JP6657083B2 - Paralysis recovery training device - Google Patents

Description

The present invention also relates to training equipment for such as a finger or forearm to treat to train a patient paralyzed.

  In this book, "passive" refers to moving a part of the body by applying external force, and "automatic" refers to moving a part of the body without applying external force.

  Stroke patients have paralyzed sites in the body. The function of this paralyzed area can be restored by improving daily living activities (ADL) and quality of life (QOL). For example, finger flexion / extension training is first performed passively by the doctor's force, then a tapping stimulus is applied to the first joint of the finger, and voluntary automatic extension is performed by extension reflex. This tapping stimulus stimulates the stretching reflex, and effective training can be expected.

  The same is true for forearm training, in which a passive exercise is followed by an optional automatic exercise. Here, it is important to apply a rapid acceleration stimulus to the patient's finger or forearm before performing the voluntary automatic movement.

However, such occupational therapy for a single patient, such as a doctor or occupational therapist, required a great deal of time and effort, and it was difficult to provide sufficient quality and quantity training. .
For the purpose of relieving the burden on humans, training devices have been conventionally proposed (for example, see Patent Document 1).

Patent Document 1 will be described with reference to the following figure.
As shown in FIG. 18, a conventional training apparatus 100 includes a base 101, a motor 102 provided at one end on the base 101, a cylinder 103 supported by the motor 102, which rotates forward and backward, A gripper (stick) 104 that stands on the cylindrical body 103, a first band 105 provided at an entrance of the cylindrical body 103, a vertical frame 106 provided at the other end on the base 101, and a first frame 105 extending from the vertical frame 106. It comprises a front receiving portion 109 and a rear receiving portion 111 for supporting the forearm portion 107 and the upper arm portion 108, respectively, a second band 112 and a third band 113 provided respectively, and a control mechanism 120.

  The wrist 114 is firmly fixed by the first hand 105, the forearm 107 is firmly fixed by the second band 112, and the upper arm 108 is firmly fixed by the third band 113.

The control mechanism 120 includes a power switch 121, a speed control knob 122 for the motor 102, an on / off switch 123 for the motor 102, a counter display unit 124 for measuring and displaying the rotation speed of the cylinder 103, and a forward / reverse rotation speed of the cylinder 103. , A control knob 125 for controlling the torque of the motor 102, and a buzzer 126 for notifying the end.
Then, the forward rotation and the reverse rotation are repeated in such a manner that the cylindrical body 103 is rotated by a predetermined angle by the motor 102 and then rotated in the opposite direction by a predetermined angle.

Such a conventional training device 100 has the following problems.
In this type of training, it is important to stimulate and enhance the remaining functions in the body. In the training device 100 according to Patent Literature 1, the cylinder 103 is rotated forward and backward by the driving force of the motor 102. Apparently, the training progresses even when the patient loses his / her forearm (weakened state). However, the effect of training cannot be obtained in a state of weakness.

It is important to focus on the patient to avoid weakness, but the training device 100 does not have such a function.
However, in the sought improvement of training effect, it is required training equipment which attained more reliably functional recovery while prompting the focus on the patient.

JP-A-4-261657

The present invention aims to provide training equipment which attained more reliably functional recovery while prompting the concentration to the patient.

The present inventors, to solve the above problems, and found that training equipment capable of performing accelerated repeat therapy is effective.
In the accelerated repetitive therapy, a therapist (such as a doctor or a physician) operates a paralyzed finger or limb of a patient to transmit a stimulus to a necessary neural circuit in a pinpoint manner, thereby inducing a target action. It is a new rehabilitation method that reconstructs and strengthens necessary neural circuits and promotes recovery from paralysis by repeating this operation patiently.
The term “promotion” refers to a technique of stimulating a part to be moved and assisting exercise so that the patient can easily perform an intended operation.

  It is difficult for a hemiplegic patient to move a paralyzed limb by his own will (command from the brain). However, by giving a stimulus to the paralyzed limb, a stretch reflex occurs, and the nerve cells are excited, and the paralyzed limb can be moved by a command from the brain. Therefore, in order to transmit stimulation to the neural circuit involved in the target movement, the target muscle is stretched quickly, causing a stretch reflex immediately after the muscle tone increases, and the target is ordered by contracting that muscle Induce the action.

  In general, hemiplegic patients have a paralyzed side and a non-paralyzed side. First, training is performed by a training device on the non-paralyzed side where various senses are good and voluntary automatic movement can be performed normally. Then, the patient is made to understand and grasp the “knack” of the training by the training device. Next, training is performed on the paralyzed side by a training device. That is, using the “knack” grasped on the non-paralyzed side, training is also performed on the paralyzed side by the training device.

  In principle, the left brain controls the right side and the right brain controls the left side, but there are "common parts" in the brain related to motor functions on both the left and right sides. When the training on the non-paralyzed side by the training device is used to grasp the movement coordination with the training device and exercise tips during the training, the effect and efficiency of the training by the training device on the paralyzed side are improved.

A stretch reflex must be triggered by a pinpoint stimulus to elicit the target movement of the forearm. In the training device according to Patent Literature 1, a pinpoint stretch reflex cannot be easily caused.
On the other hand, in the present invention, it is effective to provide a patient with a stimulating mechanism for increasing the concentration power in order to induce a stretch reflex and cause voluntary automatic movement.

According to the invention according to claim 1, by applying a force from the outside to the paralyzed part of the patient to passively move the patient, and by applying a resistance force to the paralyzed part of the patient Athletic means capable of both performing voluntary automatic movement, which allows the patient to exercise his or her own intention to exercise the paralyzed part, and applying a stimulus to convey the timing of applying force to the patient Stimulus presenting means, wherein the movement means rotates in a first rotational direction at a first angular velocity, and then rotates in the first rotational direction at a second angular velocity greater than the first angular velocity, with said first rotational direction to rotate in a second rotational direction opposite, providing paralysis rehabilitation apparatus that stimulation to the patient beginning at realm of the first angular velocity by the stimulus presentation means Is done.

In the invention according to claim 2 , preferably, the stimulus given to the patient is such that at least one of a visual stimulus, an auditory stimulus, and a tactile stimulus is given to the patient.

In the invention according to claim 3 , preferably, the visual stimulus is light emission.

In the invention according to claim 4 , preferably, the auditory stimulus is sound.

In the invention according to claim 5 , preferably, the tactile stimulation is mechanical vibration.

In the invention according to claim 6 , preferably, the exercise means is a stick operated by the patient, and the stick is rotatably held about an axis orthogonal to the longitudinal axis. When a passive movement is performed by applying force to the paralyzed part and the patient rotates in a second direction opposite to the first direction, voluntary automatic movement is performed by applying a resistance to the paralyzed part of the patient. It is configured to be performed.

In the invention according to claim 7 , it is preferable that the application of the stimulus to the patient regarding one of vision and hearing is completed before the stick rotates in the second direction.

In the invention according to claim 8 , it is preferable that the application of the stimulus to the patient regarding one of the visual sense and the auditory sense is finished at the same time when the stick finishes rotating in the first direction.

According to the ninth aspect of the present invention, preferably, the application of the stimulus relating to the tactile sensation to the patient is completed during the rotation of the stick in the second direction.

According to the first aspect of the present invention, a stimulus presentation unit for applying a stimulus to a hemiplegic patient is provided during training for recovering the function of the hemiplegic patient, so that the patient can easily know the timing of performing voluntary automatic exercise. There is an effect that can be.
In addition, the invention according to claim 1, since the stimulation to the patient by the stimulation presenting unit has to be initiated by the realm of the first angular velocity, the patient can be recognized with a timing to shift to optional automatic movement allowance effective.

According to the second aspect of the present invention, the stimulus presenting means provides the patient with one or a combination of a visual stimulus, an auditory stimulus, and a tactile stimulus. There is an effect that the stimulating means can be appropriately selected according to the condition.

According to the third aspect of the present invention, since the visual stimulus is based on light emission, there is an effect that the stimulus to the patient can be clearly and easily performed.

According to the fourth aspect of the present invention, since the auditory stimulus is based on voice, the patient can understand the meaning of the stimulus, and there is an effect that the patient can smoothly shift to voluntary automatic exercise.

In the invention according to claim 5 , since the tactile stimulus is caused by vibration, there is an effect that the burden of training on the patient can be reduced.

According to a sixth aspect of the present invention, the exercise means is a stick operated by the patient, and the stick is rotatably held about an axis perpendicular to the longitudinal axis. When the stick rotates in the first direction, the patient is paralyzed. When a force is applied to the part to perform a passive movement, and when rotating in a second direction opposite to the first direction, an optional automatic movement is performed by applying a resistance force to a paralyzed part of the patient. With such a configuration, there is an effect that the structure of the training apparatus is simple and the burden on the patient can be reduced.

The invention according to claim 7 is characterized in that the application of the stimulus relating to one of vision and hearing to the patient is finished before the stick rotates in the second direction, so that the timing at which the patient shifts to voluntary automatic movement Has the effect of being able to reliably recognize.

According to the invention of claim 8 , since the application of the stimulus to the patient regarding either the visual sense or the auditory sense ends at the same time as the end of the rotation of the stick in the first direction, the patient shifts to voluntary automatic movement. There is an effect that the timing of performing can be recognized more reliably.

According to the ninth aspect of the present invention, the tactile stimulus to the patient is terminated during the rotation of the stick in the second direction. There is an effect that the timing to shift to the automatic exercise can be recognized.

It is a side view of the paralysis function recovery training apparatus which concerns on this invention. It is a perspective view of the paralysis function recovery training apparatus which concerns on this invention. It is a perspective view of a half cylinder. FIG. 2 is a sectional view taken along line 4 of FIG. 1. FIG. 5 is a sectional view taken along line 5 of FIG. 1. It is a disassembled perspective view of the principal part of the paralysis function recovery training device. FIG. 7 is a sectional view taken along line 7-7 of FIG. 6. It is a front view of a wrist support part. It is an operation view of a wrist support part. It is an effect | action figure of the paralysis function recovery training apparatus. It is an action figure of a half cylinder. It is a figure explaining a passive exercise. It is a front view of a torque detection mechanism. FIG. 3 is a diagram illustrating the principle of a torque detection mechanism. It is a figure explaining an operation of a luminescence stimulation mechanism and an auditory stimulation mechanism. It is a figure explaining the principle of a vibration stimulation mechanism. It is a figure explaining an operation of a vibration stimulation mechanism. It is a block diagram of the conventional training device.

  Hereinafter, preferred embodiments of the present invention will be described with reference to the accompanying drawings.

  As shown in FIG. 1, the paralysis function recovery training device 10 includes a moving table 12 provided with casters (free wheels) 11, a forearm mounting table 13 provided at one end on the moving table 12, and A device base 14 provided, a half-cylinder body 15 supported on the device base 14 so as to be rotatable around a horizontal axis and having an open upper surface, and a stick as a movement means provided in the half-cylinder body 15 16, a wrist support portion 17 provided in the half-cylinder body 15, a drive shaft 18 having one end connected to the half-cylinder body 15 and extending along the horizontal axis, and rotating the drive shaft 18 provided on the device base 14. Bearing bases 19, 19 freely supported, a servomotor 21 provided on the device base 14 for driving the drive shaft 18, an encoder 23 provided on the servomotor 21 for measuring the rotation angle of the motor shaft 22, The rotation angle information is obtained from the encoder 23, and the half cylinder 15 is repeatedly rotated in one direction in the left and right direction, stopped, reversely rotated, and stopped. A first angular velocity and a second angular velocity higher than the first angular velocity are used to control muscle stimulation to generate reflexes and excite nerve cells, and inversion reverses muscle stimulation to maintain muscle tone. For this purpose, the control unit 24 includes a control unit 24 that performs a series of controls for applying a resistance force, and a torque conversion unit 25 that calculates a torque applied to the stick 16 and sends the calculated torque to the control unit 24.

Note that a part of the casters 11 may be ordinary wheels (non-uniform wheels). Further, the casters 11 may be omitted. In this case, the moving table 12 is a simple table.
In the case of a table, an appropriate table or desk can be used in place of the table. Therefore, whether or not the movable table 12 is arranged below the apparatus base 14 is optional.
However, since the servomotor 21 and the encoder 23 are heavy, it is recommended to integrate the apparatus base 14 and the movable base 12 as in the present embodiment in order to reduce the burden on humans.

  In addition, the half-barrel cylinder 15 only needs to have a part of the cylinder cut out, and the notch ratio is not limited to 50%. Further, the half cylinder 15 is basically a half cylinder, but may be a polygon cylinder.

  A torque detection mechanism 60 is provided between the half cylinder 15 and the drive shaft 18. The configuration and operation of the torque detection mechanism 60 will be described later.

  As shown in FIG. 2, the moving table 12 includes a main table section 27 supported by four columns 26, a sub-table section 29 extending from the main table section 27 and having a tip supported by a single column 28. Consists of The sub-table portion 29 is elongated, and has spaces 31 and 32 on the left and right sides thereof, so that a patient can enter at least one of the spaces 31 and 32. It is preferable to reduce the weight of the movable base 12 by using a lightweight section steel including the columns 26 and 28, specifically, an aluminum sash.

Light emitting elements 71, 71 as a visual stimulus mechanism, which is one form of stimulus presenting means, are provided on the top of the stick 16. The blinking of these light emitting elements 71 is controlled by the control unit 24. The control unit 25 is provided with a speaker 72 as an auditory stimulus mechanism, which is one form of stimulus presenting means, on the front (the surface closest to the patient).
For the other components, the reference numerals in FIG. 1 are used, and the description is omitted.

As shown in FIG. 3, the half cylinder 15 has an open upper surface.
As shown in FIG. 4, the half cylinder 15 is supported by a first cam follower 31 and a second cam follower 32 so as to be rotatable around a horizontal axis.
Further, as shown in FIG. 5, the half cylinder 15 is supported by a third cam follower 33, a fourth cam follower 34, and a fifth cam follower 35 so as to be rotatable about a horizontal axis.

  The fourth cam follower 34 at the center can be removed. The cam followers 31 to 35 are an assembly comprising a support shaft, a needle bearing attached to the shaft, and a roller surrounding the needle bearing. Optional.

  As shown in FIG. 6, the drive shaft 18 is connected to the motor shaft 22 of the servomotor 21 via a coupling 36. A band-shaped rod-shaped member 38 extending upward is fixed to the distal end of the drive shaft 18, and a square shaft 39 is formed on the distal end side of the rod-shaped member 38, and a male screw is formed on the distal end side of the square shaft 39. A part 41 is formed.

  A disk 42 is fixed to one end of the half cylinder 15, and a square hole 43 is provided in the disk 42. The square shaft portion 39 is fitted into the square hole 43. Thereafter, as shown in FIG. 3, the nut 44 is attached to the male screw portion 41. As described above, the drive shaft 18 is connected to the half cylinder 15, and the half cylinder 15 is positioned in the axial direction. In other words, there is no concern that the half cylinder 15 moves in the axial direction during rotation.

  As shown in FIG. 6, the drive shaft 18 is rotatably supported by a pair of bearing stands 19,19. A key 45 is fixed to the drive shaft 18 between these bearing stands 19. A stopper block 46 is fixed to the device base 14 between the bearing pedestals 19.

  As shown in FIG. 7, the stopper block 46 has stop surfaces 47 and 48 on the upper surface, and the stop surfaces 47 and 48 are arranged below the drive shaft 18. In the neutral state, the key 45 is on the drive shaft 18. The drive shaft 18 is turned 90 ° to the left and right from the neutral position, up to 180 °. That is, the key 45 moves to the position indicated by the imaginary line. Even the key 45 indicated by the imaginary line has a gap α of about 1.5 mm from the stop surface 47. Therefore, the key 45 does not normally hit the stop surface 47. The same applies to the stop surface 48.

  When the rotation amount of the drive shaft 18 changes due to a control system trouble or the like, the key 45 hits one of the stop surface 47 and the stopper surface 48, and the drive shaft 18 does not rotate any more. As a result, there is no need to worry that the half cylinder (FIG. 3, reference numeral 15) rotates beyond a predetermined angle. That is, in the present invention, the rotation amount is controlled by the encoder, but a mechanical stopper is provided in preparation for a failure of the encoder and the like, and safety is enhanced.

  As shown in FIG. 8, the wrist support portion 17 includes a U-shaped bracket 49 that opens upward, and left and right sides that sandwich the wrist and are supported by screws 51 and 52 on walls 51 and 51 of the bracket 49. It comprises bending members 53 and 54. The screw 52 can be turned with the finger bar 55.

  As shown in FIG. 9, training is performed in a state where the wrist 56 is sandwiched between the left and right bending members 53 and 54 via the cushions 57 and 57, but the bracket 49 and the left and right bending members 53 and 54 are , The upper part is open, so that the wrist 56 can be pulled upward as shown by a white arrow if the patient desires. That is, the feeling of oppression and restraint is reduced by the amount of the feeling of opening, and more preferable training can be performed.

As shown in FIG. 10, the patient needs to train, for example, on his left hand, and places the wrist 56 on the wrist support 17 and the forearm 58 on the forearm platform 13.
Turning the left wrist 56 toward the center of the body as shown by the arrow (1) is referred to as “pronation” and turning outward as shown by the arrow (2) is referred to as “supination”. Call.

The movement of turning the arrow (1) or the arrow (2) by one's own will be called "voluntary automatic movement". In order to cause this voluntary automatic movement to be greater, the movement of applying an external force and rotating the other side is described. Called "passive exercise."
For example, performing "passive motion" in the direction of arrow (1) can cause "optional automatic motion" in the direction of arrow (2).

In FIG. 11A, the wrist is not shown because the drawing becomes complicated, but the training is started from this neutral state.
As shown in FIG. 11B, a passive movement is performed by the servomotor 21.
Specifically, as shown in FIG. 12, first, a passive movement is performed at a first angular velocity, a sudden acceleration is performed, and a passive movement is performed at a second angular velocity. For example, the first angular velocity is 2.5 radians / second and the second angular velocity is 11.0 radians / second. That is, the second angular velocity is set to be about 2 to 5 times the first angular velocity.

  The rapid acceleration is set to the maximum acceleration that the servo motor 21 can output. For example, the transition is made from the first angular velocity to the second angular velocity in 0.01 seconds. At this time, the angular acceleration is (11.0−2.5) /0.01=about 1000 radians / second 2.

That is, after a certain rotation at the first angular velocity, the muscle is rapidly rotated at the sudden acceleration and the second angular velocity to increase the muscle tension for function recovery. Then, the stretching reflex is excited by the muscle tone.
Due to this stretch reflex, contraction of the muscle is promoted, and as shown in FIG. 11 (c), voluntary automatic exercise is performed at the will of the patient. However, a slight resistance is generated in order to maintain the muscle tone by continuing the muscle stimulation by the servo motor 21.

  In order to generate a light resistance by the servomotor 21, the patient needs to know the torque generated during automatic rotation. That is, if the torque is large, the resistance (resistance torque) is increased, and if the torque is small, the resistance is reduced, so that the patient is not burdened.

The present invention includes a torque detection mechanism for that purpose.
The shaft torque can be detected by attaching a strain gauge to the drive shaft 18. However, when the outer diameter of the drive shaft 18 is small, the amount of torsion of the shaft (see FIG. 14, reference sign θa) is small, so that measurement is difficult and a measurement error increases.
In the present invention, as described below, a torque detection mechanism having good measurement accuracy is employed.

  As shown in FIG. 13, the torque detecting mechanism 60 includes a pin 61 erected on the outer peripheral portion of the disk 42 so as to extend to the drawing table, and a rod-shaped member having one end fitted to the pin 61 and extending to the rotation center of the disk 42. 38, a constricted portion 62 provided in the middle of the rod-shaped member 38, a strain cage 63 stuck to the constricted portion 62, and a torque conversion unit 25 for converting strain information obtained by the strain cage 63 into torque. Become.

  One end of the rod-shaped member 38 is fitted to the pin 61 via a long hole 64 extending in the longitudinal direction of the rod-shaped member 38, thereby allowing the rod-shaped member 38 to move with respect to the pin 61. The other end of the rod-shaped member 38 is sandwiched between the flanges 65 and 66 by another square shaft portion 67 of the drive shaft 18.

  The rod-shaped member 38 may be a round bar or a square bar other than the band plate, and the shape is arbitrary. However, in the case of a band plate, since the width of both ends is large, one end can be easily attached to the disk 42 and the other end can be easily attached to the drive shaft 18 by utilizing this width.

The operation of the torque detecting mechanism 60 having such a configuration will be described below.
As shown in FIG. 14 (a), a torque Tm is applied to the disc 42 via the stick 16 by an optional automatic movement. This torque Tm is transmitted directly to the drive shaft 18 and also indirectly to the drive shaft 18 via the rod-shaped member 38. If the directly transmitted torque is Ta and the indirectly transmitted torque is Ts, then Tm = Ta + Ts. The strain cage 63 is provided only on the bar-shaped member 38.

As shown in FIG. 14 (b), the rod-shaped member 38 is bent in a U-shape with the constricted portion 62 as a bending point by the torque Ts. The bending increases as the torque Ts increases. With this regularity, the torque Ts can be calculated structurally.
Here, the length from the bending point to the drive shaft 18 is L1, the length from the bending point to the pin 61 is L2, the length of the constricted portion 62 is Lx, and the width of the constricted portion 62 is b. Although not shown in the figure, the thickness of the constricted portion 62 (the front and back dimensions in the drawing) is h. Further, the longitudinal elastic coefficient (Young's modulus) of the constricted portion 62 is E.

As shown in FIG. 14C, when the torque Ta acts on the drive shaft 18, the drive shaft 18 is slightly twisted. The angle θa in the figure increases as the torque Ta increases. With this regularity, the torque Ta can also be calculated structurally.
Here, the length of the drive shaft 18 is LL, and the diameter is R. Also, let G be the transverse elastic coefficient of the drive shaft 18.

  Although detailed description is omitted, the torque Ta is a function of Ts as shown below.

Since the torque Ts can be obtained by the strain gauge 63, the torque conversion unit 25 obtains the torque Tm based on the strain information obtained by the strain gauge 63. The resistance torque is generated by the servo motor 21 in accordance with the torque Tm. Details of this resistance torque will be described later.
Applying a moderate amount of resistance during the voluntary exercise allows the patient's forearm to sustain stimulation, maintain muscle tone, and rotate more.

  In FIG. 14B, as the width b of the constricted portion 64 is smaller, the rod-shaped member 38 is largely bent, and a larger distortion is generated in the constricted portion 64. Since the strain gauge 63 is attached to the constricted portion 64, the torque Tm can be determined with high accuracy. That is, the torque can be detected with much higher accuracy than when a strain gauge is directly attached to the drive shaft 18 shown in FIG.

Next, how to determine the resistance torque will be described.
When the current angle of the servomotor is θ, the virtual inertia is I, the virtual viscosity is C, and the virtual elasticity is K, the impedance equation for the sensed torque Tm is as follows.

At constant speed, the value of C is adjusted to determine the magnitude of the resistance force. During acceleration / deceleration, the resistance torque can be determined by adjusting K1 and K2. In particular, when the time delay is reduced, the value of I may be set so as to approach K2 = 0 after C is determined.
As described above, the resistance torque Tn is set to an appropriate value.

Next, the operation of the visual stimulating mechanism and the auditory stimulating mechanism will be described.
What is important in the exercise timing stimulus is to inform the patient (a hemiplegic patient) of the timing of voluntary automatic driving and to cause the voluntary automatic movement. If this cannot be achieved, it will not be an effective stimulus. Therefore, in order to cause an effective voluntary automatic movement, it is necessary to examine the start / stop timing of the visual stimulating mechanism and the auditory stimulating mechanism. The following items need to be considered for the start / stop timing of the visual stimulus mechanism and the auditory stimulus mechanism.
-In order to perform more effective training, it is necessary to perform voluntary automatic exercise at the same time as the stretch reflex is performed.
-It takes time for the two stimulating mechanisms to start operating, for the patient to sense changes from visual and auditory senses, and to exercise by voluntary commands from the brain.
・ Improve the patient's concentration.

  Thereby, when performing a voluntary automatic movement or passive second angular velocity movement, when the stimulation is started, it takes time for the patient to sense the stimulation from the stimulation mechanism and optionally activate the muscle, The patient's stretch reflex ends, and the rotational effect cannot be synchronized with the rhythm and the training effect is reduced. Thus, it is too late to start the stimulation from an optional automatic movement or a passive second angular velocity movement.

Based on this knowledge, the start timing of the stimulus is set to be in the middle of the passive first angular velocity. By starting stimulation in the middle of the first angular velocity, the stretch reflex is performed, and at the same time, the voluntary automatic movement can be performed by a voluntary command from the brain.
In addition, the end timing of the stimulus is until the end of the passive second angular velocity. The stimulation mechanism is required to improve and maintain the patient's concentration. By shortening the stimulation time, the concentration of the patient can be improved and maintained. From the above findings, the control shown in FIG. 15 is provided.

In FIG. 15, the vertical axis is the rotation angle, and the dimension is different from the angular velocity shown in FIG.
The passive movement is performed at the first angular velocity and the second angular velocity. Since the first angular velocity is low, the gradient is represented by a straight line with a small gradient. Since the first angular velocity is high, the gradient is represented by a straight line with a large gradient, and the boundary has a sharp acceleration.

  In the present invention, light emission (or sound generation) is started in the middle of the first angular velocity range, preferably at the end point Ps. That is, at the end of the normal rotation, the light emitting elements 71, 71 shown in FIG. 2 start emitting light, and the speaker 72 emits a sound. Since the stick 16 is gripped, the patient immediately sees the light emission. Further, since the speaker 72 is placed near the patient, the patient immediately hears the sound. The patient then concentrates his mind. As a result, the stretch reflex is sufficiently enhanced. Light emission (or sound generation) ends at the second angular velocity end time point Pf. The light emission (or sound generation) time is very short, for example, about 0.2 seconds.

  In addition, in FIG. 15, it was examined to apply a stimulus in the second angular velocity region or at the start of voluntary automatic movement (at the start of reversal), but there was a time delay, and the extension reflex did not sufficiently increase. Thus, as in the present invention, when the stimulation is started in the first angular velocity region, preferably in the last stage of the first angular velocity region, the time delay is eliminated, and the stretch reflex is sufficiently increased.

The above description can be summarized as follows.
In FIG. 11, an arrow (1) in FIG. 11B indicates a passive movement, and an arrow (2) in FIG. 11C indicates an automatic movement, that is, an optional automatic movement. The patient can perform passive exercise and optional automatic exercise with the same exercise means (stick 16). The stick 16 is provided with a light emitting element 71 as a stimulus presenting means, and is notified of the timing of applying force.

  That is, the apparatus shown in FIG. 11 includes a servomotor 21 as a passive movement means for applying a force from the outside to the paralyzed part of the patient to passively move the paralyzed part, and a resistance force to the paralyzed part of the patient. Servo motor 21 as an optional automatic movement means that can exercise the paralyzed part by the patient's own intention by adding force and stimulus to tell the patient when to apply force And a light emitting element 41 as stimulus presenting means.

Next, a description will be given of a vibration stimulating mechanism which is an embodiment of the stimulus presenting means.
What is important in vibration stimulation is whether it induces and amplifies stretch reflexes in the patient's training target muscle, causing its voluntary automatic movement. However, if a vibrational stimulus is applied at the start of the passive exercise, the training target muscle will perform an unexpected contraction early and antagonize the passive direction, so that sufficient passive exercise and the resulting extension reflex will not be possible. Also, if a vibration stimulus is applied at the start of the automatic exercise, the effect of the vibration stimulus decreases because the stretching reflex has already been induced by the facilitating stimulus.

If amplification and induction of stretch reflex cannot be realized, it will not be an effective stimulus. Therefore, it is necessary to start and end the vibration stimulus at a timing at which an effective stretching reflex is induced. The following items need to be considered for the start / end timing of the vibration stimulus.
-When the stimulation is started at the passive second angular velocity by the vibration stimulating mechanism, it takes time for the patient to sense the vibration and prompt the extension reflex.
-After the induction of the stretching reflex, the voluntary automatic movement can be sustained by increasing the voluntary automatic movement sensitivity.

That is, if the vibration stimulus is started at the passive second angular velocity, it takes time until the body senses the vibration and stretches and reflects the muscle, and the training effect is reduced. Therefore, it has been found that starting the vibration stimulation at the second passive angular velocity is too slow.
Based on this finding, it was decided to start the vibration stimulation in the middle of the first angular velocity region of the passive movement. A specific example will be described with reference to FIGS.

As shown in FIG. 16, the vibration stimulating mechanism includes wiring 73 extending from the control unit 24, and vibration pads 74 and 75 provided at the end of the wiring 73 and having vibrators.
Vibration pads 74 and 75 are attached to the inside and outside of the forearm 58, respectively. One vibrating pad 74 stimulates the pronation muscle, and the other vibration pad 75 stimulates the supination muscle.

  The type of the vibrator is not limited as long as it is a part that converts electric energy such as a vibration motor that converts rotational motion into vibration, piezoelectric ceramic that is distorted by electric energy, or mechanical energy of compressed air into vibration.

As shown in FIG. 17, the vibration starts in the middle of the first angular velocity, in this example, before the middle. The vibration continues during the rapid acceleration, the second angular velocity, and the time lag, and ends during the reverse rotation.
Unlike light and sound, vibration has the effect of promoting stretching reflection. Moreover, vibration has a milder effect on the patient than light or sound. That is, by giving a vibration stimulus halfway through reversal, the extension reflex can be promoted without increasing the burden on the patient. The vibration duration during one cycle is, for example, about 0.8 seconds.

The light-emitting element 71 as the visual stimulus mechanism may be turned on continuously during the stimulation time, or may be turned on and off repeatedly in a short time.
Further, the light emitting element may be a light emitting body composed of an arrow mac or a character indicating the direction of movement. In the case of such a luminous body, since the patient can understand the meaning of the stimulus, it is possible to shift to the voluntary automatic movement more smoothly.

The speaker 72 as the auditory stimulation mechanism may be a buzzer or a bell. However, considering that a sound that is gentle to the ear is generated, a speaker that emits a synthesized sound is preferable.
The pronunciation may be a recording of a human voice or a voice synthesized by imitating a human voice. In the case of such a sound, the patient can understand the meaning of the stimulus, so that the operation can be smoothly shifted to the voluntary automatic movement.

  In the above-described embodiment, the hemiplegic forearm function recovery training for hemiplegic patients has been described. However, the present invention is not limited to hemiplegic patients and can be applied to ataxia patients. In the above embodiment, the paralysis function recovery training device of the type in which the hemiplegic patient holds the rotating stick has been described. However, other types, for example, a paralysis function having a structure of reciprocating a part of the patient's body. It can also be applied to recovery training devices.

  INDUSTRIAL APPLICABILITY The present invention is suitable for training for forearm training of a patient whose left or right body is paralyzed to promote recovery.

  10: Paralysis function recovery training device, 16: Stick as an exercise means, 21: Servo motor serving both as a passive exercise means and optional automatic exercise means, 71 ... Light emitting element as a visual stimulus mechanism which is one form of stimulus presentation means , 72... A speaker as an auditory stimulus mechanism as one form of the stimulus presenting means; 74, 75... A vibration pad as a vibration stimulating mechanism as one form of the stimulus presenting means.

Claims (9)

Passive exercise in which the patient is paralyzed by applying force from the outside to the paralyzed part, and by applying resistance to the paralyzed part of the patient, the patient exerts his or her own power by applying resistance. An exercise means capable of performing both an optional automatic exercise capable of exercising the paralyzed part; and a stimulus presentation means for applying a stimulus for conveying a timing of applying force to a patient, The means rotates at a first angular velocity in a first rotational direction, and then rotates at a second angular velocity greater than the first angular velocity in the first rotational direction, and then reverses the first rotational direction. as well as rotate in a second rotational direction, the stimulus presentation means paralysis rehabilitation device irritation to patients so as to start with realm of the first angular velocity by.
  The paralysis function recovery training apparatus according to claim 1, wherein the stimulus presentation unit applies at least one of a visual stimulus, an auditory stimulus, and a tactile stimulus to the patient. The training apparatus for paralyzed function recovery according to claim 2 , wherein the visual stimulus is caused by light emission. The paralysis function recovery training device according to claim 2 , wherein the auditory stimulus is a sound. The paralysis function recovery training device according to claim 2 , wherein the tactile stimulus is generated by mechanical vibration.   The movement means is a stick operated by the patient, and the stick is rotatably held around an axis perpendicular to the longitudinal axis, and when rotating in the first direction, applies a force to a paralyzed portion of the patient. When performing a passive movement and rotating in a second direction opposite to the first direction, the patient is configured to perform a voluntary automatic movement by applying a resistance to a paralyzed portion of the patient. The paralysis function recovery training device according to claim 1. The paralysis function recovery training device according to claim 6 , wherein the application of the stimulus regarding one of visual and auditory stimuli to the patient is completed before the stick is rotated in the second direction. The paralysis function recovery training apparatus according to claim 6 , wherein the application of the stimulus regarding one of visual and auditory senses to the patient ends at the same time as the end of the rotation of the stick in the first direction. The paralysis function recovery training device according to claim 6 , wherein the application of the stimulus regarding the tactile sensation to the patient is completed during the rotation of the stick in the second direction.

Images