EP3263086B1 - Hand orthosis, module member and means for attaching a hand orthosis - Google Patents

Description

The invention relates to a hand orthosis for bending and / or stretching at least one finger of a patient's hand, with a force introduction means which can be coupled to at least one finger segment assigned to a finger of the patient's hand. Further disclosed is a module member for a finger segment of a hand orthosis and a fastening means for a hand orthosis.

Orthoses are already known from the prior art and are used in particular - usually as passive splints - in patients in whom, for example, after a stroke neurological deficits appear, which is associated with a spasticity of the fingers or the hand. The orthoses can counteract the spasticity. Dynamic rails are also known from the state of the art, by which - for example, after injuries of the flexor tendons of the hand - movement deficits and possibly a renewed tearing of these tendons to be prevented in the healing phase by the affected finger, for example, by an elastic band in a bent Attitude is fixed. The patient can then do the Move finger against the restoring force of the band. In the treatment of stroke patients are also stationary hand-held robot used, for example, from the US 8,574,178 B2 are known.

The US 5,178,137 discloses a hand orthosis according to the preamble of claim 1. The document shows an orthosis, the finger segments of which are formed of outer and inner module members, which can be pivoted against each other. By a spindle drive can thereby bend the finger segment and stretch.

From the WO 2016/088071 For example, an orthosis is known whose finger segments are made up of individual module links coupled together by a chain. By connecting the module members to the chain, it is possible to adjust the axial distance of individual module members relative to each other.

The DE 201 13 431 U1 shows a glove with stiffening strips which are mounted on the glove, for example, to provide increased stability in a goalkeeper glove. An active adjustment of the module members does not take place here.

In the hand orthoses known from the prior art, however, it has proved to be disadvantageous that an adaptation of the orthoses to the anatomy of the respective patient is often only inadequate and possible with a very great effort. In addition, due to the usually very voluminous and massive design of the finger segments of a patient, the hand robots known from the prior art can not be used over a longer period of time since they must be used with a support because of the associated weight. In addition, these handheld robots are very costly and can therefore only in large Therapy centers, however, are not used in the household of the affected patient.

In addition, the known hand orthoses, which are commonly used to treat stroke patients having only limited control of the affected hand or insufficient muscle activity to deploy the affected hand, are unable to provide the patient with the affected hand enable. In these cases, the patient is then, despite the provision of a hand orthosis not able to take objects safely with the affected hand, so that even the opening of a bottle and other simple activities of everyday life are very cumbersome and thus the quality of life of the patient adversely affected.

The hand orthotic part of the present invention is therefore based on the object to reduce the disadvantages mentioned above and to provide a hand orthosis, which simulates the anatomy of the human finger and at the same time provides an individual adaptability to the fingers of a patient's hand. The Handorthese part of the problem is solved by a hand orthosis according to claim 1.

This makes it possible to specifically adapt the length of the individual finger segments to the individual length of the respective finger of the patient's hand. The adaptation can be made relatively easy by an orthopedic technician or even by a technically non-trained person by the number of module elements used is adapted to the length of the respective finger. The articulated connection of the module members also makes it possible to emulate the physiology of the patient's hand very well.

In this context, it has also proven to be particularly advantageous if the module members each have at least one latching member and at least one latching seat for receiving a corresponding latching member of an adjacent module member. As a result, adjacent module members can be easily connected to each other to make the adaptation to the respective patient's hand. It has also proved to be advantageous if the latching connection from the Detent member and the locking seat at the same time forms a hinge connection. As a result, the joints necessary for bending and / or stretching the finger can be realized. The arrangement of the locking seats in a region which essentially corresponds to the physiological position of the ankle rotation axes, the functionality of the hand orthosis according to the invention can also be improved.

According to the invention, a stiffening means for local stiffening of the finger segment is provided. For this purpose, in each case a receptacle for the stiffening means is formed in the finger segment and there in the individual module members. By means of the ascending means, individual regions of the finger segments and in particular adjacent module members can then be connected to one another in such a way that the articulated connection between these modular members is prevented, ie a local stiffening of the finger segments becomes possible. As a result, the anatomy of the human finger can be simulated in a simple manner, so that a joint connection is held only in those areas in which the finger joints are formed in one hand. In this context, it is also provided in the context of the invention that any number of finger joints is modeled by the local stiffening. The stiffening improves the functionality of the finger segment. The stiffening means may for example be formed as a wire which is inserted into the receptacle. In the context of the invention, however, it is also possible that adjacent module members are firmly connected to each other by a screw connection. Alternatively, it is also provided that the stiffening means is designed as a stiffening comb, the tines can be secured in correspondingly shaped recordings in the finger segment, and Although preferably clipped. In this context, it has also proven to be advantageous if the receptacle is formed on the side facing away from the finger of the module member.

In order not to limit the use and in particular the Griffertigkeiten the patient's hand, it has also proven useful when the finger segments of the hand orthosis are placed on top of the fingers.

Since, when bending the finger, a tightening of the skin on the upper side of the finger occurs, which causes a change in length of the upper side of the finger, it has proven to be advantageous if the finger segment is assigned a guide receptacle for receiving a linear guide. In particular, if the linear guide is associated with a finger, it is thereby possible to couple the finger segments of the hand orthosis with the finger so that a linear guided relative displacement between the finger and the finger segment is possible to compensate for the change in length of the finger. In particular, it is also provided in the context of the invention that the guide receptacle is formed in the module member. In this context, it has also proven to be advantageous if a coupling means is provided for coupling the linear guide with the finger segment or the module member. This coupling means can cooperate, for example, with a slot of the linear guide. Due to the slot-shaped design, in addition to the coupling of the finger segments with the patient's hand, in particular a limitation of the relative adjustment between the finger segment and the linear guide can be achieved. At the same time, it is also ensured by the linear guide that only one adjustment in one direction. In particular, dimensionally stable wires are provided as coupling means in the context of the invention.

It has also proved to be advantageous if the linear guide is associated with a fastener attachable to the patient's hand. The attachment means, which is attachable to a patient's hand, the hand orthosis can be attached to the patient's hand or on their fingers to transfer the movement of the finger segments on the fingers. The fastening means may be formed in the context of the invention, in particular as a glove, thereby ensuring that a coupling of the finger segments with the patient's hand done in a manner that the application of the orthosis is facilitated. In addition, compared to the use of other fastening means, such as Velcro, provided by the glove a significantly improved comfort, which allows the wearer to wear the hand orthosis according to the invention longer and even lasting. For a short-term supply, however, it has also proven to be useful if the fastening means comprises a Velcro connection, which is a particularly cost-effective way of attachment. In the context of the invention, it is provided in this case in particular that the linear guide is associated with a finger portion of the glove, whereby the transmission of the movement of the finger segments on the fingers of the patient is favored. In order to increase the stability and power transmission in this case, it is further provided in this regard that the linear guide is integrated into the fastening means, that is, for example, is worked directly into this in the manufacturing process. When the fastener is formed as a glove, it has been found to be particularly useful when the glove is made of silicone because it provides excellent wearing comfort. In addition, one is made of silicone manufactured glove easy to clean. In order to favor the transmission of power from the finger segment to the finger, it has also been proven that the linear guide is associated with a support base through which the force transmitted to the finger is evenly distributed. The support base can be formed in particular concave and thereby nestle particularly well on the finger.

It has also proven itself, if the at least one force introduction means is selected from a group that includes electric drives and elastic return elements. While elastic return elements - such as springs - are particularly preferred in those cases in which the patient is able to move the fingers of his hand equipped with the orthosis in one direction, so either to bend or stretch, and thus only the Support in the other direction is required, an electric drive, which may for example be designed as a servomotor or as a servomotor, indicated in those cases in which the patient is neither able to bend the fingers of the hand or stretch , In the context of the invention, it is also provided in particular that each finger segment is assigned its own force introduction means. However, within the scope of the invention it is also conceivable for a force introduction means to act on several finger segments together in order to bend and / or stretch them together. It is also possible to couple several fingers at once with one finger segment.

Furthermore, it has proven to be particularly advantageous if the force introduction means is connected to a finger segment by at least one pull-pressure element in such a way that bending and / or stretching of a finger connected to the finger segment by the finger Force introduction is possible. Thus, a particularly simple way is given to ensure the bending and / or stretching of the fingers connected to the finger segment by tensile or compressive forces are transmitted to the finger segment by the force application means. It is provided in the context of the invention, in particular, that a train-pressure element is designed both for the transmission of tensile and compressive forces. Alternatively, however, it is also provided that two train pressure elements are kept available, one of which transmits tensile and the other pressure forces from the force generating means to the finger segment. Due to the tensile force can be stretched a bent finger and the pressure force is ultimately bent a stretched finger, but in the context of the invention, the reverse application of force is possible.

It has proven in this context, even if the at least one train-pressure element is formed wire-shaped or rod-shaped. However, it must be ensured in this regard that the tension-compression element has sufficient flexibility to be able to be adjusted by the force introduction means and at the same time be able to follow the movement of the finger can. It has also proven to be particularly useful when the pull-push element is attached to the distal end of the finger segment. Thus, an associated finger of the patient's hand can be easily bent or stretched, as this improves the lever acting on the finger. A suitable material for the tension-compression element may contain, for example, nitinol.

In order to ensure the most compact possible construction of the hand orthosis according to the invention, it has furthermore proven to be advantageous if the module member has at least one bushing for the tension-compression element assigned. Thus, the train-pressure element can be guided in the module members and is thus protected in particular from damage. In addition, this also allows a very low height of the module members reach, which in turn has a positive effect on the comfort of the hand orthosis.

It has also proven to be advantageous if the at least one force introduction means can be activated by a control pulse of a pulse generator. Thus, by a suitable control pulse, the bending or stretching of the patient's fingers and thus the opening and closing of the patient's hand can be controlled. In this context, it has proven to be particularly advantageous if the pulse generator is selected from its group, which includes a proximity sensor, a muscle force sensor or a button. By using a muscular force sensor, it is possible for the patient to open or close the affected hand by a residual muscle activity provided by the patient, which can be tapped, for example, in the forearm according to the principle of electromyography. However, if the existing muscle power is not sufficient for this purpose, as an alternative or in addition, a proximity sensor can be used within the scope of the invention, which automatically closes the hand when it approaches an object to be gripped, in order to grasp the object. In the context of the invention, however, it is also provided that the pulse generator is designed as a key, so that the fingers are adjusted when you press the button. In particular, different movement patterns can be specified with different keys. In particular, the key can also be present virtually on an external, not directly associated with the hand-held operating device, such as a smartphone. In this case the pulse transmission is wireless, for example by a Bluetooth transmission.

In this context, it has also proven to be particularly favorable if a splint is provided, which is preferably attachable to the patient's forearm. In particular, the force introduction means and, if appropriate, the power supply and the control of the hand orthosis can be accommodated on the rail, which can be individually adapted to the anatomical particularities of the respective patient. In particular, the proximal ends of the finger segments can also be fastened to the rail.

It has also proven to be useful if the at least one finger segment in each case comprises a proximal coupling piece and a distal end segment. The proximal coupling piece can be fastened to the rail and the pull-pressure element can be attached to the distal end segment.

Adjacent module links can be easily connected. In addition, a hinge connection is provided by the latching connection of the locking member and the locking seat. Furthermore, in the module body, a receptacle for a stiffening means may be formed to the To bridge articulation between adjacent module members. Also, the module body may have a guide receptacle for Recording a linear guide. Furthermore, it is also provided that in the module body openings are formed, such as holes through which a coupling means for coupling the linear guide with the module body can be introduced. In addition, bushings for receiving a train-pressure element can be formed in the module body.

Furthermore, a fastening means is disclosed, wherein the fastening means is associated with a linear guide for coupling with a finger segment of a hand orthosis. This makes it possible to connect the fastening means with the finger segments or the module members of a hand orthosis to transmit the movement of the finger segments on the fingers of the patient's hand and at the same time compensate for the flexed length change of the finger, without limiting the wearing comfort. It has proven to be particularly preferable if the fastening means is selected from a group comprising a glove and a hook-and-loop fastener tape. If the fastening means is designed as a glove, it is also provided that the linear guides are arranged on the upper side of the glove, in particular in the region of the finger portions of the glove and have a slot with which the glove can be coupled to the finger segment. It has also proved to be useful if the glove is made of silicone.

Fig. 1

eine perspektivische Ansicht auf eine erfindungsgemäße Handorthese,

Fig. 2

ein Fingersegment in einem gestrecktem Zustand,

Fig. 3

einen Längsschnitt durch das Fingersegment aus der Figur 2 in einem gebeugtem Zustand,

Fig. 4

eine perspektivische Ansicht eines Modulgliedes,

Fig. 5

eine perspektivische Ansicht einer nicht zur Erfindung gehörenden Linearführung, und

Fig. 6

eine perspektivische Ansicht eines nicht zur Erfindung gehörenden Befestigungsmittels.

In the following the invention will be explained in more detail in an embodiment shown in the drawing; show it:

Fig. 1

a perspective view of a hand orthosis according to the invention,

Fig. 2

a finger segment in an extended state,

Fig. 3

a longitudinal section through the finger segment of the FIG. 2 in a bent state,

Fig. 4

a perspective view of a module member,

Fig. 5

a perspective view of a not belonging to the invention linear guide, and

Fig. 6

a perspective view of a non-invention attachment means.

FIG. 1 shows a perspective view of a hand orthosis 1 according to the invention, which has a plurality of finger segments 2, which are each connected to a finger 3 of a patient's hand 4. The Finder segments 2 are connected via two train-pressure elements 5 with a force introduction means 6, by which the finger segments 2 can be bent and / or stretched. In order to ensure the transmission of the movement of the finger segments 2 on the fingers 3 of the patient's hand 4, the finger segments 2 are coupled in the embodiment shown with the finger portions 7 of a glove 8, which is slipped over the patient's hand 4 and serves as a fastening means. The arranged at the top of the fingers 3 finger segments 2 are guided in linear guides 9, which in the outside of the glove 8 are integrated. The finger segments 2 are attached at their proximal end to a forearm rail 10, on which also the Force introduction means 6, which are executed in the embodiment shown as servomotors 11, and their control and power supply are stored, which are not shown in the drawing. The finger segments 2 are formed in several parts in the embodiment shown and have at the proximal end in each case a coupling piece 12 with which the finger segment 2 is fastened to the forearm rail 10, and at the distal end an end segment 13, on which the pull-pressure element 5 is attached. Between the coupling piece 12 and the end segment 13, the finger segment 2 is formed from a plurality of module members 14, the number of which varies depending on the length of the finger 3. The individual module members 14 are hinged together to allow bending and / or stretching of the finger 3. In the module members 14 while the train-pressure elements 5 are guided.

FIG. 2 shows a side view of a finger segment 2 of a hand orthosis according to the invention 1. The finger segment 2 is formed from the coupling piece 12, a total of eight module members 14 and the distal end segment 13. The module members 14 are connected via a latching connection 15 with the adjacent elements. FIG. 2 can also be a support base 28 of the recorded in the distal end segment 13 linear guide 9 refer, by which the force acting on the finger 3 is evenly distributed. The distal end segment 13 is associated with a fastener 16 to which the train-pressure elements 5 are attached. The tension-pressure elements 5 are guided in the interior of the module members 14, as in particular the bent representation of the finger segment 2 can be removed, which in the FIG. 3 is shown.

From the FIG. 3 In particular, it is also clear that the latching connection 15 of the module members 14 serves as a hinge connection 17. The latching connection 15 is formed on the finger 3 side facing the finger segment 2, while bushings 18, in which the train-pressure elements 5 are guided on the side facing away from the finger 3 of the module members 14 is formed. Of the FIG. 3 can also be seen that several module members 14 of the finger segment 2 are connected to the coupling piece 12 and others in turn with the end segment 13 by a rod-shaped stiffening means 29, so that the hinge joints 17 of the so stiffened module members 14 are disabled. The stiffening means is introduced into corresponding receptacles 21, which are formed in the module members 14 and the coupling piece 12 and the end segment 13. In the in the FIG. 3 illustrated embodiment, only two module members 14 are not stiffened and thus form a finger joint. In the finger segment 2 is - in guide seats 25 - and the linear guide 9 is added. The linear guide 9 in this case has a slot 26, can be passed through the coupling means 24 in order to connect the finger segment 2 with the linear guide 9 such that a limited, linearly guided adjustment between the finger segment 2 and the linear guide 9 is possible to change lengths to balance at the flexion of the finger 3. The coupling means 24 can be used in bores 23 which are formed in the individual elements of the finger segment 2.

FIG. 4 shows in a perspective view a module member 14 for a finger segment 2 of a hand orthosis 1. The FIG. 4 It can be seen in particular that the module member 14 is formed from a module body 22, which is essentially a basic shape of an isosceles triangle with has rounded corners. At the finger 3 facing side, which forms the base of the isosceles triangle, two locking members 19 and two locking seats 20 for receiving a corresponding locking member 19 of an adjacent module member 14 are arranged. By the locking member 19 and the corresponding locking seat 20 so that ultimately the locking connection 15 and thus the hinge joint 17 between adjacent module members 14 and to the coupling piece 12 and optionally made to the end segment 13. Of the FIG. 4 Furthermore, the bushings 18 can be seen, which serve to supply the train-pressure elements 5 of the force introduction means 6 to the distal end of the finger segment 2, in particular to its distal end segment 13. The module body 22 also has the receptacle 21 for that in the drawing not shown stiffening means 29, with the adjacent module members 14 firmly connected to each other - so stiffened - can be to put the hinge joint 17 inoperative. The receptacle 21 is arranged in the embodiment shown in the apex of the isosceles triangle, that is, opposite the base. Parallel to the articulation axis of the articulated connection 17, the module body 22, which penetrates the module body 22 parallel to its base, forms a bore 23 through which the coupling means 24 can be inserted in order to connect the module member 14 to the linear guide 9. For this purpose, first, the linear guide 9, the below with reference to FIG. 5 is explained in more detail, introduced into the guide receptacle 25, which is formed opposite the tip in the base of the module body 22 of the module member 14. By the coupling means 24, the module member 14 can be fixed to the linear guide 9, that a limited linear displacement of the components relative to each other remains possible to compensate for a change in length of the finger 3, which occurs by the tightening of the skin in bending the finger 3.

FIG. 5 shows a perspective view of the linear guide 9, which can be inserted into the guide receptacle 25 of the module member 14 or the end segment 13. For coupling the linear guide 9 with the guide receptacle 25, the linear guide 9, the slot 26 through which the coupling means 24 can be pushed through. At the proximal end of the linear guide 9, the slot 26 has a curvature 27 pointing in the direction of the finger 3, by means of which the flexion of the finger 3 is favored. Furthermore, the linear guide 9 is associated with a support base 28, whereby the transmitted from the finger segment 2 on the finger 3 force is evenly distributed.

FIG. 6 shows a perspective view of the fastening means for a Handorthese 1, which is designed as a glove 8 in the illustrated embodiment. The glove 8 has in this case a plurality of finger sections 7, to each of which a linear guide 9 is associated, which is integrated into the glove 8 for this purpose. The finger segments 2 can then be attached to the linear guides 9 by passing the coupling means 24 through the holes 23 and the slots 26 formed in the linear guide 9.

The structure and function of the hand-held orthosis 1 according to the invention will be described again below. First, the finger segments 2 are individually adapted to the fingers 3 of the patient's hand 4. Depending on the length of the fingers 3 while a different number of module members 14 is used, which are connected via the locking connection 15 hinged together. Adjacent hinged connections 17 can be disabled by the stiffening means 29, which in the corresponding receptacles 21 adjacent module members 14th can be introduced and is formed for example as a rod. The finger segments 2 are then attached to the forearm rail 10 at their proximal ends with the docking pieces 12. The coupling pieces 12 are also used to supply the adjustment of the finger segments 2 causing train-pressure elements 5 of the also arranged on the forearm rail 10 force introduction means 6 to the distally disposed end segments 13 to which the train-pressure elements 5 are fixed with the fastener 16. In order to transmit the forces induced by the force introduction means 6 via the tension-pressure elements 5 to the respective fingers 3 of the patient's hand 4, the finger segments 2 are connected via the coupling means 24 to the linear guide 9. It is ensured by the linear guide 9 that the change in length induced by the bending of the fingers 3 on the upper side of the fingers 3 can be compensated, since a linear displacement of the finger segments 2 relative to the linear guide 9 and thus the finger 3 remains possible.

LIST OF REFERENCE NUMBERS

1

orthosis

2

finger segment

3

finger

4

patient hand

5

Train-pressure element

6

Force application means

7

finger portions

8th

Glove

9

linear guide

10

forearm splint

11

servomotor

12

coupling piece

13

end segment

14

modular link

15

locking connection

16

fastener

17

articulation

18

execution

19

locking member

20

Rest seat

21

admission

22

module body

23

drilling

24

coupling agent

25

guide seat

26

slot

27

curvature

28

support base

29

stiffener

Claims (10)

1. Hand orthosis for bending and/or extending at least one finger (3) of a patient's hand (4), with a strength initiation means (6), which is coupled to at least one finger segment (2) which can be assigned to a finger (3) of the patient's hand (4), wherein the at least one finger segment (2) comprises a plurality of module members (14), which are connected to one another in jointed manner, wherein the length of the at least one finger segment (2) can be adjusted by way of the number of module members (14) used, characterised in that the hand orthosis comprises a stiffening means (29) for the local stiffening of the finger segment (2), wherein provision is made in the module members (14) in each case for a receiver (21) for the stiffening means (29).
2. Hand orthosis according to claim 1, characterised in that the module members (14) in each case comprise at least one engagement member (19) and at least one engagement seat (20), for accommodating a corresponding engagement member (19) of an adjacent module member (14).
3. Hand orthosis according to claim 1 or 2, characterised in that the at least one strength initiation means (6) is selected from a group which includes electric drives and elastic resetting elements.
4. Hand orthosis according to any one of claims 1 to 3, characterised in that the strength initiation means (6) is connected to the finger segment (2) by means of at least one pull-push element (5) in such a way that bending or extending of a finger (3) connected to the finger segment (2) is possible by means of the strength of the strength initiation means (6).
5. Hand orthosis according to claim 4, characterised in that the at least one pull-push element (5) is configured in the form of a wire or a rod.
6. Hand orthosis according to claim 4 or 5, characterised in that at least one passage guide (18) for the pull-push element (5) is assigned to the module member (14).
7. Hand orthosis according to any one of claims 3 to 6, characterised in that the at least one strength initiation means (6) is configured as an electric drive (11), which can be activated by a control pulse from a pulse generator.
8. Hand orthosis according to claim 7, characterised in that the pulse generator is selected from a group which contain a proximity sensor, a muscle strength sensor, or a button.
9. Hand orthosis according to any one of claims 1 to 8, characterised in that a rail (10) is provided, which can preferably be secured to the underarm of the patient.
10. Hand orthosis according to any one of claims 1 to 9, characterised in that the at least one finger segment (2) comprises in each case a proximal coupling piece (12) and a distal end segment (13).

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