Abstract
A device for performing individual movement analysis and movement therapy on a patient includes a control and analysis unit configured to control a first intervention device in such a way that a first trajectory of the movement of an extremity of the patient is disrupted by a force exerted by a movement module onto the extremity of the patient. A response to this disruption is measured by changed measured values from at least one force sensor and/or at least one angle sensor, and a new, second trajectory is calculated therefrom. New control parameters for controlling the first intervention device are calculated from a comparison of the second trajectory with the first trajectory and/or a target trajectory or the comparison of the disrupted measured values with the non-disrupted measured values.
Claims
1-9. (canceled)
10. A device for performing an individual movement analysis and movement therapy on a patient, the device comprising: a first intervention device constructed as a rehabilitation mechanism configured for an automated rehabilitation movement of extremities, at least of joints, muscles and tendons of legs, of a patient according to plan; at least one movement module configured to be brought into operative connection with the extremities of the patient; said at least one movement module including at least one of: at least one force sensor for measuring an absolute value of a force between said at least one movement module and an extremity of the patient, or at least one angle sensor for measuring a direction of the force between said at least one movement module and the extremity of the patient; and a control and analysis unit for controlling said first intervention device and analysis of a trajectory of the movement of the extremity of the patient calculated from actual values of at least one of said at least one force sensor or said at least one angle sensor; said control and analysis unit is configured: to control said first intervention device to disrupt a first trajectory of the movement of the extremity of the patient by a force exerted by said at least one movement module on the extremity of the patient; to measure a response to the disruption by way of altered measured values of at least one of said at least one force sensor or said at least one angle sensor and calculate a new, second trajectory therefrom; and to calculate new control parameters for further control of said first intervention device from a comparison of the second trajectory with at least one of the first trajectory or a target trajectory or a comparison of the disrupted and non-disrupted measured values of at least one of said at least one force sensor or said at least one angle sensor.
11. The device according to claim 10, wherein: said rehabilitation mechanism has at least one of one knee module or a foot module forming said at least one movement module; said one knee module configured to be brought into operative connection with knee joints of the patient and said one knee module including at least one of: said at least one force sensor for measuring an absolute value of a force between said one knee module and a knee joint of the patient, or said at least one angle sensor for measuring a direction of the force between the knee module and the knee joint of the patient; and said foot module configured for accommodating feet of the patient and said foot module including said at least one force sensor for measuring an absolute value of a force between said foot module and each foot of the patient.
12. The device according to claim 10, which further comprises at least one second intervention device for interaction with the patient, said at least one second intervention device being configured to interchange control data with said control and analysis unit.
13. The device according to claim 12, wherein said at least one second intervention device is configured to interact with the body of the patient or with at least one of a leg, a knee joint or a foot of the patient.
14. The device according to claim 12, wherein said at least one second intervention device is a device for at least one of generating a vibration or performing electromyostimulation.
15. The device according to claim 12, wherein said at least one second intervention device is a device for generating at least one of visual stimuli or acoustic stimuli.
16. The device according to claim 12, wherein said at least one second intervention device is a device for scheduled administration of a medicament.
17. The device according to claim 10, wherein said control and analysis unit includes a device for performing electromyography.
18. The device according to claim 10, which further comprises a device for reversibly connecting the device or said first intervention device to a bed or to a hospital bed configured to be driven vertically.
Description
[0019] These and additional details and further advantages of the invention are described below on the basis of preferred exemplary embodiments, which, however, do not restrict the present invention, and in conjunction with the attached drawing, in which schematically:
[0020] FIG. 1 shows a side view of an embodiment of a device according to the invention;
[0021] FIG. 2 shows a further embodiment of a device according to the invention, having a device for reversibly connecting the device to a bed;
[0022] FIG. 3 shows a further embodiment of the device according to the invention while carrying out an individual movement analysis and movement therapy, with trajectories plotted in exemplary fashion;
[0023] FIG. 4a shows a further embodiment of the device according to the invention while carrying out an individual movement analysis and movement therapy, with step heights and flexion angles of a hip joint plotted in exemplary fashion;
[0024] FIG. 4b shows an exemplary plot of the step heights measured by the device from FIG. 4a before and after a disruption, for a first case where the step height is greater before the disruption than after the disruption;
[0025] FIG. 4c shows an exemplary plot of the step heights measured by the device from FIG. 4a before and after a disruption, for a second case where the step height is smaller before the disruption than after the disruption;
[0026] FIG. 5a shows a further embodiment of the device according to the invention while carrying out an individual movement analysis and movement therapy, with the disruption consisting of the device preventing a movement of the extremity;
[0027] FIG. 5b shows an exemplary plot of the force exerted by the patient on the device from FIG. 5a, as measured by the latter, in the case of a non-disrupted movement of the extremity and in the case of a disrupted, especially fully prevented, movement of the extremity; and
[0028] FIG. 5c shows an exemplary plot of a flexion angle, corresponding to the performance of an individual movement analysis and movement therapy as shown in FIGS. 5a and 5b in exemplary fashion, as a function of time.
[0029] In the following description of preferred embodiments of the present invention, identical reference signs denote identical or comparable components.
[0030] FIG. 1 shows a side view of an embodiment of a device 1 according to the invention. The device 1 according to the invention comprises at least one first intervention means 3 in the form of a rehabilitation mechanism 30, suitably designed for an automated rehabilitation movement of the extremities 94, at least ii of the joints, muscles and tendons of the legs 92, of a patient 90 according to plan, having at least one movement module 5 capable of being brought into operative connection with the extremities 94 of the patient 90. In this case, the movement module 5 comprises at least one force sensor 41; 51 for measuring an absolute value of a force F(t) between the movement module 5 and an extremity 94 of the patient 90 (cf. also FIGS. 3 and 5A) and/or at least one angle sensor 52 for measuring the direction of the force F(t) between the movement module 5 and the extremity 94 of the patient 90. The device 1 according to the invention moreover comprises at least one control and analysis unit 6 for controlling the first intervention means 3 and analysis of a trajectory T.sub.1; T.sub.2; . . . of the movement of the extremity 94 of the patient 90 calculated from the actual values of the at least one force sensor 41; 51 and/or at least one angle sensor 52,
[0031] The control and analysis unit 6 of the device 1 according to the invention is configured to control the first intervention means 3 in such a way that a first trajectory T.sub.1 of the movement of the extremity 94 of the patient 90 is disrupted by a force exerted by the movement module 5 on the extremity 94 of the patient 90; a response to this disruption P is measured by way of altered measured values of the at least one force sensor 41; 51 and/or at least one angle sensor 52 and a new, second trajectory T.sub.2 is calculated therefrom; and new control parameters for (further) control of the first intervention means 3 are calculated from a comparison of the second trajectory T.sub.2 with the first trajectory T.sub.1 and/or a target trajectory T.sub.soll or the comparison of the disrupted and non-disrupted measured values of the at least one force sensor 41; 51 and/or at least one angle sensor 52. The force sensor or force sensors 41; 51 can be arranged, in particular, on a cantilever of the movement module 5, as shown in FIG. 1, and/or in a region near the feet 91 of the patient 90, especially on a foot module 40 of the rehabilitation mechanism 30 (cf. FIG. 2 and FIG. 3 as well).
[0032] FIG. 1 moreover shows that the device 1 preferably also may comprise at least one second intervention means 7 for interaction with the patient 90, the second intervention means 7 preferably being configured to interchange (control) data with the control and analysis unit 6. In particular, the second intervention means 7 can be configured to interact with the body of the patient 90, especially with their leg 92, knee joint 93 and/or foot 91, and thereby for example to generate a further mechanical disruption P to the movement of the extremity 94 by exerting a force on the extremity 94 of the patient 90. To this end, the second intervention means 7 can be, in particular, a means 71 for generating a vibration (cf. FIG. 3) and/or a means 72 for performing electromyostimulation. Preferably, the control and analysis unit 6 may in the latter case also comprise a means 61 for performing electromyography, which advantageously serves to control and evaluate electrical or other types of external muscle stimulations. The second intervention means 7 may also be, alternatively or cumulatively, a means 73 for generating visual stimuli and/or a means 74 for generating acoustic stimuli, as shown. In such an embodiment of the invention, the second intervention means 7 can advantageously act on other senses—sense of vision and/or sense of hearing—of the patient 90 as a disruption P. Particularly in the case of patients 90 with neurological damage, the action via different sensory organs may lead to better (brain) stimulation, which in turn may advantageously assist the progress of the rehabilitation. The device 1 can then advantageously measure and evaluate the influence of such disruptions P, especially acoustic and/or visual disruptions, on the patient 90, as described above. Finally, the second intervention means 7 may, alternatively or cumulatively, also be a means 75 for scheduled administration of a medicament. In this case, the disruption P consists in a targeted administration and/or the targeted omission of a medicament, that is to say a pharmacological intervention. By way of example, such a second intervention means 7 advantageously facilitates testing of which medicaments are advantageous or disadvantageous for the healing process, what active ingredient doses are effective and whether, for example, a change of sedative or the administration of a certain neurotransmitter such as serotonin, noradrenaline or dopamine can influence the healing process (preferably in a positive manner). The device 1 according to the invention can advantageously measure deviations in the behavior of the patient, in particular deviations in their sequence of movement, which are so small that they would not (yet) even be noticed by a therapist during a conventional movement therapy, as a result of which the accuracy of the results obtained advantageously increases.
[0033] FIG. 2 shows a further embodiment of a device 1 according to the invention, which comprises a device 11 for reversibly connecting the device 1, especially the first intervention means 3, to a bed 80. In this case, the bed 80 can preferably be a hospital bed that can be driven into the vertical. As is shown in FIG. 2, the device 1 can have a mobile design with the aid of such a device 11 for a reversible connection, and can be connected to a bed 80 for carrying out an individual movement analysis and movement therapy and can be removed again after the completion of the analysis or therapy. A possible device 11 is disclosed for example in DE 10 2018 129 370.4 from the applicant, comprehensive reference being made thereto at this juncture in respect of the functionality of the device 11.
[0034] FIG. 2 moreover shows that the device 1 may also have a rehabilitation mechanism 30 as a movement module 5, said rehabilitation mechanism comprising at least one knee module 50 capable of being brought into operative connection with the knee joints 93 of the patient 90; the knee module 50 preferably comprising at least one force sensor 51 for measuring an absolute value of a force F(t) between the knee module 50 and a knee joint 93 of the patient 90 and/or at least one angle sensor 52 for measuring the direction of the force F(t) between the knee module 50 and the knee joint 93 of the patient 90. Alternatively or cumulatively, the rehabilitation mechanism 30 may also comprise a foot module 40 for accommodating the feet 91 of the patient 90; the foot module 40 preferably comprising at least one force sensor 41 for measuring an absolute value of a force between the foot module 40 and each foot 91 of the patient 90.
[0035] FIG. 3 now shows a further embodiment of the device 1 according to the invention while carrying out an individual movement analysis and movement therapy, with trajectories T.sub.soll, T.sub.1, T.sub.2 plotted in exemplary fashion. To carry out a movement analysis, extremities 94 of the patient 90, shown here using the example of a leg 92, may be brought into operative connection with the movement module 5. To this end, FIG. 3 shows an operative connection on the thigh in the region of the knee joint 93 in exemplary fashion; however, the leg 92 may also be brought into operative connection with the first intervention means 3 on the lower leg, as shown in FIGS. 1, 4a and 5a, and/or at another location. With the aid of the at least one force sensor 41; 51—FIG. 3 shows a force sensor 51 on a cantilever of the movement module 5 and a force sensor 41 in the region of a foot module 40—and/or the at least one angle sensor 52, it is then possible to determine a trajectory T.sub.1; T.sub.2; . . . by means of the control and analysis unit 6 by way of the measurement of an absolute value of a force F(t) between the movement module 5 and the extremity 94 or by measuring the direction of the force F(t) during a movement of the extremity 94, and to store said trajectory for further use. In this way, the device 1 for example advantageously facilitates the creation of a database of non-disrupted, “normal” trajectories T.sub.1; T.sub.2; . . . of healthy humans, with the first intervention means 3, in particular the rehabilitation mechanism 30, not exerting any sort of disruption P on the movement of the subject during such a recording, but instead only accompanying the movement.
[0036] In the case of a convalescing patient 90, an actual trajectory T.sub.1; T.sub.2; . . . of the movement of the extremities 94 firstly can be measured in a similar manner with the aid of the device 1 according to the invention and can be compared with the above-described database entries, that is to say with target trajectories T.sub.soll of healthy humans, for the purposes of estimating the current healing state. Secondly, a disruption P that acts on the patient 90 can also be generated by means of the first intervention means 3, especially by means of the movement module 5, and/or by means of one or more second intervention means 7, before and/or during a movement of the extremities 94, and a possible deviation from a comparison trajectory induced thereby can be measured. In this case, in particular, the comparison trajectory can be either a target trajectory T.sub.soll of a healthy human stored in the database or else a trajectory T.sub.1; T.sub.2; . . . of the patient 90 themselves already measured earlier, hence advantageously logging the progress of the healing of the respective patient 90 on an individual basis.
[0037] The device 1 according to the invention moreover allows statements to be made about the ability of the patient 90 to adapt to a disturbance P by way of a quantification of non-disrupted and disrupted measured values of the at least one force sensor 41; 51 and/or at least one angle sensor 52, and thereby allows an assessment of said patient's state of health and/or the rehabilitation success. Two of these quantification methods are presented below in exemplary fashion:
[0038] FIG. 4a shows an embodiment of the device 1 according to the invention while performing an individual movement analysis and movement therapy, with exemplary plotted step heights H.sub.up; H.sub.p and flexion angles φ.sub.up; φ.sub.p of a hip joint 95. In this quantification method, it is possible to generate a disruption P acting on the patient 90 during a plurality of successive movement cycles (“steps”) controlled and/or accompanied by the device 1, be it by exerting a force by way of the first intervention means 3 or by another disruption P by way of a second intervention means 7. In this case, a step height H.sub.up; H.sub.p and/or a flexion angle φ.sub.up; φ.sub.p of a hip joint 95 can preferably be chosen as measurement parameter, with the disruption P, especially an exertion of force on the extremities 94 of the patient 90, being able to have effects on the measured step height H.sub.up; H.sub.p or the flexion angles φ.sub.up; φ.sub.p of a hip joint 95. Depending on the state of health of the patient 90, there may be a motor adaptation of the patient 90 after a certain period during which the disruption P acts on the patient 90 and/or after the disruption P was removed again; the patient 90 recovers from the respective disruption P, which in turn may be reflected in a change of the aforementioned measured values.
[0039] FIG. 4b shows an exemplary plot of the step heights H.sub.up; H.sub.p measured by the device 1 from FIG. 4a before and after a disruption P for a first case, where the step height H.sub.up before the disruption P is greater than the step height H.sub.p after the disruption P.
[0040] Accordingly, FIG. 4c shows an exemplary plot of the step heights H.sub.up; H.sub.p measured by the device 1 from FIG. 4a before and after a disruption P for a second case, where the step height H.sub.up before the disruption P is smaller than the step height H.sub.p after the disruption. In both figures, H(n) denotes the step height of the respective step numbered n.
[0041] It is evident from both FIG. 4b and FIG. 4c that the step height H.sub.p after the onset of the disruption P differs significantly from the non-disrupted step height H.sub.up. As the number n of steps increases following the onset of the disruption P, the measured value approaches the non-disrupted step height H.sub.up again, however, the speed with which and/or the extent to which this adaptation occurs (=the “ability to recover”) depending on the current, individual state of health of the patient 90 and therefore being able to provide indications in regard to the effectiveness of an applied form of therapy (movement therapy, medicinal therapy, etc.).
[0042] A second possible quantification process facilitated by the device 1 according to the invention is outlined in FIGS. 5a to c.
[0043] FIG. 5a shows one embodiment of the device 1 according to the invention while carrying out an individual movement analysis and movement therapy, with the disruption P consisting of the device 1 preventing a movement of the extremity 94. To this end, a patient 90 can be operatively connected to the device 1 according to the invention, especially to the first intervention means 3, preferably via the movement module 5. Subsequently, the force F(t) between the movement module 5 and an extremity 94 of the patient 90 can be measured with the aid of at least one force sensor 41; 51 during the execution of a movement cycle, that is to say a “step”, in a non-disrupted state. In the next step, the extremity 94, especially the leg 92 as shown here, is held securely by the first intervention means 3, preferably the movement module 5, that is to say is virtually fully prevented from carrying out its movement. Now, the force F(t) generated by the patient 90 to fight against the impediment by the first intervention means 3 and to nevertheless move can be measured with the aid of the force sensor or sensors 41; 51.
[0044] FIG. 5b shows an exemplary plot of the force F(t) exerted by the patient 90 on the device 1 from FIG. 5a, as measured by the latter, in the case of a non-disrupted movement of the extremity 94 and in the case of a disrupted, especially fully prevented, movement of the extremity 94; and FIG. 5 shows an exemplary plot of a flexion angle φ.sub.(t); corresponding to the performance of an individual movement analysis and movement therapy as shown in FIGS. 5a and 5b in exemplary fashion, as a function of time t. In this case, F.sub.up(t) and φ.sub.up(t) each describe the non-disrupted state and F.sub.p(t) and φ.sub.p(t) describe the disrupted state, in which the first intervention means 3 virtually fully prevents the movement. In the example shown here, the leg 92 of the patient 90 is kept stretched out in the disrupted state—the flexion angle φ.sub.p(t) of the hip joint 95 consequently remains constant at 0° or 180° (depending on the definition of the zero) throughout the period t of the disruption P (=holding the leg 92 securely). The force F.sub.p(t) with which the patient 90 works against the disruption P depends in turn on the current, individual state of health and can be compared with the measured values of the non-disrupted step F.sub.up(t) and/or with database of values of healthy humans or other patients.
[0045] The present invention relates to a device 1 for performing individual movement analysis and therapy on a patient, which device is characterized in that a control and analysis unit 6 is designed to control the first intervention means 3 in such a way that a first trajectory T.sub.1 of the movement of an extremity 94 of the patient 90 is disrupted by a force exerted by a movement module 5 onto the extremity 94 of the patient 90; a response to this disruption P is measured via changed measured values from at least one force sensor 41; 51 and/or at least one angle sensor 52, and a new, second trajectory T.sub.2 is calculated therefrom; and new control parameters for (further) controlling the first intervention means 3 are calculated from a comparison of the second trajectory T.sub.2 with the first trajectory T.sub.1 and/or a target trajectory T.sub.soll or the comparison of the disrupted measured values with the non-disrupted measured values. Advantageously, the device 1 according to the invention in particular facilitates the testing of patients in the early stage of their healing process in respect of the chances of success of possible therapy interventions, the development of an individualized therapy strategy and the tracking of the healing process even during the movement therapy. Within the scope of the individualized movement analysis and movement therapy facilitated by the device 1 according to the invention, it is possible in particular to deduce the type of therapy intervention or therapy component to which the respective patient 90 is most likely to react as a “responder”, that is to say with positive progress of the rehabilitation, by way of a targeted addition or omission of different therapy components.
LIST OF REFERENCE SIGNS
[0046] 1 Device [0047] 11 Device for reversibly connecting the device (1), especially the first intervention means (3), to a bed (80), in particular to a hospital bed that can be driven into the vertical [0048] 3 First intervention means [0049] 30 Rehabilitation mechanism [0050] 40 Foot module [0051] 41 Force sensor [0052] 5 Movement module [0053] 50 Knee module [0054] 51 Force sensor [0055] 52 Angle sensor [0056] 6 Control and analysis unit [0057] 61 Means for performing electromyography [0058] 7 Second intervention means [0059] 71 Means for generating a vibration [0060] 72 Means for performing electromyostimulation [0061] 73 Means for generating visual stimuli [0062] 74 Means for generating acoustic stimuli [0063] 75 Means for scheduled administration of a medicament [0064] 80 Bed, especially hospital bed that can be driven into the vertical [0065] 90 Patient [0066] 91 Foot [0067] 92 Leg [0068] 93 Knee joint [0069] 94 Extremity [0070] 95 Hip joint [0071] T.sub.soll; T.sub.1; T.sub.2; . . . Trajectory [0072] F(t) Force between the movement module (5) and an extremity (94) of the patient (90) [0073] F.sub.up(t); F.sub.p(t) Force (F(t)), non-disrupted and disrupted, respectively [0074] H.sub.up(n); H.sub.p(n) Step height; non-disrupted and disrupted, respectively [0075] φ.sub.up(t); φ.sub.p(t) Flexion angle of the hip joint (95), non-disrupted and disrupted, respectively [0076] T Time [0077] n Step number [0078] P Disruption
