EP4376781A1 - Orthosis - Google Patents

Abstract

The invention relates to an orthosis comprising: a first fastening element (15) for fastening a first orthosis component (10) to a proximal body part of a user; a second orthosis component (20) having a second fastening element (21) for being fixed to a distal body part of the user; and a joint device (30) which is located at the proximal end (22) of the second orthosis component (20) and which has a joint upper part (40) and which makes it possible for the second orthosis component (20) to pivot about a joint axis (4) in the sagittal plane relative to the joint upper part (40), the joint upper part (40) being mounted or designed on the first orthosis component (10) in a fastening device (11) so as to be pivotable and/or displaceable in the frontal plane and so as to be rotationally rigid in the sagittal plane.

Description

Otto Bock Healthcare Products GmbH Brehmstrasse 16 1110 Vienna Austria

orthosis

The invention relates to an orthosis with a first fastening element for fastening a first orthosis component to a proximal body part of a user, a second orthosis component with a second fastening element for fastening to a distal body part of the user and a joint device arranged at the proximal end of the second orthosis component, which Has joint upper part and allows pivoting of the second orthotic component in the sagittal plane relative to the joint upper part about a joint axis. The orthosis is designed in particular as a hip orthosis or shoulder orthosis.

Orthoses are orthopedic devices that are applied to an existing limb and that guide, limit or support movement. Drives or resistance devices that can be adjusted or adjusted can be arranged between components that are connected to one another in an articulated manner. The adjustment can take place on the basis of sensor data that is transmitted to a data processing device. Within the scope of this application, orthoses are also understood to mean exoskeletons that are placed on the body of a patient and form an external support structure, in particular to guide and influence the movements of a user, e.g. to support them with drives or to brake them using resistance devices. Orthoses and exoskeletons as their special cases can be used and deployed for training purposes or for therapeutic purposes in addition to supporting daily activities.

Orthoses are fixed using fastening devices or fastening elements that are arranged on shells, rails or struts. The shells, rails or struts are usually connected to one another in an articulated manner or are resiliently mounted on one another. For fastening and safe installation of the S/KS - FJÜIÖ / 2G 10 Orthoses on the respective limbs or the torso are provided with shells or clasps, which at least partially surround the limbs and are firmly positioned on the limbs or the torso via buckles, belt buckles, clamps or the like.

In particular in the case of orthoses on joints that can be shifted in more than one plane, the guidance of the respective joint axis or joint axes is important and possibly difficult to implement. For example, the hip or shoulder joint is a ball-and-socket joint whose center point is inside the body, making it difficult to precisely align the axis of an external joint. However, good alignment of the joint axes is necessary to ensure a comfortable fit and good power transmission of the orthosis and to avoid relative movements.

WO 2015-197704 A1 discloses a leg orthosis with a fastening device for fixing the leg orthosis on a torso of an orthosis user and at least one joint device via which a first orthosis component that can be fixed on an extremity of the orthosis user is pivotably mounted relative to the fastening device. The joint device has at least three joints, each of which has at least one pivot axis that intersect at a common point.

The object of the present invention is to provide an orthosis with which simplified and improved guidance of the respective limb can be achieved.

According to the invention, this object is achieved by an orthosis having the features of the main claim. Advantageous refinements and developments of the invention are disclosed in the dependent claims, the description and the figures.

The orthosis with a first fastening element for fastening a first orthosis component to a proximal body part of a user, a second orthosis component with a second fastening element for fastening to a distal body part of the user and a joint device arranged at the proximal end of the second orthosis component, the has an upper joint part and allows the second orthosis component to be pivoted in the sagittal plane relative to the upper part about a joint axis, provides that the upper joint part is designed to be pivotable and/or displaceable in the frontal plane and torsionally rigid in the sagittal plane on the first orthosis component or in or on a fastening device is stored on it. A joint device is arranged or formed on the second orthotic component, for example an upper arm splint or a thigh splint, which allows pivoting about a joint axis formed by the joint device in the sagittal plane. In order to enable further movements in joints with more than one degree of freedom, the joint device itself with the joint upper part is mounted or designed such that it can pivot and/or slide in the frontal plane on the first orthotic component on or in a fastening device. For example, if the orthosis is designed as a hip orthosis, pivoting is not only possible in the sagittal plane, but also pivoting or displacement in the frontal plane, so that adduction or abduction and/or internal rotation and/or external rotation is possible in a transverse plane or is facilitated. The mounting of the upper joint part itself provides resistance to pivoting about a pivot axis in the frontal plane, so that an actuator, for example a damper or a drive or another resistance device, can be arranged between the upper joint part and the second orthosis component in order to support a movement or to moderate. The upper part of the joint is displaceably mounted in the frontal plane as an alternative or in addition to pivoting, so that a displacement in the medial-lateral direction is possible. As a result, relative movements between the first orthosis component and the second orthosis component can be balanced and compensated due to the position of the natural joint at a distance from the joint device.

In one embodiment, the upper joint part is mounted so that it can be rotated and/or pivoted in the frontal plane and is also displaceable in the proximal-distal direction. A displacement of the upper part of the joint in the anterior-posterior direction, however, is prevented. In this configuration, the joint upper part is mounted in a floating manner on the fastening device and can be displaced upwards or downwards, optionally in combination with a displacement away from the body or towards the body in the frontal plane and/or a rotation around the axis of abduction and axis of adduction. This allows the leg, for example, to swing forwards and backwards around the joint axis of the joint device, preferably in a controlled manner, and to carry out an adduction and abduction movement due to the different mounting of the joint upper part on the first prosthesis component, whereas a displaceable displacement in the walking direction or against the walking direction is not possible. As a result, the assignment of the first orthosis component and the second orthosis component via the joint device is passed on and the displacement about the joint axis can be influenced.

In one embodiment, the upper joint part is designed to be flexible in the frontal plane, so that pivoting and/or displacement within the frontal plane is carried out by deformation of the upper joint part as such. The upper joint part is thus rigidly fastened or formed on the first orthotic component and allows pivoting and/or displacement in the frontal plane by deformation, in particular elastic deformation of the upper joint part or a part of the upper joint part. The deformability can be achieved through a corresponding geometry of the joint upper part, for example through a bellows structure, through a corresponding cross section of the joint upper part or through a multi-component design of the

Joint upper part with rigid and flexible, especially elastic parts.

The joint upper part can be mounted or designed to be rotatable or torsionally rigid in the transversal plane. This makes it possible for rotation about the longitudinal axis of the joint upper part and thus also of the second orthotic component to be enabled or blocked. Depending on the intended use of the orthosis, this enables or prevents internal and external rotation, for example of the thigh or upper arm, for example to protect tissue damaged in injuries or to avoid unwanted stress. With a rotatable storage in the transverse plane can by

Additional devices that moderate or cause movement, for example to provide increased resistance in some areas, preferably elastically, or as a function of sensor data, or to specify a range of motion for therapeutic reasons, for example to guide a limb passively. In one embodiment, the upper joint part itself is designed in multiple parts, as a result of which the properties and functionalities of the upper joint part can be designed to be more variable. A multi-part configuration enables the individual components of the upper joint part to be displaced relative to one another, for example by displacement or pivoting. The joint upper part can be mounted in a slotted guide or in a pin along a slotted guide on the first orthosis component. Different materials can be combined with each other and additional functions can be integrated into the upper part of the joint. If several parts of the upper joint part are attached to one another in an articulated manner, parts of the upper joint part can be pivoted in the frontal plane or displaceability within the frontal plane in the upper joint part itself. The integration of flexible portions or components enables a compact configuration of the upper joint part with simultaneous mobility of at least parts of the upper joint part relative to the first orthosis component.

In one embodiment, the joint upper part is mounted elastically on the fastening device in the frontal plane and is pretensioned in particular in the medial direction and/or in the lateral direction. During the medial biasing, the upper joint is moved or preloaded toward the first orthotic component such that the upper joint is retained within a guide or on the first orthotic component. This prevents or at least makes it more difficult for the joint upper part to separate from the first orthosis component during use.

In one embodiment, the joint upper part is mounted on the fastening device on at least one pin or bolt and/or between two side guides. The spigot may be formed on or attached to the upper joint and is within a recess or bore within the first

Orthotic component stored and / or out. Conversely, a pin can be arranged or formed in the receptacle for the upper joint part on the first orthosis component, which engages in a recess of the upper joint part, for example a correspondingly shaped groove, or which is at least partially surrounded by a correspondingly shaped hook-like section of the upper joint part is so that the upper part of the joint can give away the longitudinal axis of the pivot around. The bolt on the joint upper part can also be non-round and mounted in a corresponding bearing surface of a fork-like receptacle on the first orthosis component. A link guide can be formed by arranging the link in the upper joint part or in the receptacle for the upper joint part on the first orthosis component.

In one embodiment, the joint upper part is designed as an elastic element, so that the pivotability and/or displaceability in the frontal plane is provided by the elastic element itself. The design of the joint upper part as an elastic element has the effect, among other things, that after a deformation and the elimination of the deformation force, an initial state is automatically resumed.

In one embodiment, a stop for limiting displacement in the distal direction is formed between the fastening device and the upper joint part. This stop prevents the second orthotic component from moving along the length of the distal limb and becoming dislodged or separated from the first orthotic component. Movement in the proximal direction is advantageously allowed, so that adduction and abduction are possible. During an abduction movement, an arm or leg is moved away from the center of the body, which may necessitate displacement of the upper joint proximally or upwardly from the upper joint socket. An adduction movement, i.e. bringing a part of the body closer to the middle of the body, remains possible without restrictions up to a certain abduction path due to the movable bearing of the upper part of the joint. Only when the stop prevents further displacement in the distal direction is either the displaceability restricted or resistance to further movement is countered, for example by an elastic element such as a rubber buffer.

In one embodiment, an actuator and/or energy store is arranged between the upper joint part and the second orthosis component, with which it is possible to move the upper joint part relative to the second Influencing the orthotic component or performing this movement. The actuator, for example a motor, a brake, an elastic element, a hydraulic and/or pneumatic damper, influences the movement of the orthotic components relative to one another, in particular the pivoting movement about the joint axis and/or enables such movements.

In one embodiment, the fastening device is provided with a parallel guide, in which the joint upper part is guided. The parallel guide is designed, for example, as a U-shaped rail, in which the correspondingly designed joint upper part is guided in a pivotable and/or displaceable manner. The parallel guidance prevents a displacement in the anterior-posterior direction of the joint upper part relative to the first orthosis component. In addition, it can block the rotational degree of freedom about a pivot axis in the frontal plane, in particular about a horizontal pivot axis or in particular a pivot axis running within the frontal plane in an angular range of up to 90° to the horizontal, and thereby effectively enable the pivoting about the joint axis to be influenced . The parallel guide also allows a displacement in the proximal-distal direction, optionally up to a stop that prevents further displacement or shifting along the longitudinal extent of the parallel guide. In addition, the parallel guidance enables displacement within the frontal plane, ie in the medial direction or lateral direction, without the desired restriction of at least one rotational degree of freedom of the joint upper part within its bearing on the first orthotic component being eliminated. An abduction movement and/or an adduction movement is also possible in this embodiment.

When the orthosis is configured as a hip orthosis, the first fastening element is designed to fix the first orthosis component to the user's torso, while the second fastening element is designed to fix the second orthosis component to the user's thigh. In one embodiment of the orthosis as a shoulder orthosis, the first fastening element is designed to fix the first orthosis component to the upper body of the user, the second fastening element to fix the second orthosis component is designed to be fixed to the upper arm of the user. The first fasteners are, for example, a Harness, trunk-encircling cuff, multi-part shell, or bandage placed around the shoulder joint and secured to the trunk by straps or bandages or cuffs on the contralateral side. A second fastening element for fixing the second orthosis component on the thigh or on the upper arm is, for example, a clasp, a shell, a belt, a textile or a combination thereof.

Exemplary embodiments of the invention are explained in more detail below with reference to the accompanying figures.

FIG. 1 shows a perspective representation of a hip orthosis;

FIG. 2 shows a detailed view of a joint device;

FIG. 3 shows a detailed view of a fastening device;

FIG. 4 different views of the hip orthosis according to FIG. 1;

FIG. 5 shows a schematic representation of the mounting of the upper joint part;

Figure 6 - a variant of Figure 5;

FIG. 7 shows a representation of a multi-part joint upper part;

Figure 8 - different storage configurations;

FIG. 9 shows a mounting of the joint upper part on a pin;

FIG. 10, a variant of FIG. 9;

FIG. 11 shows a variant of FIG. 9 with a hook-shaped joint upper part;

FIG. 12—variants of FIG. 11;

FIG. 13 - variants of a bolt bearing; FIG. 14 shows a variant of FIG. 11 with a deformable joint upper part;

Figure 15 - a variant of Figure 14;

FIG. 16 shows a variant with a connecting link in the upper part of the joint;

FIG. 17 shows an individual representation of a joint upper part;

FIG. 18 shows a side view with an upper joint part which is flexible in the frontal plane; Figure 19 is a front view of an elastic upper joint;

FIG. 20 shows a rotatable mounting of the upper joint part;

FIG. 21 shows a plan view of a bearing according to FIG. 20;

Figure 22 - a variant of Figure 20;

FIG. 23 shows a variant with a molded elastic joint upper part;

Figure 24 is a front view of Figure 23;

FIG. 25 shows a schematic representation of the functioning of the bearing according to FIG. 23;

FIG. 26—an embodiment as a shoulder orthosis;

Figure 27 is a side view of Figure 26;

Figure 28 is a front view of Figure 26 in two positions;

FIG. 29 is a perspective view according to FIG. 28; and FIG. 30, a variant of FIG. 26 with an elastic joint upper part. FIG. 1 shows a schematic representation of an orthosis in the form of a hip orthosis with a first orthosis component 10 with a first attachment element 15 for attachment to the torso or pelvis of a user. The first fastening element 15 can be used, for example, as a belt,

Cuff, shell, partial shell or some other device can be designed with which the hip orthosis can be fixed to the user's body so that it can be removed and put back on again. The first orthotic component 10 has a fastening device 11 on or in which a part of a joint device 30 can be fixed. The joint device 30 has an upper joint part 40 which is designed in several parts in the exemplary embodiment shown. The upper joint part 40 has a bearing part 41 which is connected to an upper bearing component 42 via screws. The upper bearing component 42 is part of the joint device 30, which has a lower bearing component or lower joint part 32, on which a rail box is arranged or formed, in which a second orthotic component 20 is detachably fixed via screws. The second orthosis component 20 is arranged distally to the first orthosis component 10 and is mounted on the upper joint part 40 such that it can pivot about a joint axis. In the exemplary embodiment shown, the second orthotic component is a thigh splint 20, at the proximal end 22 of which the joint device 30 is positioned. A second fastening element 21 in the form of a thigh cuff or a thigh shell is arranged on the second orthosis component 20 distal to the joint device 30 in order to fix the second orthosis component 20 on the thigh. An actuator 50 is arranged between the upper joint part 40 and a lower joint part 32 , which is mounted with its distal end on the second orthosis component 20 and spans the joint device 30 . The proximal end of the actuator 50 is fixed to the upper joint part 40 on a cantilever. The actuator 50 can be a damper, a drive or an energy store, in particular an elastic element, or a combination thereof.

A third orthotic component, not shown, can be connected to the second orthotic component 20 further distally, for example a lower leg splint, which is connected via an orthotic knee joint to the Lower leg splint is connected. A foot part or a footrest can also be attached to it.

In FIG. 2, the articulation device 30 is shown in more detail on an enlarged scale. The bearing part 41 of the multi-part joint upper part 40 is rail-like and has a box profile, which forms a projection or shoulder on its underside facing the body. This projection or step serves to increase the contact area and can also be omitted. The bearing component 42 forms, together with the lower joint part 32, a joint axis 4, which in the applied state of the

hip orthosis is at the level of the natural hip joint. The joint device 30 is advantageously positioned on the user's body in such a way that the joint axis 4 essentially runs through the natural hip joint, ie is mounted at the level of the natural hip joint in the frontal plane and is oriented perpendicularly to the sagittal plane. The articulation axis 4 allows the user to walk normally forwards and pivot the leg in the sagittal plane in the anterior-posterior direction. FIG. 2 shows the forwardly directed cantilever of the upper joint part 40 for fastening the actuator 50 (not shown) on the joint device 30 .

FIG. 3 shows an enlarged representation of the first orthotic component 10 with the attachment device 11 for the upper joint part 40 . The fastening device 11 has two side guides 110 which are aligned essentially parallel to one another and between which the bearing part 41 of the joint upper part 40 is inserted. The first fastening element 15 in the form of a belt or a cuff, on which the first orthotic component 10 is arranged, is only indicated.

It can be seen from FIGS. 1 to 3 that the joint upper part 40 is not rigidly mounted in the fastening device 11 but rather allows pivoting and, to a certain extent, displacement within the frontal plane between the two lateral guides 110 . This allows a relative displacement of the upper joint part 40 and in particular of the bearing part 41 to the fastening device 11 during abduction and adduction. About the two side guides 110 is a shift about an axis of rotation of the Corresponds to longitudinal axis 4 and is oriented essentially parallel thereto, blocked. The upper joint part 40 is mounted in a torsionally rigid manner on the first orthotic component 10 in the sagittal plane when fitted, thereby enabling the lower joint part 32 or the second orthotic component 20 to be supported relative to the upper joint part 40 and thus also relative to the first

Orthosis component 10 in the sagittal plane. The joint device 30 together with the actuator 50 can influence a movement of the leg in the sagittal plane, and the range of motion can also be limited, for example, via stops within the joint device, should it be necessary to limit the hip flexion angle or the extension angle. Due to the laterally open design of the fastening device 11, it is possible first to fix the first orthosis component 10 to the torso or the pelvis of the user as the proximal part of the body and then to fix the remaining part of the hip orthosis thereto. A reverse order is also possible. The upper joint part 40 is inserted or hooked into the fastening device 11 with the bearing part 41 and guided between the two lateral guides 110 with the inwardly protruding projection. If the joint axis 4 is individually correctly positioned for the user, the second orthosis component 20 is fixed to the thigh with the second fastening element 21 so that the hip orthosis is correctly positioned.

Six different views of movement situations of a hip orthosis are shown in FIG. The two illustrations on the left show plan views from above in the proximal-distal direction, with the joint device 30 which forms a joint axis 4 which is oriented laterally outward and runs at the level of the natural hip joint. The joint upper part 40 is mounted between the two side guides 110 in the fastening device 11 on the first orthotic component 10 . The strap or buckle for attachment to the user is shown in phantom. In addition to pivoting about the joint axis 4 , twisting along the longitudinal extension of the thigh is not possible; internal rotation or external rotation of the leg about the hip joint is blocked via the lateral guides 110 .

The two middle representations of Figure 4 show a front view of the orthosis with the hinge axis 4, the side guides 110 and the Fastening device 11. In the upper representation, the second orthosis component 20 is in a starting position, in the lower representation in a position pivoted outwards in the frontal plane. The pivoting is not blocked by the bearing in the fastening device 11, which is indicated by the double arrow.

The two illustrations on the right show a side view, in which it is made clear that flexion and extension is only possible around the joint axis 4; displacement of the upper joint part 40 around a pivot axis, which is oriented perpendicularly to the sagittal plane in the frontal plane, is blocked.

In the embodiment according to FIGS. 1 to 4, two rotational degrees of freedom are blocked when the upper joint part 40 is mounted on the fastening device 11, namely about the pivot axis in the sagittal plane and in the transverse plane; pivoting about a pivot axis perpendicular to the sagittal plane in the frontal plane is possible.

The joint upper part 40 can be guided in the fastening device 11 for longitudinal displacement, the inwardly projecting projection or the lug on the bearing part 41 can block a displacement in the distal direction, so that at a

Abduction, the storage part 41 can be moved upwards, in the case of an adduction beyond a standard dimension, the nose on the storage part 41 touches down on a projection within the fastening device 11 . FIG. 5 shows a variant of the mounting of the joint upper part 40 in a schematic sectional view. The fastening arrangement 11 with, for example, a side guide accommodates the joint upper part 40 . In this embodiment, too, the joint upper part 40 is made in several parts and has a bearing part 41 which is mounted on the first orthotic component 10 under tension by a spring 46 in the direction of the first fastening element 15 . The bearing part 41 is coupled in an articulated manner about an additional pivot axis 47 to the bearing component 42 on which the lower part of the articulation device 30 (not shown in detail) is then pivoted. The pivot axis 47 runs orthogonally to the joint axis 4 and within the sagittal plane, so that an abduction of the second orthotic component 20 with a pivoting about the second pivot axis 47 is possible. If transverse forces occur which cause a lateral or outward displacement of the bearing part 41 in the frontal plane, this movement is counteracted by the spring 46 . The abutment of the bearing part 41 or the contact of the bearing part 41 on the side wall of the fastening device 11 prevents the upper joint part 40 from being able to twist in the sagittal plane.

A variant of the bearing according to FIG. 5 is shown in FIG. 6, in which the bearing part 41 forms a gate 43, in the exemplary embodiment shown as a straight slot guide, in which a pin 44 is guided. The pin 44 can simultaneously serve as a stop and limit displacement in the proximal and distal directions. Depending on the positioning and dimensioning of the bearing part 41 relative to the fastening device 11 , in particular to the wall near the body, pivoting of the bearing part 41 about the pin 44 is also possible. An elastic mounting or a pre-stress in a starting position, for example in a maximum stop position at the proximal end of the connecting link 43 and/or a pre-stress in the medial direction, is also possible. The gate 43 does not necessarily have to be straight.

FIG. 7 shows a variant of the joint upper part 40 in which several parts 41, 42 of the same shape are connected to one another in an articulated manner. The individual parts 41, 42 can only be displaced relative to one another about exactly one pivot axis and enable the entire upper joint part 40 with the distal components to be displaced medial or lateral within the frontal plane. Pivoting in the sagittal plane is prevented, as is twisting in the transverse plane. The parts 41, 42 do not necessarily have to be of the same shape, in particular they can have different center distances. In the case of two or more parts 41, 42, displacement in a proximal or distal direction is also possible.

Various forms of a guide or guide 13 are shown in FIG. 8, in which guides 13 are formed in a side wall or in a side guide, as shown with reference numeral 110 in FIGS. In the upper illustration, the slide 13 is shown as a hole in which a pin, not shown, is guided on the upper joint part 40 . The spigot can also be smaller than the bore to allow limited movement. Also, the delimiting bore does not necessarily have to be round. In the middle depiction, link 13 is shown as an arcuate groove, in the lower depiction of FIG. 8 as a straight groove, which runs from lateral-distal to medial-proximal.

A further variant is shown in FIG. The upper joint part 40 is designed in several parts and, in addition to the bearing component 42 , has the bearing part 41 which has two laterally protruding pins 44 which rest on a bearing seat on the upper side of the fastening device 11 . The fastening device 11 can be arcuate and surround the bearing part 41 circumferentially. For assembly, the bearing part 41 is inserted from above into the free space within the fastening device 11 and then connected to the bearing component 42 via screws. The storage valley 41 is shown in the illustration on the right in FIG. The pins 44 protrude laterally from the base body of the bearing part 41 and rest on the curved bearing seat. There is a possibility of displacement upwards or in the proximal direction, as well as a possibility of displacement in the lateral direction and pivoting about the pivot axis, which are formed by the pins 44 . Rotation in the sagittal plane about an axis in the frontal plane is inhibited.

A variant of the embodiment according to FIG. 9 is shown in FIG. 10, in which the pins 44 no longer have a cylindrical cross section, but rather a contour adapted to the contour of the bearing seat. The bottom is rounded but not circular. This provides increased stability against abduction and prevents twisting about the length of the leg. Analogously to FIG. 9, the fastening device can form a lateral arc next to the body part, for example the pelvis, alternatively two laterally outwardly projecting cheeks with upwardly curved ends can form the fastening arrangement 11 . The two cheeks can also form lateral guides. A variant of FIGS. 9 and 10 is shown in FIG. At the same time, the bolt 14 forms a pivot axis about which the bearing part 41 can pivot during abduction. Torsion of the upper joint part 40 in the sagittal plane is prevented by the weight of the orthosis and the resulting support of the bearing part 41 on the bolt 14, so that reaction forces between the lower joint part 32 and the upper joint part 40 are absorbed and transmitted via the first orthosis component 10 and the

Fastener 11 can be transferred to the torso of the user.

The representations in Figure 12 show different configurations of the bearing part 41. In the upper representation, the free space for the bolt 14 essentially corresponds to the diameter of the bolt 14, with a sufficiently large free space between the bent end of the bearing part 41 and the section leading downwards consists to insert the bolt 14 in the upper, hooked end. In the illustration below, the free, upper leg extends obliquely downwards, resulting in an approximately triangular free space for accommodating the bolt 14 . Here, too, the passage is dimensioned sufficiently large so that the storage part 41 can be hooked onto the torso or the body of the user after the first orthosis component 10 has been put on.

Different cross-sectional shapes of bolt 14 are shown in FIG.

A variant of the configuration of the bearing part 41 is shown in FIG. Here, too, the bearing part 41 is hook-shaped as part of the upper joint part 40 . In the upper, curved area, the bearing part 41 has a bellows structure which enables deformation, in particular elastic deformation, when the inner leg protruding downwards during pivoting rests against the bolt 14 and the outer leg of the bearing part is moved further outwards. This situation is shown in the dashed representation and indicated by the arrow. Due to the weakening of the material and the resulting bellows structure, elastic deformation is possible in this area. In principle it is also possible to do that

Joint upper part 40 or in particular the storage part 41 to be configured from several components and from different materials and to specifically combine elastic areas with essentially rigid material sections. As a result, targeted deformability, in particular elastic deformability with defined restoring forces, can be achieved.

FIG. 15 shows a perspective view of such an embodiment according to FIG. The two lateral guides 110, which project outwards from a base 12, receive between them the bolt 14 on which the bearing part 41 is placed. The bearing part 41 has a rectangular cross-section, so that a contact over almost the entire length of the bolt 14 is ensured, which blocks twisting in the sagittal plane. Material weaknesses 410 or elastic components are worked into the apex area of the hook-shaped contour, which facilitate or enable pivoting and elastic resetting.

In FIG. 16, instead of a hooked or attached bearing on a bolt 14, the bearing part 41 is provided with a link 43 in which the bolt 14 is guided. To assemble the orthosis, the bolt 14 is first removed and the link 43 is then aligned in such a way that the bolt 14 can be reinserted and pushed through the link. The bolt 14 is then fixed to the side walls 110 . This enables it to be pivoted and displaced about the bolt 14, but rotation of the upper joint part 40 in the sagittal plane is blocked. In FIG. 16, two different forms of link 43 are shown; in addition to a curved groove, an oversized bore can also serve as link 13. As an alternative to a receptacle between two side walls 110, the bearing part 41 can also form two cheeks, which extend on both sides next to a central body of the fastening device 11 with two pins or bolts 14 protruding laterally outwards. A further variant is shown in FIG. This results in a deformability that allows lateral displacement of the lower joint part 32 and thus of the entire joint device 30 within the frontal plane, but still prevents twisting in the sagittal plane. In addition to a detachable fastening of the bearing part 41 to the fastening arrangement 11, these can also be designed in one piece, so that part of the upper joint part 40 is formed or formed on the fastening device 11. The bearing component 42 or the joint device 30 can be fastened to the distal end of the bearing part 41 .

A further variant is shown in FIG. 18 and shown in a side view. The first fastening element 15 is designed as a belt that is placed around the pelvis and positioned on the body, for example, using a Velcro fastener. On the outside of the fastening device 15 is a

Hook and loop fastener area, for example a hook area arranged on which a complementary component of the hook and loop fastener, for example a fleece portion, is attached. The bearing part 41 is of flat design and is fixed over a comparatively large surface area to the Velcro portion of the fastening device 11 . Due to the flat design of the bearing part 41, flexibility about pivot axes within the main extension planes of the bearing part 41 is possible, but rotation about a pivot axis perpendicular to the sagittal plane is blocked, as indicated by the crossed-out double arrow. The bearing component 42 of the upper joint part is fastened to the bearing part 41 so that the joint device 30 is pivotably mounted with the lower joint part 32 and the second orthosis component 20 . In the exemplary embodiment, an energy store 51 is arranged between upper joint part 40 and second orthosis component 20, which is designed as an elastic element, for example a spring or an elastomer, so that energy is stored during extension and released again to support flexion.

In the figure 19 is a schematic representation of the connection according to the figure 17 is shown, from which it can be seen that a deformation around the Deformation areas or elastic areas 410 on the attachment device through the storage part 41 is possible in an abduction.

A variant is shown in FIG. 20, in which, similarly to FIGS. 1 to 4, the fastening device has two side guides 110 between which the bearing part 41 is mounted. This effectively prevents twisting of the joint upper part 40 in the sagittal plane. In contrast to the embodiment according to FIGS. 1 to 4, the bearing part 41 is round, so that rotation about its longitudinal extension is possible, ie internal rotation and external rotation of the limb is made possible. A longitudinal displaceability in the proximal-distal direction is given as well as a displaceability in the medial-lateral direction and a pivoting about an essentially horizontal axis running in the anterior-posterior direction. FIG. 21 shows a top view of a storage situation according to FIG. 20, a lateral deflection to the outside or to the side is possible, which also facilitates assembly by inserting the storage part 41 between the side guides 110. 22 shows a variant of the embodiment according to FIGS. 20 and 21, in which the proximal end of the bearing part 41 has a stop 45, so that displacement in the distal direction is limited, but displacement in the proximal direction within the side guides 110 is still possible remains.

FIG. 23 shows a variant with an elastic mounting part 41 with a rectangular cross section, which is formed onto the fastening device 11, fastened in a form-fitting manner or fixed in some other way. The bearing component 42 is fastened to the bearing part 41 as part of the joint device 30 . FIG. 24 shows the embodiment in a front view. In the upper illustration of FIG. 25, the mode of operation of a displaceability of the joint upper part 40 and more precisely of the bearing part 41 is shown. Due to the design as a panel-like element with a comparatively large main surface with a small thickness, it is possible to achieve high stability perpendicular to the main surface, so that a displacement by applying a Moments about an axis perpendicular to the sagittal plane shows little or no deformation effect within the frontal plane, which is indicated in the top left illustration of FIG. Pivoting outwards and twisting in the longitudinal extension of the second orthotic component 20, as shown in the other two illustrations above, are possible. The illustration below shows that abduction movement is ensured while rotation in the sagittal plane is blocked at the same time.

FIG. 26 shows an embodiment in the form of a shoulder orthosis. The first orthosis component 10 is fastened to a shoulder to be supplied in the form of a cuff or a support shell via a strap 15 as the first fastening element. The strap 15 is guided along the contralateral side below the armpit and fixed, for example, with a Velcro fastener. There are other attachment options, for example several dimensionally stable shells, similar to a suit of armor. At the first

The orthosis component 10 is the fastening device 11, in which the joint upper part 40 is guided, as is explained, for example, with reference to FIGS. The joint device 30 with a joint axis is arranged at the level of the shoulder joint and enables a pivoting movement of the arm in the sagittal plane. In the illustrated embodiment, an energy store 51 is arranged between the second orthotic component 20, which is designed as an upper arm splint and is fixed to the upper arm via an upper arm cuff as the second fastening element 21, and the joint upper part 40, which energy storage device facilitates a lifting movement of the arm in the sagittal plane. when relaxed. With an angular configuration of the bearing part 41 with a corresponding lateral guide, external rotation of the arm is not possible. With a rotatable mounting of the joint upper part 40 similar to FIG. 20, an external rotation of the lower arm is given by the rotation of the upper arm about its longitudinal extent.

FIG. 27 shows the shoulder orthosis according to FIG other rotational degrees of freedom but not are restricted. The translational degrees of freedom are limited by the two lateral guides, optionally a stop to prevent excessive displacement in the distal direction, and the contact with the body. FIG. 28 shows the possible displaceability of the shoulder orthosis according to FIGS. 26 and 27 with the static or almost static fastening device 11 and the possibility of abducting the upper arm.

Figure 29 shows two possible positions of the arm when the orthosis is designed as a shoulder orthosis, in which the fastening device 11 is in a clip-like configuration and opens outwards with a downward-hanging arm and then with the opening upwards with a horizontally outstretched arm is shown. Figure 30 shows a variant of the definition and design of the

Joint upper part 40 with molded or formed deformation areas or elastic areas 410 and an integrally formed attachment device 11, which is integrally formed or attached to the first orthotic component and can be fixed to the torso of the user via an attachment element 15 explained with reference to FIG. Here, too, an energy store 51 is arranged between the joint upper part 40 and the second orthotic component 20 to support a lifting movement of the arm. It is fixed to the upper arm using an upper arm cuff as the second fastening element 21.

Claims

patent claims 1. Orthosis with a first fastening element (15) for fastening a first orthosis component (10) to a proximal body part of a user, a second orthosis component (20) with a second fastening element (21) for fixing to a distal body part of the user and one to the proximal end (22) of the second orthotic component (20) arranged joint device (30), which has an upper joint part (40) and allows pivoting of the second orthotic component (20) in the sagittal plane relative to the upper joint part (40) about a joint axis (4). , characterized in that the upper joint part (40) is mounted or formed in a fastening device (11) on the first orthotic component (10) such that it can be pivoted and/or displaced in the frontal plane and is torsionally rigid in the sagittal plane. 2. Orthosis according to claim 1, characterized in that the joint upper part (40) is mounted displaceably in the proximal-distal direction and not displaceably in the anterior-posterior direction. 3. Orthosis according to claim 1 or 2, characterized in that the joint upper part (40) is flexible in the frontal plane. 4. Orthosis according to one of the preceding claims, characterized in that the joint upper part (40) is rotatably or torsionally rigidly mounted or formed in the transverse plane. 5. Orthosis according to one of the preceding claims, characterized in that the joint upper part (40) is designed in several parts. 6. Orthosis according to claim 5, characterized in that the parts (41, 42) of the joint upper part (40) are articulated to one another. 7. Orthosis according to one of the preceding claims, characterized in that the upper joint part (40) on the fastening device (11) at least a pin (44) or bolt (14) and/or between two lateral guides (110). 8. Orthosis according to one of the preceding claims, characterized in that the joint upper part (40) is designed as an elastic element. 9. Orthosis according to one of the preceding claims, characterized in that the joint upper part (40) is mounted elastically on the fastening device (11) in the frontal plane. 10. Orthosis according to one of the preceding claims, characterized in that the joint upper part (40) is guided in a link (13) or has a link (43). 11. Orthosis according to one of the preceding claims, characterized in that between the fastening device (11) and the joint upper part (40) a stop (44, 45) is formed to limit displacement in the distal direction. 12. Orthosis according to one of the preceding claims, characterized in that an actuator (50) and/or energy store (51) is arranged between the joint upper part (40) and the second orthosis component (20). 13. Orthosis according to one of the preceding claims, characterized in that the fastening device (11) is provided with a parallel guide, in which the joint upper part (40) is guided. 14. Orthosis according to one of the preceding claims, characterized in that the orthosis is designed as a hip orthosis, with the first fastening element (15) for fixing the first orthosis component (10) on the torso of the user and the second fastening element (21) for fixing the second orthotic component (20) on the thigh of the user. 15. Orthosis according to one of the preceding claims, characterized in that the orthosis is designed as a shoulder orthosis, with the first fastening element (15) for fixing the first orthosis component (10) on the upper body of the user and the second fastening element (21) for fixing the second orthosis component (20) on the upper arm of the user.