Apparatus for motor rehabilitation of upper and lower limbs

Abstract

An apparatus for the motor rehabilitation of the upper and lower limbs is disclosed, which is compact, portable, lightweight, and easy to transport. The apparatus has an adapter for the distal end of the patient's limb, a robotic arm, a gear system, two motors, and virtual and/or augmented reality software to interact with the patient. A management and control system makes possible the execution of movements and exercises in the three-dimensional space so that patients with neurological, musculoskeletal, muscular, rheumatic, motor and/or cognitive diseases or injuries and patients in post-surgical recovery may exercise and recover the movements of their upper and/or lower limbs. The equipment may also be used for the purpose of training and physical fitness.

Claims

1. An apparatus for motor rehabilitation of upper and lower limbs, the apparatus comprising: a robotic arm having a proximal robotic arm end and terminating in a distal robotic arm end, the robotic arm including a larger rod, having a length between about 1 cm and about 100 cm, and a smaller rod, having a length between about 5 cm and about 50 cm; an adapter connected to the distal robotic arm end, and configured for connection to a distal end of the upper or lower limb; a gear system operatively coupled to the proximal robotic arm end, the gear system including two opposing gears, a spider gear, and a connection element; two motors operatively coupled to the gear system, each of the two motors configured to directly drive one of the two opposing gears and both of the two opposing gears configured to drive the spider gear; at least one driver in electrical communication with the motors; virtual or augmented reality software; a management and control system in communication with the at least one driver and the virtual or augmented reality software; a display in communication with the virtual or augmented reality software; wherein, the apparatus is configured to move the robotic arm in three-dimensional space with curvilinear trajectories; and, wherein, when only the distal end of the upper or lower limb is connected to the apparatus, the limb is suspended in space.

2. The apparatus of claim 1, wherein the adapter has one of: a spherical shape, an anatomical shape corresponding to a finger or a hand, a handle shape, a joystick shape, or a shape configured to be gripped by a hand.

3. The apparatus of claim 2, wherein the adapter has one of: a spherical shape or an anatomical shape corresponding to a finger or a hand.

4. The apparatus of claim 1, wherein the adapter includes sensors configured for actuation by a patient to obtain an effect in the virtual or augmented reality software.

5. The apparatus of claim 1, wherein the adapter has the shape of: a sphere, an ellipsoid, a plate, a pedal, or a shape configured for connection to a foot.

6. The apparatus of claim 1, wherein the connection of the distal end of the upper or lower limb to the adapter includes one of: a glove, a sock, adhesive tape, or a strap having a hook and loop fastener.

7. The apparatus of claim 1, wherein the adapter is formed of silicon, plastics, polymers, elastomers, foams, woods, or metals.

8. The apparatus of claim 7, wherein the adapter includes superficial coverings, textures, or relieves.

9. The apparatus of claim 1, wherein the adapter is connected to the robotic arm by one of: a bearing system, a universal joint, or a spherical joint.

10. The apparatus of claim 1, wherein the larger rod and the smaller rod are substantially straight and are joined at an angle relative to one another.

11. The apparatus of claim 1, wherein the larger rod and the smaller rod each have a curvature.

12. The apparatus of claim 1, wherein the robotic arm is formed of silicon, plastics, polymers, elastomers, foams, woods, or metals.

13. The apparatus of claim 12, wherein the robotic arm has a core and a superficial covering, relief, or texture.

14. The apparatus of claim 13, wherein the core of the robotic arm is formed of metal and the superficial covering is formed of plastic.

15. The apparatus of claim 1, wherein the robotic arm is affixed to the spider gear.

16. The apparatus of claim 1, wherein each of the two opposing gears is connected to one of the two motors through a semi-axle or a bushing.

17. The apparatus of claim 1, wherein a fixation pin connects the spider gear to the connection element, and the spider gear has a perpendicular orientation in relation to the two opposing gears.

18. The apparatus of claim 1, wherein the spider gear and the two opposing gears are conical or semi-spherical, have straight or helical teeth, and have a mechanism to prevent clearances or backlash.

19. The apparatus of claim 1, wherein the connection element which has the shape of a prism with polygonal or circular base, the shape of a sphere, or the shape of a polyhedron.

20. The apparatus of claim 1, further including a gear reduction box operatively coupling one of the two opposing gears and one of the two motors.

21. The apparatus of claim 1, wherein the motors have a torque between about 0.05 Nm and about 50 Nm, and position sensors are in electrical connection with the motors.

22. The apparatus of claim 1, wherein each motor is aligned axially with one of the opposing gears or is positioned perpendicularly to one of the opposing gears.

23. The apparatus of claim 1, wherein the drivers are configured to receive logical signals from the management and control system, convert the logical signals into electrical signals, and transmit the electrical signals to the motors.

24. The apparatus of claim 1, wherein the virtual or augmented reality software is configured to: display environments with figures, colors, and sounds to simulate a user's daily life situations; exhibit the user's movements; show corrections to the user's movement; and be used by one or more patients simultaneously.

25. The apparatus of claim 1, wherein the virtual or augmented reality software communicates with a database configured to store data about movements and exercises for motor rehabilitation or for training and physical fitness exercises.

26. The apparatus of claim 1, wherein the management and control system is configured to: calculate a trajectory, a force, and an acceleration for execution by the user in each movement; send logical signals to the drivers; receive feedback from the drivers; recalculate the trajectory, the force, and the acceleration of the user's movement based upon the feedback; send signals to the drivers for the correction of the user's movements; and send logical signals to the virtual or augmented reality software to show the corrections of movements on the display.

27. The apparatus of claim 1, further including at least one video port having a format of USB, VGA, HDMI, DVI, or other standard market format.

28. The apparatus of claim 1, further including a human interface device configured to access control interface functions.

29. The apparatus of claim 1, wherein the apparatus is sized for transportation by a single person and is configured for operation without external installations.

30. The apparatus of claim 1, further including virtual or augmented reality glasses for visualization of games, scenarios, and environments of the virtual or augmented reality software.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) FIG. 1 shows a perspective view of a motor rehabilitation apparatus for the upper and lower limbs, having a sphere-shaped adapter for the end of the upper limb.

(2) FIG. 2 shows a perspective view of an embodiment of the apparatus having an anatomical-shaped adapter for the end of the upper limb.

(3) FIG. 3 shows a perspective view of an embodiment of the apparatus having an adapter in pedal form for the end of the lower limb.

(4) FIG. 4 shows the apparatus inside a carrying case.

(5) FIG. 5 shows a cut-away view of a robotic arm of the apparatus.

(6) FIG. 6 shows a view of the robotic arm and drive system.

(7) FIG. 7 is a cross-sectional view of the gear system.

(8) FIG. 8 shows a perspective view of the apparatus in its external configuration.

(9) FIG. 9 is a schematic drawing of the functional relation between the apparatus, a control system, and software.

(10) FIG. 10 shows the apparatus with cooperating hardware for a virtual environment.

(11) FIG. 11 shows an embodiment of the apparatus in use with an upper limb.

(12) FIG. 12 shows another embodiment of the apparatus in use with the upper limb.

(13) FIG. 13 shows an embodiment of the apparatus in use with a lower limb.

(14) FIG. 14 shows an exemplary motion of opposing gears of the apparatus.

(15) FIG. 15 shows the trajectory of the robotic arm corresponding to the gear motion of FIG. 14.

(16) FIG. 16 shows another exemplary motion of the opposing gears.

(17) FIG. 17 shows the trajectory of the robotic arm corresponding to the gear motion of FIG. 16.

(18) FIG. 18 shows another exemplary motion of the opposing gears.

(19) FIG. 19 shows the trajectory of the robotic arm corresponding to the gear motion of FIG. 18.

(20) FIGS. 20-22 show exemplary trajectories of robotic arm movements, with correspondence shown by the virtual and/or augmented reality software.

(21) FIG. 23 shows results of a clinical trial before motor rehabilitation treatment.

(22) FIG. 24 shows results of the clinical trial after motor rehabilitation treatment with the apparatus.

DETAILED DESCRIPTION OF THE INVENTION

(23) Referring initially to FIGS. 1-3, there are illustrated perspective views of embodiments of the motor rehabilitation apparatus for the upper and lower limbs, in which we can observe the apparatus (1), the emergency button (2), the tablet (3), the biometric reader (4), and the robotic arm (6). The embodiments of FIGS. 1-3 include, respectively, a sphere-shaped adapter for the end of the upper limb (5), an anatomical-shaped adapter for the end of the upper limb (7), and adapter in pedal format for the end of the lower limb (8).

(24) The apparatus (1) can be used by patients with neurological, musculoskeletal, muscular, rheumatic, motor and/or cognitive diseases or injuries; patients who suffered accidents or physical traumas; patients who are under a recovery process after surgery; patients who have to correct or re-learn motor movements; patients who have to perform preventive training so as to prevent the progression of disease; and for individuals in search of training and physical fitness.

(25) The apparatus (1) works with movements and exercises in three-dimensional space. It is able to leave the limb suspended in space and under the influence of gravity. It permits movements along a curvilinear trajectory.

(26) With these features, the movements and exercises become more complex and integrated, and are more similar to those that people perform in their daily life activities. These exercises also require greater muscular activation and the use of a greater number of muscular groups and joints of the limb. In this way these exercises promote greater brain stimulus, in which the brain will have to recruit a higher number of neural circuits to execute the exercises, which lead to a more complete, faster and more effective rehabilitation of the individual's capacity.

(27) The apparatus (1) can also be employed successfully in the evaluation, diagnosis and monitoring of the patient's rehabilitation because it allows the measurement of the force, the spatial trajectory, the velocity, the accuracy and other diagnostic and follow-up variables, which make it possible to obtain accurate and objective numerical data for a more careful evaluation and for the establishment of a more effective and faster rehabilitation plan.

(28) In cases of training and physical fitness, the apparatus permits the practice of exercises and movements directed toward a faster and more effective development of the individual, setting the exercises in an entertaining and motivating virtual environment, with colors, sounds and games.

(29) The apparatus is compact, lightweight, easy to transport and does not require previously prepared facilities for its installation. FIG. 4 shows the apparatus (1) inside a carrying case (9). It can be transported inside the carrying case (9), which allows its use in the patient's home, in rehabilitation clinics, in physiotherapy clinics, in medical clinics, hospitals and in sport centers.

(30) Referring now to FIGS. 11-13, embodiments of the apparatus are shown in use. FIG. 11 shows the patient (47) with the upper limb (31) and the hand (32) on the adapter (5), demonstrating that the patient's limb is suspended in three-dimensional space and connected to the apparatus only by the adapter (5). FIG. 12 shows the patient's hand (32) connected to the adapter through straps having hook and loop fasteners (33). FIG. 13 illustrates the patient's foot (34) connected to the adapter (8) by straps with hook and loop fasteners (33), where it is possible to observe that the leg (35) is suspended in three-dimensional space and that the apparatus (1) is positioned on the floor.

(31) In use, the apparatus should be placed on a table if the exercises are for the upper limbs, or on the floor if the exercises are for the lower limb. The patient should be seated or standing in front of the apparatus. The hand (32) or foot (34) should be connected to the adapter (5, 7 or 8) by a glove or sock, tapes, or straps with hook and loop fasteners (33).

(32) For the upper limb rehabilitation cases, the adapter has preferably the shape of a sphere (5) or an anatomical shape (7) for the patient's fingers or hand, but also it is possible to employ an adapter in the form of a handle, a joystick or another format that allows the patient's hand to grip.

(33) In the lower limb rehabilitation cases, the adapter will have preferably the shape of a sphere, an ellipsoidal, a plate, a pedal (8) or other form that allows positioning of the foot.

(34) In terms of materials, the adapter (5, 7 or 8) will be made preferably of silicon, but plastics, polymers, elastomers, foams, woods, metals or other materials can be employed, and may include superficial coverings, textures, or relieves that may facilitate the connection with the patient's distal end or stimulate tactile aspects or the individual's sensitivity.

(35) It is important to emphasize that the only point of connection of the patient's limb with the apparatus is through the adapter, which leaves the limb (31, 35) suspended in space, without any support or sustaining apparatus, under the action of gravity and free to move in three-dimensional space, which permits rehabilitation exercises and movements to be very similar with the movements that the person performs in daily life activities and leads to faster and more effective results.

(36) FIG. 5 shows a cut-away view of the robotic arm, showing the sphere-shaped adapter (5), the universal joint (10), the sensor (45), the larger rod (11), and the smaller rod (12). In this figure it is possible to see that the larger rod and the smaller rod have a core (13) and a superficial covering (14).

(37) The adapter (5, 7 or 8) can be fixed on the robotic arm (6) or can contain, inside, a universal joint, a bearing system, or a spherical joint (10) to allow mobility in relation to the robotic arm (6), such that preferably the bearing system, universal joint, or the spherical joint will be used to allow the rotational movement of the adapter in relation to the robotic arm, leading to a larger number of possible movements of the patient's limb.

(38) The adapter can contain sensors (45) internally so that the patient may press it and obtain visual, audible, or other type of effects on the screen of the virtual and/or augmented reality software, which stimulates the cognitive function of the brain together with the exercise for the individual's motor system.

(39) The robotic arm (6), is preferably formed by a larger rod (11), with length varying between about 1 cm and about 100 cm, and a smaller rod (12), with length between about 5 cm and about 50 cm.

(40) The rods can be straight or have some type of curvature and the union between them can form any angle with each other.

(41) It is also possible to have the robotic arm with the smaller rod, whether straight or with some curvature, and with length between about 5 cm and about 100 cm.

(42) The robotic arm (6) can be solid and made of metal, plastic, wood, polymer or other type of material, having or not superficial coverings, relieves, or textures. It can also be manufactured with a core made from these materials and can have a superficial covering, relief, or texture made with the mentioned materials. In a preferential configuration, the robotic arm will have a metal core (13) and a plastic covering (14).

(43) On one end, the robotic arm (6) is connected to the adapter for the patient's hand or foot and, on the other end, it is connected to a gear system, with satellite arrangement, such that its fixation to the gear system is done through screws, pins, adhesives, glue or other fixation element.

(44) FIG. 6 shows a view of the robotic arm (6), the sphere-shaped adapter (5), the gear system composed of opposing gears (15), the connection element (16) and the spider gear (17), the bushings (18) which interconnect each opposing gear to a motor (19) and the gear reduction boxes (20).

(45) FIG. 7 is a cross-sectional view of the gear system that shows the opposing gears (15), the connection element (16), the spider gear (17), the fixation pin (21) from the spider gear to the connection element, the fixation screw (22) of the spider gear in the smaller rod (12) of the robotic arm, the larger rod (11) and the bushings (18).

(46) The gear system is composed of two opposing gears (15), a spider gear (17), and a connection element (16) that is positioned between them.

(47) The gears are conic or semi-spherical, may have straight or helical teeth and may have or not a mechanism to prevent clearances or backlash.

(48) The connection element (16) between the gears may have the shape of polygonal or circular base prism, shape of a sphere, or shape of a polyhedron. It is connected to the spider gear (17) through a fixation pin (21) and is in contact with the opposing gears (15), maintaining the connection between the three gears.

(49) The spider gear (17) is connected to the robotic arm (6) and is in a position perpendicular to the opposing gears (15).

(50) Each opposing gear is connected to a motor (19) through a semi-axle and/or a bushing (18) and there can be or not a gear reduction box (20) between the opposing gear (15) and the corresponding motor (19).

(51) FIG. 8 shows the apparatus (1) in its external configuration with the motors positioned perpendicularly to the axis of the opposing gears, which also presents the sphere-shaped adapter (5), the robotic arm (6), the tablet (3) and the biometric reader (4).

(52) The combination of movements of the gears generates a wide range of trajectories for the robotic arm and for the patient's limb in three-dimensional space, making possible the execution of several rehabilitation and training and physical fitness movements and exercises.

(53) Without being exhaustive, but for the purpose of illustrating some combinations of these movement of the gears and their results in the trajectories of the robotic arm and the patient's limb, the inventors present the following examples, with reference to FIGS. 14-19.

(54) FIG. 14 shows the opposing gears (15) with rotations (36a and 36b) in the same direction around a common axis. When the two opposing gears (15) have rotations in the same direction around a common axis and with the same magnitude (36a and 36b), the connection element (16) and the spider gear (17) trace a curvilinear trajectory on a plane perpendicular to the horizontal axis of the opposing gears, causing the robotic arm and the patient's limb to describe the curvilinear trajectory (37) on this same perpendicular plane, leading the robotic arm from the position (48a) to the position (48b), as shown in FIG. 15 wherein initial position (48a) of the robotic arm is shown in a lighter color tone and the final position (48b) in a darker tone.

(55) FIG. 16 shows the opposing gears (15) with rotations (38a and 38b) in opposite directions around a common axis but with the same magnitude. In this situation, the spider gear (17) rotates around its own central axis, the connection element (16) remains in the same place, and the robotic arm and the patient's limb trace a movement (39) with curvilinear trajectory on a plane perpendicular to the central axis of the spider gear, as shown in FIG. 17. With these rotations, the robotic arm is moved from the initial position (49a) to the final position (49b), where FIG. 17 shows the initial position (49a) of the robotic arm in a lighter color tone and the final position (49b) in a darker tone.

(56) FIG. 18 shows the opposing gears (15) with rotations with different magnitude (40a and 40b) and in opposite directions. In this case, the connection element (16) and the spider gear (17) move on planes oblique to the horizontal plane which intersects the axis of the opposing gears, causing the robotic arm and the patient's limb to move in curvilinear oblique trajectories in three-dimensional space.

(57) FIG. 19 shows the trajectory (41) of the movement of the robotic arm (6), which is generated by the rotations (40a and 40b) shown in FIG. 18. With these rotations, the robotic arm (6) traces, in three-dimensional space, a movement with curvilinear trajectory and oblique to the horizontal plane that cuts the axis of the opposing gears. FIG. 19 shows the initial position (50a) of the robotic arm in a lighter color tone and the final position (50b) in a darker tone, with the apparatus shown in perspective view.

(58) The motors (19) have torque between about 0.05 Nm and about 50 Nm and have position sensors that will transmit information to the management and control system.

(59) Motors (19) can be aligned with the corresponding opposing gears (see FIG. 6) or can be positioned perpendicularly to them, such that, in this case, the transmission of the movement from the motor to the opposing gear will use a connector or an L-shaped gear reduction box.

(60) Referring now to FIG. 9, a schematic drawing is shown of the relation between the virtual and/or augmented reality software (23), the management and control system (24), the drivers (25), the motors (19), the opposing gears (15), the spider gear (17), the robotic arm (6) and the patient's limb (26). In the figure the forward information path (27) and its feedback path also appear (28).

(61) Preferably each motor (19) is connected to a driver (25), which is a converter of logical signals into electrical signals, and there is a connection between the two drivers of the apparatus for data synchronization. However, it is possible that there be only one driver, serving the two motors.

(62) The driver receives the logical signals coming from the management and control system (24), and converts these logical signals into electrical signals which will be sent to the motors (19) to generate the rotations and torques in the gears.

(63) The management and control system (24) receives information (27) from the virtual and/or augmented reality software (23) and manages and controls in real time the data transmissions between the virtual and/or augmented reality software (23), the drivers (25), the motors (19), thus controlling the movement of the gears (15 and 17), the robotic arm (6) and the patient's limb.

(64) Internally, the virtual and/or augmented reality software (23) keeps the information and data of the movements that will be applied in the motor rehabilitation exercises or in the training and physical fitness exercises, by transmitting this information (27) to the management and control system (24), which calculates the trajectory to be performed by the patient, and also the force and acceleration of the movement, and send logical signals to the drivers (25), which will convert them into electrical signals that will produce the movement of the motors (19), generating rotations and torques in the gears.

(65) With this, we will have the movements of the gears, the robotic arm and the patient's limb in a given trajectory, with certain force and certain acceleration.

(66) The management and control system (24) also receives feedback (28) with the information on the patient's movements, compares with the information received from the virtual and/or augmented reality software, recalculates trajectories and sends signals to the motors to carry out rotations and torques to correct the trajectory, the force and the acceleration of the patient's movement.

(67) FIG. 10 shows the apparatus (1) with a monitor (29) which shows the games, scenarios and virtual environments of the virtual and/or augmented reality software (23). The apparatus and monitor are both are positioned on a table (30).

(68) In the visual interaction with the patient, the virtual and/or augmented reality software (23) shows, on a computer monitor (29), on a television screen, on a projector or on any other visual media, games, scenarios and environments with figures, colors and sounds to simulate people's daily life situations, presenting to the patient a friendly, entertaining and motivating graphical interface.

(69) To facilitate the patient's immersion into the games and in the virtual scenarios and to expand the cognitive stimuli, virtual and/or augmented reality glasses can be employed. However, the virtual and/or augmented reality software operates normally without the use of glasses.

(70) For the purpose of illustrating the interaction among the various components of the motor rehabilitation apparatus for the upper and lower limbs, some additional examples will be presented in the following paragraphs, which should not be considered exhaustive or limiting of any aspect of this invention.

(71) Referring to FIG. 20, consider a rehabilitation movement (42) of the upper limb, which consists in picking up an object on a table and placing it in a cupboard in front of the table by means of a curvilinear trajectory in three-dimensional space. The virtual and/or augmented reality software transmits the information and data from the movement (42) to the management and control system, which calculates the trajectory, force and acceleration necessary to execute this movement. This information or logical signals are transmitted to the drivers, where they are converted into electrical signals, which are transmitted to the motors, which in turn, transmit rotations and torques to the opposing gears that move the connection element and the spider gear, producing the movement (37) of the robotic arm, which moves the patient's limb. The movement transmitted to the patient's limb will be shown on the screen and the patient will view his/her virtual hand (46), which will allow a stimulus not only of the cognitive function but also of the motor system of the patient.

(72) FIG. 20 shows the initial position (48a) of the robotic arm in a lighter color tone and the final position (48b) in a darker tone. The virtual and/or augmented reality software may typically use colors to provide the entertaining aspects of the scenario and the motivating environment that is similar to the patient's daily life.

(73) The virtual trajectory (42) of the movement has a straight trajectory (37) in three-dimensional spherical space. This is possible because the opposing gears have rotation in the same direction around a common axis and the same magnitude (36a and 36b), see FIG. 14. With this, the connection element, the spider gear, the robotic arm and the patient's limb trace a curvilinear trajectory (37) on a plane perpendicular to the horizontal axis of the opposing gears.

(74) In case the patient exerts any force opposite to the planned movement or deviates from the trajectory assigned for the exercise, the management and control system receives this feedback, recalculates the trajectory, the force and/or acceleration, sends these data in form of logical signals to the drivers, which will send electrical signals to the motors to transmit rotations and torques to the gears, with the objective of correcting the trajectory, the force and/or the acceleration of the patient's movement. At the same time, the management and control system will send logical signals to the virtual and/or augmented reality software showing the corrections of the trajectory of the upper or lower limb on the screen or on the monitor.

(75) Referring to FIG. 21, if the desired movement (43) for the patient's exercise was to move an object laterally on a horizontal plane in a given environment, the information transmission sequence would be the same as described above; however, the movement of the opposing gears would have rotations in opposite directions around a common axis and the with same magnitude. With this, the spider gear would rotate around its own central axis, the connection element would remain in the same position and the robotic arm and the patient's limb would make a lateral movement with curvilinear trajectory on a horizontal plane parallel to the horizontal axis of the opposing gears. With this, the patient would see on the screen of the virtual and/or augmented reality software the movement (43) and the virtual hand (46) and the apparatus would describe the curvilinear trajectory (39) which leads the robotic arm from the position (49a), shown in a lighter color tone, to (49b), shown in a darker color tone.

(76) In another situation, as can be seen in FIG. 22, if the exercise was to pick up a fruit on a plate on the table and to place it in a fruit basket located in a place above and to the right of the fruit's initial position, the virtual and/or augmented reality software would send the information from the movement to the management and control system, which would calculate its trajectory, force and acceleration, sending these data to the drivers, which would transmit this information to the motors that would generate rotations and torques. With this, the opposing gears would rotate in opposite directions in relation to a common axis and with different magnitude, causing the connection element, the spider gear, the robotic arm and the patient's limb to describe a movement (41) in three-dimensional space in a curvilinear oblique trajectory in relation to the horizontal plane which intersects the horizontal axis of the opposing gears. The patient would view the movement (44) on the screen, together with the virtual hand (46), and the end of the robotic arm would describe the trajectory (41), going from position (50a) to (50b). FIG. 22 shows the initial position (50a) of the robotic arm in a lighter color tone and the final position (50b) in a darker tone, with the apparatus shown in a frontal view, carrying the same movement presented in FIG. 19 in the perspective view.

(77) Aside from its application in rehabilitation exercises, the apparatus can also be used for training and physical fitness exercises. In this case, the apparatus works predominantly in the active-assistive mode, offering resistance to the movement to be performed by the person, so that the effort may be more intense and guided, providing a faster and more efficient physical fitness exercise.

(78) During the development of the apparatus presented herein, the inventors performed several clinical trials and obtained excellent results, increasing the efficacy of the rehabilitation exercises, improving the patients' responses and engaging the patients in the treatment.

(79) In one of the clinical trials, the force, the trajectory, the velocity and the accuracy of the movements of 8 patients with injuries and sequelae resulting from stroke were assessed to establish the initial situation of each case and to define the rehabilitation treatment to be applied. These patients are considered chronic by the conventional motor scales.

(80) Next, 18 rehabilitation sessions were carried out with a duration of 1 hour each, such that each patient executed between 690 and 900 reaching movements per session with the injured limb. These movements generated flexion, extension, abduction and adduction of the shoulder; extension and flexion of the elbow; flexion, extension, adduction and abduction of the wrist; ipsilateral movements; and contralateral movements.

(81) After 18 rehabilitation sessions, an assessment of the patients was carried out once more and an improvement in the motor and functional performance of the patients' limb was confirmed, with larger amplitude of movement of the shoulders, elbow, and wrist; improvement in flexion, extension, internal and external rotation, abduction and adduction of the limb; greater accuracy of the trajectory in the movements; and improvements of the force and the velocity of the movements.

(82) It is worth emphasizing that if these exercises were performed by a physiotherapist, without using the present apparatus, the patient would have performed only 80 to 100 movements per session, which would lead to longer recovery times and less effective recovery.

(83) Another clinical trial was done on chronic patients who presented brain injuries that made performing vertical movements against the force of gravity difficult.

(84) The apparatus was used to assess the initial and final conditions of the patients and it was also employed to exercise these patients.

(85) To perform the exercises, the virtual and/or augmented reality software presented the scenario of picking up an ingredient on the table and placing it in a cupboard, repeating the exercise for 4 other ingredients. Thus, each patient had to perform movements in 5 different trajectories in three-dimensional space.

(86) Before the exercises with the present apparatus, the patients were not able to carry out the vertical movement of placing the ingredient in the cupboard and, after 18 rehabilitation sessions using the apparatus, these chronic patients were able to pick up the ingredient on the table and place it in the cupboard.

(87) To facilitate the visualization of this typical example of a patient, FIG. 23 shows the projection, on the two-dimensional plane, of the three-dimensional reaching movement in each of the 5 trajectories before the use of the invented apparatus. FIG. 24 shows the same projection of this reaching movement in 5 trajectories after the rehabilitation treatment with the apparatus.

(88) Observing FIGS. 23 & 24, it is possible to verify that the patient was able to perform the movements with greater amplitude and extension after the treatment with this motor rehabilitation apparatus.

(89) The present apparatus is able to solve the problems of the current state of the technology and to contribute to the expansion of this field of human knowledge, presenting a new and original way of performing therapeutic exercises and movements for motor rehabilitation of the upper and lower limbs and for people's training and physical fitness exercises.

(90) The execution of movements and exercises in three-dimensional space, with the limb suspended, under the action of gravitational force and with curvilinear trajectory represents a great advantage because the movements become more complex and integrated. They are more similar to those that are performed by a person in his/her daily life activities; they require a greater muscular activation; and they move a greater number of muscular groups and limb joints and they produce much more stimulus in the patient's brain leading to a faster and more effective rehabilitation of the individual's capacity.

(91) Another advantage of the apparatus is related to the use of a virtual and/or augmented reality software which has a friendly, entertaining, and motivating graphical interface, which has games, scenarios and environments with figures, colors and sounds, in which the exercises are contextualized in games, scenarios and virtual environments which are very similar to the people's daily life situations. With this, the patient becomes more motivated to execute the exercises because he/she is able to understand the usefulness of the movement, he/she becomes more engaged with his/her own rehabilitation or training, and there is a stimulus not only of the patient motor system but also of his/her cognitive function.

(92) Another advantage of this apparatus is that it is compact, portable, lightweight, easy to transport, and does not require special facilities for its installation and its use because the patient can carry the apparatus home and perform the rehabilitation exercises as many times as he/she can or wishes, which increases his/her speed of recovery. If a person is using the apparatus for training and physical fitness exercises, this advantage continues to be worthwhile because he/she can carry the apparatus to any place and to perform the exercises many times a day.

(93) The possibility of programming the exercises for each patient constitutes another advantage of the invented apparatus because the patient interacts with the apparatus and performs the prescribed exercises for his/her rehabilitation. Thus, the physiotherapist supervises the exercises and he/she is free to attend to other patients in the same period of time.

(94) The configuration of the gear system is another advantage because it is simple, compact and functional, and allows the execution of movements and exercises in three-dimensional space with the use of only two motors, which contributes to the apparatus being compact, lightweight, easy to transport, and having lower manufacturing cost.

(95) Thus, the present apparatus assists the patients to perform their rehabilitation exercises and helps people to obtain a better and faster physical fitness.

(96) The embodiments of the apparatus and method of use described herein are exemplary and numerous modifications, combinations, variations, and rearrangements can be readily envisioned to achieve an equivalent result, all of which are intended to be embraced within the scope of the appended claims. Further, nothing in the above-provided discussions of the apparatus and method should be construed as limiting the invention to a particular embodiment or combination of embodiments. The scope of the invention is defined by the appended claims.