Abstract:
A tool for neurological and diagnostic testing comprises the combination of a stethoscope with a reflex hammer. When mounted on the stethoscope head the reflex hammer extends beyond the head, without interfering with the normal use of the stethoscope. A handle, which may or may not be joined to the reflex hammer, is positioned on the flexible stethoscope tubing and provides a gripping surface for using the tool for neurological testing. One embodiment has an opening between the reflex hammer body and the handle enabling the user to grasp and rotate the stethoscope head. The reflex hammer, which can be made from one or more members, is adaptable for use with binaural and electronic stethoscopes. A detent on the handle provides an ergonomic grip, or a place for inclusion of indicia.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
   This application claims the benefit of U.S. Provisional Patent Application Ser. No. 60/392,319, filed 27 Jun. 2002, the contents of which are hereby incorporated by reference herein in their entirety. 

   FIELD OF THE INVENTION 
   This invention relates to a medical diagnostic tool, and more specifically to a stethoscope capable of neurological diagnosis and percussion functions. 
   BACKGROUND OF THE INVENTION 
   Reflex hammers, which have heretofore been in common use, have had a variety of functional limitations. For example most reflex hammers are heavy, bulky instruments that physicians have to carry with them. Storing reflex hammers in pockets causes discomfort due to the odd shape and needed weight for reflex testing. For example, a common hatchet-type reflex hammer is made with a hatchet-like head connected to a ridged shaft. This type of reflex hammer, as well as others with shafts does not permit easy portability. Additionally reflex hammers can be inadvertently lost, misplaced or not handy when needed when not carried in pockets or lab coats. While it is known that a large population of physicians have used standard stethoscopes, alone, for reflex tests without this device, they have had limited success, due to the flex of the hose tubing, and some discomfort to the patient who has been contacted because of the hardness and shape of the stethoscope head. 
   U.S. Pat. No. 6,510,918 B2 (Bates) describes a combined stethoscope and reflex hammer, wherein the head of the reflex hammer is incorporated into an o-ring securing the diaphragm membrane of the stethoscope chest piece. A rigid handle is provided by a penholder rigidly affixed to the stethoscope in proximity to the chest piece. The reflex hammer of the present invention is attached to the stethoscope such that neither the diaphragm nor the bell of the stethoscope is affected by the reflex hammer. 
   European Patent No. 269,048 discloses a stethoscope modified to contain several medical devices, including a reflex hammer, attached laterally to the stethoscope head, a means for retaining a needle which commonly is used for neurological testing, and a light source. 
   BRIEF SUMMARY OF THE INVENTION 
   The present invention is intended to provide a reflex hammer, which avoids the limitations, referred to above and further provide a hammer that is ideal for all normal neurological reflex testing. In the present invention the reflex hammer attaches to the distal end of a stethoscope. This has many advantages as it utilizes the existing weight of the stethoscope head. It attaches to the stethoscope in a way that does not impede the use of the stethoscope for normal pulmonary use. The shape of the hammerhead is mated to the stethoscope head in such a way that when combined the weight is equal to existing reflex hammers. Medical personnel can fold the stethoscope into their pocket, and/or drape it around their neck with no additional limitations. 
   Thus, one embodiment of the present invention is a tool for medical testing, the tool comprising, in combination:
         a stethoscope, the stethoscope comprising:
           a stethoscope head, the stethoscope head having an operational surface;   one or more earpieces; and   a means for connecting the stethoscope head with the earpiece;   
           a reflex hammer, the reflex hammer attached to the stethoscope head, the reflex hammer comprising:
           a body having a rim, a wall adjoining the rim, and an opening therein, the stethoscope head being received in the opening, the rim being larger than the stethoscope head, the body positioned on the stethoscope head such that the reflex hammer does not interfere with the stethoscope head operational surface; and
 
a handle, the handle joined to the body, the handle sized to receive and semi-rigidly receiving the connecting means therein. Another embodiment of the present invention is a method for employing a stethoscope as a neurological tool, comprising the steps of:
   
           affixing to a stethoscope, the stethoscope comprising a stethoscope head having an operational surface;   one or more earpieces; and   a means for connecting the stethoscope head with the earpiece,   a reflex hammer, the reflex hammer comprising:   a body having a rim, a wall adjoining the rim, and an opening therein,   and the rim being larger than the stethoscope head;   receiving the stethoscope head in the opening;   positioning the body on the stethoscope head such that the reflex hammer does not interfere with the stethoscope head operational surface; and   attaching a handle to the connecting means, thereby semi-rigidly receiving the connecting means therein.       

   Thus, the present invention comprises a tool for neurological and diagnostic testing comprises the combination of a stethoscope with a reflex hammer. When mounted on the stethoscope head the reflex hammer extends beyond the head, without interfering with the normal use of the stethoscope. A handle, which may or may not be joined to the reflex hammer, is positioned on the flexible stethoscope tubing and provides a gripping surface for using the tool for neurological testing. One embodiment has an opening between the reflex hammer body and the handle enabling the user to grasp and rotate the stethoscope head. The reflex hammer, which can be made from one or more members, is adaptable for use with binaural and electronic stethoscopes. A detent on the handle provides an ergonomic grip, or a place for inclusion of indicia. Additionally, the present invention can be used for percussing body parts in need of percussion for purposes of diagnosis and treatment. 
   DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS 
   The foregoing objects and advantages of the present invention will be more clearly understood when considered with the accompanying drawings, in which: 
     FIG. 1  is a perspective view of a “standard”, binaural stethoscope; 
     FIG. 2  is a close up view of a typical stethoscope head and tubing section; 
     FIG. 3  is a perspective view of an electronic stethoscope. 
     FIG. 4A  is a perspective view of an embodiment of the present invention. 
     FIG. 4B  is a perspective view of the embodiment of  FIG. 4A  attached to a stethoscope, a LITTMAN® (registered trademark of 3M Company Corp., St. Paul, Minn.) Classic II model stethoscope. 
     FIG. 5A  is a cross-sectional view of the embodiment of  FIG. 4A , taken along lines  5 A— 5 A of  FIG. 4A , attached to the stethoscope shown in  FIG. 4B . 
     FIG. 5B  is a side view of the embodiment shown in  FIG. 4B . 
     FIG. 6  is a perspective view of a reflex hammer in accordance with one embodiment of the present invention, prior to being affixed to a stethoscope head; 
     FIG. 7  is a perspective view of the reflex hammer affixed to the stethoscope, in accordance with an embodiment of the present invention; 
     FIG. 8  illustrates schematic views of a reflex hammer embodying the present invention in actual usage when striking the knee of an individual; 
     FIG. 9A  illustrates an adaptation in manufacturing, by increasing the length of the stem going into the stethoscope head, in accordance with one embodiment of the present invention; 
     FIG. 9B  illustrates a locking mechanism on the stem, in accordance with an embodiment of the present invention; 
     FIG. 10  shows a donut-shaped attachment element mounted on the head of the stethoscope to increase the surface area of the reflex striking force, in accordance with an embodiment of the present invention; 
     FIG. 11  shows an add-on stem that would allow a stethoscope head to function as a reflex hammer, in accordance with an embodiment of the present invention; 
     FIG. 12  illustrates both the donut-shaped attachment element and the add-on stem, attached to a stethoscope, in accordance with an embodiment of the present invention; 
     FIGS. 13A  and B illustrate an embodiment of the reflex hammer manufactured as a two-piece clam shell that can snap together around a stethoscope head; and 
     FIGS. 14A  and B illustrate another embodiment of the reflex hammer manufactured as a two-piece asymmetrical clam shell that can be snapped together around the stethoscope head. 

   DETAILED DESCRIPTION OF THE INVENTION 
   The present invention is a medical device that can be used both as a stethoscope for the monitoring of bodily sounds, and as a reflex hammer for performing neurological testing and related functions. 
   Stethoscopes are well-known medical instruments, the “standard” (binaural) variety ( FIGS. 1 and 2 ) being the most commonly known type. Stethoscopes enable the user to listen to respiratory and cardiac sounds within the chest, and for auscultation of the vascular or other sounds within the body. Newer, electronic stethoscopes have been developed which are stated to improve the user&#39;s ability to monitor these bodily sounds. 
   Referring to the binaural stethoscope shown in  FIG. 1 , stethoscope  1  comprises a stethoscope head  3  having chest pieces  4  and  5 , (chest pieces), a tubular stem  6  that extends from the stethoscope head  3  into a length of flexible tubing  7  that bifurcates and leads to two ear pieces  8 , which are placed in the user&#39;s ears in order to listen to the sounds picked up by the operational surfaces  4  and  5 . Surrounding chest pieces  4  and  5 , along their outer edge, is a rim  9 , which is generally manufactured from an elastomeric material, such as a rubber. The chest pieces are connected to each other by means of a neck  10 , in communication with stem  6 . By rotation of the stem  6 , a user can switch between using the bell  4  and diaphragm  5 . 
   For purposes of this specification, the terms “bell” and “diaphragm” will be used interchangeably with “chest pieces” and “operational surfaces” when referring to reference numerals  4  and  5 , respectively. 
   Electronic stethoscopes generally resemble binaural ones, but the shapes of the head and diaphragm differ from those of a binaural stethoscope. Referring to  FIG. 3 , an electronic stethoscope  150  has a head  152  which includes a diaphragm  154 . Head  154  is joined to tubing  158  by means of stem  156 , in which some of the stethoscope electronics, such as volume controls, are contained. Module  160 , mounted between lengths of tubing  158  and  162  also includes some of the stethoscopes electronics, such as a battery and battery chamber. The second length of tubing  162  bifurcates, and is joined to earpieces  166  by means of a connecting rod  164 . Other types of stethoscopes are known that have greater than two operational surfaces. 
   In accordance with one embodiment of the invention, a reflex hammer  20  is to be affixed to a stethoscope head  3  and tube section  7  ( FIGS. 1 ,  4  and  5 ). One embodiment of the reflex hammer  20  of the present invention is illustrated in  FIGS. 4 and 5 . 
   The device  20  comprises a handle  22  that can be formed from of one or more members, and a body  24  which engages the neck  10  between the chest pieces  4  and  5  ( FIGS. 4 and 5 ). Handle  22  receives therein the stem  6  and a portion of the stethoscope tubing  7  creating a tool that is suitable for reflex testing (shown in  FIG. 8 ). The combination of the handle  22  surrounding a portion of the stethoscope tubing  7 , and the receipt of the stem  6  within the handle, creates what is termed a “semi-rigid” section, meaning that there is some flex to the combination, but much less flex than would occur in the absence of the handle (i.e., with just the tubing alone). The end  26  of the handle  22  can be used as a grip. 
   The body  24  comprises a rim  28  connecting a pair of walls  30 . In this embodiment, body  24  is hollow, the opening  32  between the walls serving to receive therein the head of a stethoscope (for example, FIGS.  4 B and  5 A– 5 B). In the region  34  that forms a junction between the body  24  and the handle  22  is an aperture  36  into which the user can insert their fingers and rotate the stem  6  of the stethoscope. In another embodiment of the present invention, the body can be solid, but still retain the opening for receipt of the stethoscope head. 
   In this embodiment of the present invention, handle  22  includes a widened region  38  and a detent  40  towards the end of the handle, i.e., most distant from the body. This detent  40  can be formed on one or both sides of the handle  22  and, in this embodiment, the detent is generally flat, allowing for ergonomic finger placement and a comfortable grip. 
   Although not shown in the figures, the detents  40  may include other elements to improve the user&#39;s comfort, such as one or more ridges, nibs, pads, cushions, strips of tape, or similar elements known to those skilled in the art. The configuration of the detents  40  is such that indicia, such as, but limited to, a manufacturer&#39;s name, a logo, directions for use, advertising content, notations, or the like, could be placed thereon, using methods known to those skilled in the art. 
   The reflex hammer body  24  has a diameter that is larger than the stethoscope head  3  (see, for example,  FIGS. 4B and 5B ) thereby allowing the reflex hammer rim  28  to make contact with the larger surface area  53  of a patient ( FIG. 8 ). The device may be secured to a range of different stethoscope tube thicknesses and head designs. A molded adapter may be provided to allow for the device to fit over a range of different stethoscopes, in accordance with an embodiment of the present invention. 
   The device may be slid over a portion of the tubular section  7  to form a tactile grip. The tactile grip allows the stethoscope head section to be gripped and used for various medical procedures. These procedures include, for example only and not intended as a limitation, reflex testing, percussion of a chest wall, or other bodily area in need of percussion for diagnostic purposes. 
     FIG. 4  illustrates a preferred method for attaching the reflex hammer  20  to a typical stethoscope. To this end, handle  22  is suitably secured to the tube  7  in a manner that allows the stethoscope dual head to rotate to its full 180 degrees to allow both the bell  4  and diaphragm  5  to be used ( FIGS. 1 ,  5 B). 
   Operation of the Device 
   The application of the reflex hammer  20  is illustrated in  FIG. 8  where its movement relative to a reflex site, such as the knee  50  of a human, is shown. In use, two positions of the reflex hammer  20  as it is moved to an impact position are illustrated (omitting the hand of the person applying the hammer for purposes of illustration). In position A in  FIG. 8 , the reflex hammer  20  has begun its movement towards the knee  50 . At position B, the reflex hammer has reached its point of impact  53  with the knee, to elicit a patellar tendon reflex, wherein the body  24  of reflex hammer strikes the patient. The reflex hammer  20  may be used in all ways as a typical reflex hammer is used. For example, it may be used in the percussion of a chest wall, or any other area of the body that may need to be percussed for diagnostic purposes. 
   Alternate Embodiments 
   Alternate embodiments are shown in  FIGS. 10 through 13 , inclusive, which differ in the shape of the body and the handle of the reflex hammer  20 . 
   For example, if the length of the stem  6  of a stethoscope were to be increased ( FIG. 9A ) from the “standard” lengths commonly employed in the industry, to form an elongated, or oversized (or extra-long) stem, thereby allowing a user to hold the stem as a reflex hammer, the present invention could be modified to suit such a stethoscope. For example,  FIG. 10  shows a reflex hammer in the form of a donut-shaped attachment element  65  mounted on the head of the stethoscope to increase the surface area of the reflex striking force, in accordance with an embodiment of the present invention. In this embodiment, the user grasps the stem  6  to use the reflex hammer. 
   This attachment element  65  could be produced separately, by a manufacturer or an after-market device manufacturer, and could be made from a plastic or a rubber, or combinations thereof. This attachment element could be affixed to the stethoscope head  3  in one piece shaped like an incomplete circle, or in multiple pieces, or in symmetrical or asymmetrical shapes, where it could attach to the head around the neck  10 , or around the bell  4  and/or diaphragm  5 . Other embodiments anticipate increasing the striking area of the stethoscope head by either increasing the plastic/rubber or electrometric surface area or adding additional material to the stethoscope head. Instead of a donut-like configuration, this additional material could comprise a ring which would affix around the head of the stethoscope, and if made of an elastomeric or plastic material, provide shock absorbing properties as well. This ring could be affixed to the head  3  in one piece shaped like an incomplete circle, or in multiple pieces, or in symmetrical or asymmetrical shapes. It could attach to the head either around the diaphragm  5 , bell aspect  4 , or around the neck  10 . 
   Further adaptations include a locking mechanism  62  that prevents the stem from rotating without first releasing the lock ( FIG. 9B ). The presence of a locking mechanism would lock the stethoscope head  3  on its axis so that the head does not shift or rotate upon striking, as when used in neurological or other diagnostic testing. As shown in  FIG. 9B , locking mechanism  62  is incorporated into the stem, where the stem comprises a rotating member  63  and a receiving member  64 . Receiving member contains an aperture  66  into which the lock  68  in inserted. Lock  68  is a tab which is spring-like, and can be made from the same material as the stem, although other suitable materials could be substituted therefor. By depressing tab  68  so that it passes through aperture  66 , and grasping the rotating member  63 , the stem can be rotated, allowing use of the bell  4  or diaphragm  5 . However, while the tool of the present invention is being used for neurological testing, the stethoscope head  3  is locked in position. A locking mechanism could also be affixed to the axis from outside of the rotational mechanism. 
   Other embodiments of a locking mechanism could include mechanisms such as depressing a spring-loaded button, tab, or ball (such as a ball bearing) through an aperture; twist-lock mechanisms, similar to those used on photographic tripods; click stop mechanisms; key lock mechanisms, or other locking mechanisms known to those skilled in the art. Such a locking mechanism could be built into the stethoscope before its initial sale, or can be designed to be retrofitted into existing stethoscopes. Similarly, a stethoscope could be modified with a telescoping device that would enable the elongation of the stem  6  to a distance similar to that of the handle  22  of an embodiment of the reflex hammer of the present invention. The distal aspect of the tubing  7  could also be made rigid by adding a stiffening attachment to the stem  6 . This elongated stem or stiffened section would act as a handle for the reflex hammer function of the stethoscope.  FIG. 11  illustrates an embodiment in which the distal aspect of the tubing  7  has been made rigid by adding a stiffening attachment  70  to the stem  6 . Stiffening element  70  is an add-on extension, or tube, made from a material such as a plastic or metal, and once mounted on this region of tubing  7 , limits the flex of the distal end of the stethoscope tubing  7 . This elongated stem or stiffened section acts as a handle for the reflex hammer function of the stethoscope. As will be described further, stiffening element  70  can fit over the tubing in a variety of ways such as: a “clam shell” design thereby clipping over the tubing, but not compressing it. It could lock in this position or could be easily removed. The design consists of a rigid tube with a slit longitudinally allowing for the tubing to be compressed into the rigid tube and then exist therein in an uncompressed fashion. This tube could extend until it reached the median aspect of the head  3  or extend any distance including the possible extension to attach or cover some aspect of the head. It could involve a flange that would extend to the head and stabilize it to stop it from rotating on its axis. 
     FIG. 12  illustrates the combination comprising both the donut-shaped attachment element  65  and the add-on stem  70  attached to a stethoscope, to act as a reflex hammer, in accordance with another embodiment of the present invention. 
     FIG. 13  shows another alternative embodiment  97  of the present invention, but manufactured in a two-piece manner. The two members  90  and  93  are symmetrical, and designed to interlock with each other to form reflex hammer  97 . Each member  90  and  93  contains one or more fastening means, which could be a hook and eye closure  95  and  96 , respectively. The fastener could also be a snap  98  or other fastener  100 , known to those skilled in the art, such as, but not intended to be limited to, a locking pin, button, nib, adhesive strips, hook and loop fasteners or the like. Alternatively, the members could contain ridges or similar means to enable them to be joined by means of a press-fit or snap-fit. The fasteners could be permanently affixed to each other or be removable depending on manufacturing method. The parts would snap, glue or fasten together in such a way that they become one piece  97  and would be able to rotate freely around the stethoscope hose. As can be seen in  FIG. 5A , the location of the fasteners  100  within the reflex hammer handle are spaced sufficiently far apart to act as a means for retaining the stethoscope tubing  7  therein, and can also function as a guide for attaching the reflex hammer of the present invention to a stethoscope. 
     FIG. 14  shows an asymmetrical version  102  of another alternative embodiment. In this embodiment, the parts would snap, glue or fasten together in such a way that the hose could be able to rotate freely if desired. The parts could either be permanently affixed to each other of removable, depending on manufacturing method. Additionally the head of the members  103 ,  104  could be asymmetrical, allowing for different striking surface areas  105 . The striking area  105  could be molded in the similar plastic as the clamshell or in a different durometer material either molded in or affixed secondarily in assembly. Additionally the parts could snap together by means of fasteners  110 , such as a button, pin, nib, press-fit or snap-fit, or other fastener as has been described previously. 
   In an embodiment of the present invention, the reflex hammer  20  is made of a plastic material, but any suitable material could be employed, including natural or synthetic rubbers, metals, polytetrafluoroethylene (TEFLON®, DuPont Corp. Wilmington Del.), nylon, other plastics, such as polyethylene, polycarbonate, polyvinyl carbonate, or the like could be substituted therefor. 
   Therefore, although this invention has been described with a certain degree of particularity, it is to be understood that the present disclosure has been made only by way of illustration and that numerous changes in the details of construction and arrangement of parts may be resorted to without departing from the spirit and scope of the invention.