RU219183U1 - EXOSKELETON FOR REHABILITATION OF MOTOR ACTIVITY OF THE HAND - Google Patents

Abstract

The utility model relates to medical equipment and can be used to treat post-stroke, post-traumatic adult patients and children with cerebral palsy. The exoskeleton comprises a body, a stationary palm lock mounted on the body, and a drive connected to a mechanism for moving the distal phalangeal element with a lock of the distal phalanges of the fingers. The mechanism for moving the distal phalangeal element is a set of movable levers that form a spatial structure in the form of two successively located proximal and distal pairs of the first and second parallelograms connected in series. At the junction of the output ends of the levers of the second parallelogram of the proximal pair of parallelograms and the input ends of the first parallelogram of the distal pair of parallelograms, a proximal phalanx element is placed, in the body of which an arc slot is made for angular movement along it of the lever for regulating the distance between the axes of rotation of the specified spatial designs. The technical result consists in ensuring the anatomical movements of the exoskeleton during compression and opening of the hand with the possibility of adjustment for different hand sizes. 9 ill.

Description

The utility model relates to medical equipment and can be used to treat post-stroke, post-traumatic adult patients and children with cerebral palsy.

There are various exoskeletons designed for the rehabilitation of neurological patients (see Klochkov A.S., Chernikova L.A. Robotic and mechanotherapeutic devices for restoring hand function after a stroke // Russian Medical Journal. 2014. No. 22. P. 1589). Existing robotic technologies allow for the most effective kinesitherapy of almost all isolated and complex hand movements, including targeted ones. The development of technologies and the expansion of the range of these devices make them more compact and affordable for individual use. Patients have the opportunity to continue the course of active complex rehabilitation at home after discharge from the hospital, which can significantly speed up the recovery of motor function of the hand.

Flexible cable rods, flat spring elements, arc guides with rollers, and complex lever compositions are used as functional elements of medical rehabilitation exoskeletons of the hand, which perform finger flexion and extension. Together with other design features, such functional elements can have various advantages and disadvantages.

A useful model of the hand exoskeleton thumb module is known (RU 186619 U1, Neurobotics LLC, 01/24/2019), which is an integral part of a device for medical rehabilitation - a motorized hand exoskeleton, which can be used to restore motor functions of the thumb in patients with neurological diseases, partial paralysis after a stroke. It provides a functional possibility for the implementation of rehabilitation measures for the development of the carpometacarpal joint of the thumb, associated with the restoration of the adduction-abduction function of the thumb, due to the constructive implementation of the exoskeleton thumb module, which ensures the mobility of the thumb support relative to the hand exoskeleton frame. The thumb module of the exoskeleton of the hand has a base equipped with an electric drive. The base is made with the possibility of pairing with the frame of the exoskeleton of the hand. The electric drive shaft is kinematically connected by means of a lever mechanism with the thumb support. The thumb support is provided with locking elements and is installed by means of an axis on the base of the module with the possibility of its reciprocating movement. The axis is collinear to the anatomical axis of rotation of the thumb.

The disadvantage of the design is that it is not possible to change the distance between the thumb support and its fixing element, as a result of which the product cannot be adjusted to work with patients of different age groups with different hand sizes.

Known exoskeleton glove with linear actuators (RU 2717046 C1, OSU named after I.S. Turgenev, 17.03.2020). The exoskeleton glove contains linear actuators according to the number of fingers on the hand, a control module that is a power source for the motors and controls the direction of their rotation, belts, rings and fingertips for attaching the glove to the limbs, and connecting elements for mechanical connection of the motors with rings and fingertips. The connecting elements are flexible rods made in the form of twisted threads, which are fixed at one end to the motor shafts placed on a large bracelet, passed through through holes in the small bracelet and through the lugs of the rings, ensuring a longitudinal arrangement of the threads along the forearm and rigidly attaching them with other ends to fingertips. The large and small bracelets are made with the possibility of their fastening on the forearm with the help of straps and are connected by a rigid hitch, the length of which corresponds to the individual size of the forearm. The result is an ergonomic, simple and safe design in use.

The disadvantage is that the rods of the device are made in the form of flexible twisted threads, which can create resistance to the movements of the fingers in only one direction - when they are bent. At the same time, procedural exercises that involve the creation of movement (or resistance to movement) in the opposite direction cannot be implemented on this device.

A simulator with biofeedback for the rehabilitation of the joints of the hands and fingers and the method of its operation are known (RU 2720323 C1, FGAOU VO KFU, 04/28/2020). The simulator with biofeedback consists of a control module made in the form of a hollow plastic case fixed on the patient's forearm, a motor module for flexion/extension of the hand, while it is equipped with a stepper motor for flexion/extension of the hand, a control module with a controller located in the module. a microcontroller, a stepper motor controller for flexion/extension of the hand, and a controller for controlling a servo drive. The control module of the simulator is fixed on the outer side of the forearm of the patient's diseased hand, the patient's fingers are inserted into the fingers of the glove and the fingers of the glove are fixed on the substrate for fixing the fingers of the glove, the patient's palm is fixed on the support-fixator of the hand, sensors are fixed on the patient's healthy hand on the middle and index fingers for measurements of the galvanic skin response of the patient.

The disadvantage is that the trajectory of movement intended for bending the fingers is not anatomical, due to which an unnatural upward bending of the hand will occur, which is impossible and unacceptable for some categories of patients.

A manipulation module of an exoskeleton, a gripper of a manipulation module of an exoskeleton, a finger of a gripper of a manipulation module of an exoskeleton are described (RU 2769584 C1, Serov, 04.04.2022). The manipulation module contains a gripping device, a swivel assembly and a receiving sleeve, which is connected to the gripping device through a swivel assembly and has a sleeve in the internal space, installed at a distance from the walls of the sleeve and on the inner surface of which an air cushion is located. In the inner space of the receiving sleeve there is also a control panel for the gripping device and the rotary assembly. The gripping device has three fingers, which consist of three phalanges and two hinged rods. The body of the gripper has three support pads for pins and rods to be articulated with the body. The use of a group of inventions makes it possible to exclude the possibility of the effect of the object being moved on the operator's hand.

The disadvantage is the impossibility of using products for rehabilitation procedures involving flexion and extension of the human fingers due to the lack of anatomy of the gripping device of the exoskeleton module.

A device for restoring movements in the upper limb is known (RU 181515 U1, Dudikov, 07/17/2018). The device for restoring movements in the upper limb contains an exoskeleton for the upper limb, consisting of a support for the forearm and a support for the hand, movably connected to each other by means of the shafts of the first and second stepper motors, and the first and second stepper motors, belts are fixed on the support for fixing the forearm for fixation and a control unit, straps for fixation are fixed on the support for the hand, the third and fourth stepper motors, on the shafts of which the frame is fixed, flexible clamps with textile fasteners and fasteners containing reed switches and LEDs on the end sides are attached to the frame, and the textile fasteners have magnets. The disadvantage of the device is the mismatch between the axes of the shafts of stepper motors and the axes of the interphalangeal joints, which makes flexion and extension of the fingers non-anatomical and unsuitable for rehabilitation medical procedures.

Known simulator with biofeedback for the rehabilitation of the joints and muscles of the hands and fingers (RU 2735986 C1, LLC "SERVICE-ROBOT", 11.11.2020). The simulator consists of a control module, a voltage boost converter module for powering stepper motors, a hand flexion/extension motor module, a hand flexion/extension motor module, sensors for monitoring the skin-galvanic reaction of the body, a glove for fixing the hand and a computer connected to the Internet. The control module is made in the form of a hollow plastic case fixed on the patient's forearm. The glove for fixing the hand contains a plastic finger lock with a T-shaped pin and a locking plate for fixing the fingers of the glove on the substrate, as well as a bending resistor sewn into the index finger of the glove with the possibility of using it as an absolute encoder for measuring the angle of bending of the fingers. The simulator also contains a soft fabric bracelet with two myosensors sewn into it, fixed on the forearm with Velcro. EFFECT: increased operational reliability and ease of use of the simulator.

The disadvantage is that the trajectory of movement intended for bending the fingers is not anatomical, due to which an unnatural upward bending of the hand will occur, which is impossible and unacceptable for some categories of patients.

There is a known method for the rehabilitation of patients after a stroke or injury using a robotic complex, including a human limb exoskeleton, controlled via a brain-computer interface through the imagination of movements (RU 2622206 C2, N.I. Pirogov Russian National Research Medical University, 13.06.2017). The patient is presented with a task on the kinesthetic imagination of the movement of the limb, the patterns of the patient's brain activity that occur during the imaginary movement are analyzed. Data is transmitted to a computer to isolate the signals responsible for the imagination of movement. The results of recognition of the task being performed are presented to the patient by visual feedback in the form of a mark on the screen. By changing the label, the correctness of the task is determined. At the same time, the results of recognition of the task being performed by the kinesthetic imagination of the movement of the paretic limb are additionally presented by tactile and proprioceptive feedback by means of an exoskeleton worn on the patient's paretic limb. With the correct recognition of the task being performed, the exoskeleton moves the limb in the direction of the imaginary movement, and with an incorrect result, in the opposite direction. The method allows to increase the effectiveness of treatment, which is achieved due to the additional involvement of tactile proprioceptive sensitivity in the restoration of motor functions. The exoskeleton of the hand used for rehabilitation procedures includes a pneumomuscle, a hinge, a rod, a lodgment, a phalanx lever and fasteners.

The disadvantage of the design is the non-coincidence of the hinge axis with the axes of the interphalangeal joints, which makes the flexion and extension of the fingers non-anatomical and unsuitable for rehabilitation medical procedures.

Known simulator for restoring the mobility of the fingers (RU 147759 U1, Kaplan, 11/20/2014). The utility model relates to medicine and is intended for the rehabilitation of patients with paralysis of the upper limbs. The utility model is aimed at providing the ability to move each finger of the hand according to the mental commands of the patient. This result is achieved by the fact that the simulator for restoring the mobility of the fingers, contains an exoskeleton of the hand, drives for moving the fingers of the exoskeleton with a control unit, while it is equipped with an individual drive for moving each of the fingers, equipped with a means of attracting the attention of the patient, and the input of the control unit for the drives of the fingers is connected with an electroencephalographic helmet worn on the patient's head, while the control unit contains a series-connected electroencephalogram recording unit, an electroencephalogram analysis unit and a unit for generating commands for finger drives.

The disadvantage is that the phalangeal elements of the exoskeleton are connected in series so that the axes of their movable joints do not coincide with the axes of the interphalangeal joints, which makes flexion and extension of the fingers non-anatomical and unsuitable for rehabilitation medical procedures.

An exoskeleton for passive hand rehabilitation is described (CN 114081793 (A), SHENZHEN NATIONAL RES INSTITUTE OF HIGH PERFORMANCE MEDICAL DEVICES CO LTD, February 25, 2022). The device for flexion and extension of four fingers contains a power device capable of independently controlled guide rail base, a connecting component of the middle finger connected to the base of the guide rail and capable of rotating around the first center of rotation relative to the base of the guide rail, and a connecting component of the middle finger connected with the possibility of rotation with the connecting element of the proximal finger of the component and is rotatable around the second center of rotation relative to the proximal finger of the connecting component.

The disadvantage is that it is not possible to change the distance between the axes of rotation of the exoskeleton elements to which the corresponding phalanges of the fingers are attached, which makes it impossible to use the exoskeleton for the rehabilitation of patients of different age groups.

Known exoskeleton for the rehabilitation of hands, aimed at providing training for both flexion and extensor muscle groups of the hand (RU 175854 U1, Pirogov Russian National Research Medical University, 21.12.2017 - prototype). The device includes a platform mounted on the forearm and fixed with a supporting element. A base lever is connected to the platform, mounted parallel to the hand and equipped with a servo drive. Two movable levers are interconnected by a rotational pair. In this case, the lever is equipped with a servo drive, is connected to the base lever by a rotational pair and rests on the proximal phalanges. The second movable lever is parallel to the middle phalanxes, connected to them through the supporting element, kinematically connected to the base lever through the connecting rod. The connecting rod is connected to the base lever and the second lever by rotational pairs with rotation axes parallel to the axis of rotation of the base lever.

The disadvantage is that the design does not provide for the possibility of adjusting the distance between two rotational pairs located near the interphalangeal joints, which makes it impossible to change the length of the movable lever and, accordingly, adjust the length of the structure to different lengths of the proximal phalanges of the hands of patients of different age groups. The supporting elements for the phalanges of the fingers do not have an anatomical shape.

The problem to be solved by this utility model is to provide anatomical movements of the exoskeleton during flexion and extension of the patient's fingers during rehabilitation procedures with the ability to adjust the size of the exoskeleton in accordance with the size of the patient's hand.

This problem is solved due to the features of the developed kinematic scheme of the exoskeleton design, which makes it possible to combine the rotation axes of the exoskeleton movable part with the rotation axes of the metacarpophalangeal and proximal interphalangeal joints of the patient's fingers, to change the distance between the axes of the exoskeleton movable part.

Patent-pending exoskeleton for rehabilitation of motor activity of the hand contains a body, a fixed palm fixator mounted on the body, and a drive connected to a mechanism for moving the distal phalangeal element with a fixator of the distal phalanges of the fingers.

The difference is as follows.

The mechanism for moving the distal phalangeal element is a set of movable levers that form a spatial structure in the form of two successively located proximal and distal pairs of the first and second parallelograms connected in series.

At the junction of the output ends of the levers of the second parallelogram of the proximal pair of parallelograms and the input ends of the first parallelogram of the distal pair of parallelograms, a proximal phalanx element is placed, in the body of which an arc slot is made for angular movement along it of the lever for regulating the distance between the axes of rotation of the specified spatial designs.

Flexion or extension of the exoskeleton in the axes of rotation, from the fixed metacarpal element to the proximal phalangeal element and further to the distal phalangeal element, is provided by four movable levers located at the level of the proximal phalangeal element between the levers of the proximal and distal pairs of parallelograms, while the position of the axes of rotation of the specified spatial structure is shifted in the plane of the structure beyond its limits and is selected from the condition of coincidence with the axes of rotation of the metacarpophalangeal and proximal interphalangeal joints of the hand.

The technical result consists in ensuring the anatomical movements of the exoskeleton during compression and opening of the patient's hand with the possibility of adjustment for different hand sizes. This allows the product to be used for the rehabilitation of patients of different age groups - both adults and children.

The essence of the utility model is illustrated in the drawings, where:

figure 1 - kinematic diagram of the movable part of the exoskeleton with a demonstration of the position of the axes of rotation of the movable elements of the exoskeleton relative to the interphalangeal joints of the finger;

fig. 2-4 - kinematic diagram of the movable part of the exoskeleton with a demonstration of bending;

Fig.5-7 - kinematic diagram of the movable part of the exoskeleton with a demonstration of the change in its length;

fig. 8 - a prototype of the exoskeleton of the hand with the described kinematic scheme of the moving part;

fig. 9 - adjustment of the length of the movable part of the exoskeleton. The arrow shows an arc slot that provides adjustment.

The design of the exoskeleton is shown in Fig. 1-7, where the positions in the drawings indicate the following elements: body 1, electromechanical actuator 2, fixed metacarpal element 11, corresponding to the metacarpal bone, movable phalangeal element 12, corresponding to the proximal phalanx of the finger, movable phalangeal element 13, corresponding to the distal phalanx of the finger, retainer 14 palms, latch 15 of the distal phalanges of the fingers, levers 21, 22, forming a semi-movable spatial structure, levers 23, 24, 31-34, forming movable spatial structures, intermediate levers 41-44, providing a spatial transmission of movement.

In the body of the movable phalangeal element 12, corresponding to the location of the proximal phalanx of the finger, an arcuate slot 51 is made, along which the adjustment lever 52 moves.

Schematically depicted are the axes 61 and 62 of rotation of the movable part of the exoskeleton, coinciding with the axes of rotation, respectively, of the metacarpophalangeal and proximal interphalangeal joints. Schematically shows the axis 70 of the metacarpal bone, axes 71-73 of the phalanges of the finger.

The movable part of the exoskeleton of the hand, corresponding to the described kinematic scheme, is a spatial mechanical structure that provides flexion and extension of the patient's fingers with the possibility of individual adjustment of the length of the structure.

All structural elements except body 1, electromechanical drive 2 and fixed metacarpal element 11 move relative to each other in the XZ plane during the operation of the exoskeleton. The levers 21-24 connecting the elements 11 and 12 form a semi-movable spatial structure in the form of two parallelograms connected in series.

The point indicating the axis 61, about which the rotation of the movable phalangeal element 12, is located at the intersection of straight lines passing through the axes of the movable connections of the elements 11, 21, 22 and elements 12, 23, 24. The levers 31-34 connecting the phalanx elements 12 and 13 , form a movable spatial structure in the form of two series-connected parallelograms with a variable initial shape.

Regarding the sign of semi-mobility of the spatial structure formed by the levers 21-24, it should be clarified that the levers can change their relative position in the process of flexion and extension, but the lower axes (shown by positions 211,221) of the levers 21 and 22 do not move, since they are fixed in a fixed metacarpal element 11. That is why the structure of 4 levers 21-24 changes its shape, but the entire structure does not move in the XZ plane, in contrast to the movable spatial structure formed by levers 31-34, which changes its shape, and completely shifts and tilts relative to fixed elements 1, 2 and 11.

The point denoting the axis 62, relative to which the distal phalangeal element 13 rotates in the coordinate system of the proximal phalangeal element 12, is located at the intersection of two straight lines passing through the axes of the movable joints of elements 52, 31, 32 and elements 13, 33, 34. Thus, the axes 61 and 62 are placed outside the design of the movable part of the exoskeleton in the XZ plane. They coincide with the axes of rotation of the metacarpophalangeal and proximal interphalangeal joints and at the same time are the axes of rotation of the movable part of the exoskeleton of the hand. This ensures the anatomical movements of the exoskeleton and the natural trajectory of the movement of the fingers during their flexion and extension during the rehabilitation procedure, which is shown by the positions of the schematically depicted axes 71-73 of the phalanges.

Through the use of intermediate movable levers 41-44, located between two pairs of spatial parallelograms, the movement is transmitted from the lever 22, which is the place of application of force from the electromechanical drive 2, mounted on the housing 1, to the phalangeal element 13. As a result, the element 13 moves as relatively movable phalangeal element 12, and relatively fixed metacarpal element 11, which also ensures the anatomical movement of the exoskeleton. Retainers 14 and 15 hold the palm and distal phalanges of the fingers, respectively, in a fixed position relative to elements 11 and 13.

The change in the length of the movable part of the exoskeleton in the direction of the X axis, and, accordingly, the distance between the axes 61 and 62, is carried out due to the angular movement of the control lever 52 in the direction of the arc slot 51, followed by fixing its position and the corresponding movements of the elements 32-34, 13, setting the initial shape of two movable parallelograms located between the phalangeal elements 12 and 13. The resulting movement of the axis 62 in the direction of the Z axis can be compensated by the shape and size of the replaceable clamps 14 and 15.

Implementation example. A sample of the exoskeleton (see Fig. 8, 9) is implemented in accordance with the formula of the utility model, tested on volunteers of different age groups with different hand sizes. As a result of the tests, due to the design features of the movable part of the exoskeleton and by adjusting the length of the movable part of the exoskeleton, it was possible to achieve alignment of the axes of the metacarpophalangeal and proximal interphalangeal joints with the axes of rotation of the movable part of the exoskeleton, taken out of the structure. The consequence of this is that the exoskeleton provides anatomical movement during flexion and extension of the fingers, which confirms the claimed technical result. Model procedures were carried out for up to 20 minutes, and during this period the subjects did not experience discomfort in the movements of the joints during the opening-compression of the hand and in tactile sensations.

Claims (1)

An exoskeleton for the rehabilitation of motor activity of the hand, comprising a body, a fixed metacarpal element with a palm lock and a drive connected to the mechanism for moving the movable distal phalangeal element with a lock for the distal phalanges of the fingers, characterized in that the mechanism for moving the movable distal phalangeal element is a combination movable levers forming a spatial structure in the form of two successively located proximal and distal pairs of series-connected first and second parallelograms, and at the junction of the output ends of the levers of the second parallelogram of the proximal pair of parallelograms and the input ends of the first parallelogram of the distal pair of parallelograms, a movable proximal phalangeal element is placed in the body in which an arc slot is made for angular movement along it, with subsequent fixation of the position, of the lever for regulating the distance between the axes of rotation of the specified spatial structure, which is part of the first parallelogram of the distal pair, and the flexion and extension of the exoskeleton in the axes of rotation, from the fixed metacarpal element to the proximal phalangeal element and further to the distal phalangeal element is provided with four movable levers located at the level of the proximal phalangeal element between the levers of the proximal and distal pairs of parallelograms, while the position of the axes of rotation of the specified spatial structure is shifted in the plane of the structure beyond its limits and is selected from the condition of coincidence with the axes of rotation of the metacarpal phalangeal and proximal interphalangeal joints of the hand; at the same time, the palm retainer and the retainer of the distal phalanges of the fingers are replaceable.

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