic damper device is arranged as functional element 150 in the receptacle 112, said damper device being coupled to the upper part 10 via the receptacle 112 and, for example, the receptacle 122 being connected to the lower part 20 via the lower support element 120.
[0052] In the embodiment according to FIG. 20, the set-up according to FIG. 19 is provided not with a hydraulic damper but instead with a driven locking and enabling device as a functional element 150, which is fastened to the upper support element 110. As an alternative to this, a drive can be arranged as functional element in the receptacle 112 according to FIG. 19. The drive permits the initiation of a pivoting movement, or at least supports a pivoting movement, about the pivot axis 40, which is located behind the drive in the illustration in FIG. 20.
[0053] FIG. 21 shows the arrangement of a computer-controlled hydraulic damper, as already shown in FIG. 11, on the orthosis. The hydraulic damper as functional element is arranged in the receptacle 112 and can be coupled via a coupling element to the receptacle 122 on the lower support element 120.
[0054] In the embodiments according to FIGS. 19 to 21, there is no change to the basic set-up with the receiving devices 50, 52, 54 and 56, the rails 60 and the first joint device 10, 20, the second joint device 130, the functional elements arranged thereon via the respective upper and lower support elements 110, 120, such as hydraulic damper, locking and enabling device, motorized drive or computer-controlled hydraulic damping system are designed such that they have fastening devices which allow the different second joint devices 130 designed as modules to be fastened to the basic set-up and the first joint device 30 to the upper part 10 and lower part 20. For example, in the case of a worsening state of health, a simple hydraulic damper system as shown in FIG. 19 can thus be adapted via a computer-controlled hydraulic damper system according to FIG. 21 to a motor-assisted, active orthosis system or an orthosis with an enabling and locking device according to FIG. 20, or, if the state of health improves, it is possible to change from a driven system via an adaptively controlled orthosis system according to FIG. 21 to a passive orthosis system according to FIG. 19 and then to a locking and enabling system according to FIG. 20.
[0055] FIGS. 19a to 21a each show medial views of the embodiments according to FIGS. 19 to 21. It will be seen in the medial view that a fastening device 160 is arranged or formed on the thigh rail 60, to which fastening device 160 the upper support element 110 can be secured via screws, bolts or the like. A corresponding fastening will take place via the lower support element 120 either directly on the lower part 20 or on the lower-leg rail 60. All of the functional elements 150 or all of the support elements 110, 120 have corresponding fastening locations 114, 116, which are configured as bores or pins, for example, and are aligned with the fastening devices 160 or can be brought into engagement with the latter, in order to achieve the second joint device 130 on the first joint device 30 by a coupling between the support elements and the upper part/lower part. The fastening device 160 can also be arranged directly on the upper part 10 or the lower part 20.
