Rehabilitative training devices for use by stroke patients

According to one embodiment, a rehabilitative training device for use with a stroke patient includes a first component that is operatively coupled to a first body part (unaffected body part) of the patient and a second component that is operatively coupled to a second body part (affected body part) of the patient. The first component and second component are operatively coupled to one another such that motion of the first component as a result of movement of the first body part by the user causes the second component and second body part to move in a symmetrical motion.

TECHNICAL FIELD

The present invention relates to rehabilitative devices and in particular, the present invention relates to rehabilitative devices that are configured to use the motion of an unaffected (or less affected) body part to “train” the affected body part and thereby incorporate the brain motor system in the rehabilitation process.

BACKGROUND

While technology continues to make rapid advancements in the medical field, there are still a number of diseases and ailments that strike a vast number of adults and can lead to death. For example, a stroke is currently the third leading cause of death in American and is also unfortunately a leading cause of adult disability. A stroke, which also referred to as a “brain attack,” occurs when a blood clot blocks an artery (a blood vessel that carries blood from the heart to the body) or a blood vessel (a conduit through which blood moves throughout the body) ruptures and thereby interrupts blood flow an area of the brain. When either of these events occurs, brain cells begin to die and brain damage occurs.

As a result of the interruption in blood flow and brain cells dying during a stroke, the affected area of the brain is unable to function and abilities controlled by that area of the brain are lost. These abilities include but are not limited to movement (ability to move one or more limbs on one side of the body), speech (ability to understand or formulate speech), memory, and sight (ability to see one side of the visual field). How a stroke patient is affected depends on where the stroke occurs in the brain and how much of the brain is damaged. For example, an individual who has a small stroke may experience only minor problems such as weakness of an arm or leg. Individuals who have larger strokes may be paralyzed on one side or lose their ability to speak. Some people recover completely from strokes, but more than ⅔ of survivors will have some type of disability for the rest of their lives. More specifically, many survivors suffer from residual neurological deficits that persistently impair function. In particular, dysfunction from upper extremity (UE) hemiparesis impairs performance of many daily activities such as dressing, bathing, self-care, and writing and as a result, functional independence is greatly reduced. In fact, studies show that only 5% of adults regain full arm function after stroke and unfortunately, 20% regain no functional use.

For a person that survives a stroke, the person will most likely undergo stroke rehabilitation which is the process by which patients with disabling strokes undergo treatment to help the patients return to a normal life as much as possible by regaining and relearning the skills of everyday living. This can be a very long and difficult process and therefore is very challenging and difficult for the patient and all loved ones. As a result, stroke rehabilitation also aims to help the survivor understand and adapt to the difficulties ahead, prevent secondary complications and educate family members to play a supporting role and assist the survivor as much as possible and where needed.

Depending upon the severity of the stroke, the rehabilitation program will vary and thus the makeup of the rehabilitation team will also vary. In any event, a rehabilitation team is usually multidisciplinary since it involves staff with different skills that are all working together to help the patient recover and relearn and develop old skills and abilities. The rehabilitation staff can include but is not limited to nursing staff, physiotherapy, occupational therapy, speech and language therapy, and usually a physician trained in rehabilitation medicine. Other rehabilitation programs will include assist from psychologists, social workers, and pharmacists since unfortunately, a large number of patients manifest post-stroke depression, and other social problems related to their disability. However, most stroke patients undergo physical therapy (PT) and occupational therapy (OT) and therefore, these are considered cornerstones of the rehabilitation process. During the rehabilitative process, assistive technology, such as a wheelchair, walkers, canes and orthosis are commonly used to assist the patient and to compensate for impairments. Speech and language therapy is provided for patients with problems understanding speech or written words, problems forming speech and problems with swallowing. While PT and OT have overlapping areas of working, their main attention fields are different in that PT involves re-learning functions such as transferring, walking and other gross motor functions. In contrast, OT focuses on exercises and training to help relearn everyday activities known as the activities of daily independent living, such as eating, drinking, dressing, bathing, cooking, reading and writing, and toileting, etc.

It is generally accepted in the medical community that there is an important treatment window for beginning the rehabilitative process. Traditionally, methods of stroke rehabilitation have been focused on the first three months after stroke and consist largely of passive (nonspecific) movement approaches or compensatory training of the nonparetic arm. This time window is in part based on and consistent with natural history studies of stroke recovery that show a plateau after three months, although it has been demonstrated that recovery can occur well beyond this window into the late chronic phase several years post-stroke. Features of the motor impairment are however different in the period immediately after stroke (i.e. the first 3 months or so) and in the later post-stroke period (after 3 months). In the beginning there is predominantly weakness, but later muscular overactivity develops in certain muscle groups that leads to abnormal posturing and masks strength gains in the non-overactive muscle groups.

Much of the therapy provided by PTs and OTs in the first 3 months is hands-on, and is spent in passively maintaining range-of-motion in the joints of the affected side so as to prevent deformity and in teaching compensatory strategies to preserve functional independence to the extent possible using the unaffected limb, assistive devices and the like. Little time and effort is expended in trying to restore muscle activation/strength in the paralyzed affected limb. With respect to rehabilitative treatment for people suffering with chronic hemiparetic arm dysfunction, there are a number of new devices for upper arm rehabilitation and training. Most of these devices concentrate on the affected arm and use mechanical devices/robotics and electrical stimulation to controllably move the affected arm. For example, there are robotic devices that facilitate movement of the targeted muscle group or groups by using a robot to sense and then stimulate appropriately if the patient is not able to complete the intended movement. These new rehabilitation devices were introduced to allow increased amounts of ‘practice’ to train the affected limb while reducing the burden on the therapist. However, these devices are overly complex, expensive (since they use computers (virtuals) and robotics), and “train” the affected limb by producing passive movements in one or more joints using an external source of energy. The complexity and costs of these devices prevent them from being used in a number of settings, including a home or remote clinic that does not have sufficient resources for purchase of expensive equipment, etc.

A number of recent studies have shown that recovery is an “active” rather than a “passive” process where it is the brain that needs to be trained in conjunction with movements of the limb. Over the last few decades it has been shown that there is a complex interaction between the two sides of the brain in the control of movement of one limb. Both sides of the brain contribute to the control of each limb, but one side is usually “inhibited” in a healthy individual. However this inhibition is removed when one side is damaged, and as a result the undamaged side of the brain may play a greater role in the recovery of the affected limb. Existing rehabilitation devices are not focused on harnessing the already available brain activity from the unaffected side to train affected arm movements.

Therefore there is a need for alternative forms of rehabilitative devices that can be used in more settings such as the ones mentioned above and can be offered in a more cost effective manner and in a more user friendly (less complex) manner.

SUMMARY

In accordance with the present invention, a number of rehabilitative devices intended for use by stroke patients are provided that are specifically configured to harness brain activity from the unaffected side to “train” affected arm movements by using the motion of the unaffected (or less affected) limb. Using the healthy limb to train the affected limb is known as “mirroring.” Although the brain control of the muscular system is almost entirely contralateral, there is approximately a 10% contribution of the ipsilateral brain to individual muscles. By using the unaffected brain to move both body parts (limbs) in the same manner, the recovery from stroke is facilitated by increasing control of the muscles by the ipsilateral brain.

According to one embodiment, a rehabilitative training device for use with a stroke patient includes a first component that is operatively coupled to a first body part (unaffected body part) of the patient and a second component that is operatively coupled to a second body part (affected body part) of the patient. The first component and second component are operatively coupled to one another such that motion of the first component as a result of movement of the first body part by the user causes the second component and second body part to move in a symmetrical motion.

The devices described herein also enable patients to conduct range-of-motion therapy within their own homes. Restricted range of motion, which typically occurs after a stroke, can cause pain, impair function, and increase the risk of skin breakdown leading to open sores. In order to reduce these complications of stroke, range-of-motion exercises are prescribed for almost all patients. The inexpensive devices described herein could be used to supplement range-of-motion therapy that patients initially receive in hospital or other therapeutic settings when still covered by insurance, but more importantly enable them to continue this important therapy at home long after insurance no longer covers it.

In one embodiment, the body parts can be selected from the group consisting of: arms, legs, ankles, wrists, shoulders, fingers, and thumbs.

These and other aspects, features and advantages shall be apparent from the accompanying Drawings and description of certain embodiments of the invention.

In accordance with the present invention, a number of rehabilitative devices intended for use by stroke patients are provided that are specifically configured to harness brain activity from the unaffected side to “train” affected arm movements by using the motion of the unaffected (or less affected) limb to “train” symmetrical motions of the affected one. Using the healthy limb to train the affected limb is known as “mirroring.” Although the brain control of the muscular system is almost entirely contralateral, there is approximately a 10% contribution of the ipsilateral brain to individual muscles. By using the unaffected brain to move both body parts (limbs) in the same manner, the recovery from stroke is facilitated by increasing control of the muscles by the ipsilateral brain.

The devices described herein also enable patients to conduct range-of-motion therapy within their own homes. Restricted range of motion, which typically occurs after a stroke, can cause pain, impair function, and increase the risk of skin breakdown leading to open sores. In order to reduce these complications of stroke, range-of-motion exercises are prescribed for almost all patients. The inexpensive devices described herein could be used to supplement range-of-motion therapy that patients initially receive in hospital or other therapeutic settings when still covered by insurance, but more importantly enable them to continue this important therapy at home long after insurance no longer covers it.

The devices, indicated by the headings below, are all based on one body part “training” the other and the active use of the patient's brain motor system to facilitate the rehabilitation.

Now referring toFIGS. 1-3and in accordance with one embodiment of the present invention, an upper limb rehabilitative device100is configured to enable a stroke patient with motor weakness in the upper limb to use her/his unaffected arm (and unaffected brain) to facilitate almost symmetrical movements with the affected arm. The underlying principle for the device100, as well as other devices described herein, is that rehabilitation of an affected muscle group can be facilitated by increasing the participation of the brain's motor systems in causing the affected muscle group to move. By using the unaffected brain to move both arms in the same manner, recovery from stroke is facilitated either by increasing the participation of any surviving neurons on the affected side of the brain or by increasing control of the muscles by the ipsilateral brain. Moreover, as described herein, studies performed by the present applicant shows that important information regarding the planning and preparation phase of hand movement can transfer from one hemisphere to the other but only if the movement to be performed by one hand is the same as the one performed by the other.

The rehabilitative device100includes a base or support member110which supports the working components of the device100and the patient interacts with during the rehabilitative process. The base110includes an upper surface or first face112and a bottom surface or second face114. The base110is generally rectangular shaped or square shaped with a wedge cut-out to partially surround the user (patient); however, other shapes can be possible so long as all of the working components are sufficiently contained within the base110.

In one embodiment, the base110is a table-like structure that includes legs that extend down therefrom to support the base110at an elevated height. To permit storage and foldability, the legs of the base110can be folded. Alternatively, the base110can be constructed so that it can be securely, yet releasably mounted to a surface of another object. For example, the base110can have a plurality of pivotable clamp members (e.g., along edges or in corners of the base110) that are constructed to lockingly secure the base110to the surface of the other object. The other surface can be in the form of a planar surface of a table or the like. In this manner, the device100can be supported by and secured to the table (e.g., a dining room or kitchen table, etc.) by simply placing the device100on the table and then securing the device100to the table by extending the pivotable clamps, opening the clamps and then positioning the clamps such that the table is at least partially received between jaws of the clamp. The clamp jaws are then locked in place with the table being securely gripped therebetween. This design permits the device100to be highly transportable and also facilitates storage since there are no leg members or the like to elevate the base110.

While the device100can be formed of any number of different materials, including wood, plastics, etc., advantages are obtained when light weight materials, such as plastics, are used. The base110can be a molded plastic article that has hollow compartments to store some of the working components of the device100as described below. In particular and as described below, the base110can include one or more compartments111that contain some of the working components of the device.

The device100includes a first arm holder/restraint120and a second arm holder/restraint130. The first arm holder120and the second arm holder130are each intended to hold (cradle) the extended arm of the user (patient) and therefore, each of the first and second arm holders120,130is an elongated structure that includes a first end122and an opposing second end124. The holders120,130can have any number of different shapes so long as they are anatomically correct and comfortable and can cradle the arm of a user. For example and as shown, each of the holders120,130has a contoured upper surface125on which the extended arm is placed. Padding and the like can be provided on the upper surface to provide greater comfort to the user. In the illustrated embodiment, the holders120,130are semi-circular shaped members. Since the arm lengths of different patients vary, the holders120,130can be configured so that the second end124, which represents a distal end of the holder, can be extended/retracted to either make greater or reduce the overall length of the holder. For example, the second end124can include a telescoping end which provides the aforementioned feature. Other designs are equally possible.

In order for the arm to be held in position in the holders120,130, and prevent slippage of the arm during movement, an adjustable member140that holds the forearm in position is provided. In the illustrated embodiment, the adjustable member140is a strap that is made of hook and loop type material. The strap140is coupled to the respective holder120,130so that the arm is secured in place by wrapping the strap about the forearm and attaching the two ends of the strap140to one another. Other means for securing the arm in place along the concave upper surface125is equally possible.

The first arm holder120is pivotally attached to the base110at a first pivot131and similarly, the second arm holder120is pivotally attached to the base110at a second pivot132. For example, the holders120,130can pivot about respective shafts that are coupled to the base110.

In one embodiment, the pivot point131,132of each holder120,130can be adjusted to accommodate for different sized patients. For example, smaller patients will require the holders120,130to be spaced closer to one another and therefore adjustment of the pivot points131,132may be needed. The pivot point can be adjusted in any number of different ways including having the pivot point be defined by an axial shaft about which the holder pivots, with the shaft being adjustable along a guide channel or track. For example, the guide channel can include different locking locations or settings into which the shaft is disposed and locked. In this manner, both holders120,130can be adjusted in the same manner to ensure that the two pivot points mirror one another. Alternatively, the pivot can be moved by disengaging the pivot shaft from one opening in the base110and disposing it within another opening, thereby defining a new pivot.

In order to glide smoothly across the top face112, each of the holders120,130can have a pivotable (rotatable) roller (wheel) disposed along its underside closer to the second end124that not only elevates the second end124relative to the face112but also allows the holder to move in a pivoting motion across the top face112as described below.

Each holder120,130includes a first (inner) edge151and an opposing second (outer) edge152. When arranged on the base110in a spaced relationship, the first edges150face one another, while the second edges152face in opposite directions. Each holder120,130has a number of coupling members that permit the holder120,130to be coupled to another member. For example, the first edge151of each holder120,130includes at least one first coupling member160, while the second edge152includes at least one second coupling member169. The coupling members160,170are configured to allow attachment between a separate member and the respective holder. In the illustrated embodiment, the coupling members160,170are structures which permit mechanical attachment thereto. For example and as illustrated, the coupling members160,170can be in the form of eyelets that permit an object to be attached to the holder120,130.

In the illustrated embodiment, there is a plurality of first coupling members160that are arranged linearly along the first edge151. The first coupling members160provide adjustment capability in the event that the pivot point is adjusted by moving the holder120,130along the base110. This feature is discussed in more detail below.

The device100is constructed such that movement of the first holder120or second holder130is mirrored in the corresponding second holder130or first holder120and therefore movement of the unaffected forearm is mimicked by an identical or similar movement in the affected forearm. The respective pivoting movements of the holders120,130are identified by arrows141inFIG. 3. In other words, as a result of the mechanical coupling between first holder120and the second holder130, one of the first and second holders120,130acts as a driven member since movement thereof is caused by movement of the unaffected arm that is supported thereby and the other of the first and second holders120,140acts as a slave member since movement (a driving action) in one holder is translated into movement of the other holder.

The mechanical coupling between the first holder120and the second holder130can be accomplished in a number of different ways. For example and as shown inFIG. 3, a first type of mechanical coupling can be in the form of a series of pulleys and cables (cords) that link the first holder120to the second holder130in such a way, that the above described desired movements result.

More specifically, the mechanical coupling mechanism includes a first set of pulleys and a first cable150that is routed along the first set of pulleys and a second set of pulleys and a second cable160that is routed along the second set of pulleys. As shown inFIG. 1, the first set of pulleys includes four pulleys, namely, a first pulley170, a second pulley172, a third pulley174and a fourth pulley176that are located on different levels (planes) of the base110as described below. The first cable150has a first end152and an opposing second end154. The first cable150can be formed of any number of different materials, including synthetic materials, such as nylons, etc., or it can be formed as a thin metal wire, etc.

Similarly, the second set of pulleys includes four pulleys, namely, a fifth pulley178, a sixth pulley180, a seventh pulley182and an eighth pulley184that are located on different levels (planes) of the base110as described below. The second cable160has a first end162and an opposing second end164. The second cable160is typically formed of the same material as the first cable150.

The two planes in which the pulleys are located can be thought of as an upper plane that lies along the upper surface of the base110and a lower plane that passes through the inner hollow compartment111that is formed in the base110and is located below the upper surface of the base110.

The first and second pulleys170,172are rotatably mounted to the upper surface of the base110in a spaced relationship relative to the outer edge152of the first holder120, while the third and fourth pulleys174,176are located within the inner hollow compartment111of the base and are rotatably mounted to a floor of the base110and thus are located in the second plane. The first and second pulleys170,172can be located along one end of the base110and the third and fourth pulleys174,176can be located side-by-side within the inner compartment111proximate the first arm holder120that overlies them. Similarly, the fifth and sixth pulleys178,180are rotatably mounted to the upper surface of the base110in a spaced relationship relative to the outer edge152of the second holder130, while the seventh and eighth pulleys182,184are located within the inner hollow compartment111of the base and are rotatably mounted to a floor of the base110and thus are located in the second plane. The fifth and sixth pulleys178,180can be located along one end of the base110and the seventh and eighth pulleys182,184can be located side-by-side within the inner compartment111.

In order to route the first and second cables150,160along the respective pulleys in two different planes, the base110has several slots or openings to permit routing of the cable between the upper surface (first plane) of the base110and the inner compartment111(second plane) of the base110. For example, the base110can have a first opening190that receives the first cable150and permits communication between the two planes and a second opening192that also receives the first cable150and permits communication between the two planes. A third opening194is provided for receiving the second cable160and, as described below, the second cable160is also routed within the second opening192. As shown in the figure, the first and third openings190,194can be thought of as lateral or side openings, while the second opening192can be thought of as a center opening due to its formation between the first and second arm holders120,130.

The routing of each of the cables150,160is now described with reference toFIGS. 1 and 3. The first end153of the first cable150is attached to the outer edge152of the first holder120and is routed into engagement with the first pulley170and then the second pulley172. The first cable150passes down through the first opening190into the inner compartment111where it engages the third pulley174and then the fourth pulley176before passing up through the second (center) opening192where it extends across the upper surface and terminates with the second end154being attached to the inner edge151of the second arm holder130. Thus, the first cable160can be thought of as being attached between the outer edge of the first arm holder120and the inner edge of the second arm holder130.

The second cable160is routed in a similar manner in that the first end162of the second cable160is attached to the outer edge152of the second holder130and is routed into engagement with the fifth pulley178and then the sixth pulley180. The second cable160passes down through the third opening194into the inner compartment111where it engages the seventh pulley182and then the eighth pulley184before passing up through the second (center) opening192where it extends across the upper surface and terminates with the second end164being attached to the inner edge151of the first arm holder150. Thus, the first cable160can be thought of as being attached between the outer edge of the first arm holder120and the inner edge of the second arm holder130. InFIG. 3, it will be appreciated that the portion of the cable150,160that is located within the inner compartment111is shown in broken lines.

The attachment between a respective end of one of the cables and the corresponding edge of the arm holder can be accomplished in any number of different ways including the use of different types of fasteners. For example, each end of the cable can include a cable clamp that mates with a snap hook that is located along the edge. This permits quick and easy attachment and detachment between the two members.

It will be appreciated that device100can be thought of as including a first side and a second side that is a mirror image with the first side being the side at which the unaffected arm is positioned and the second side being the side at which the affected arm is positioned.

As a result of the aforementioned arrangement, the dorsal connection to the left forearm is attached to the ventral side of the right forearm by one cable, and the ventral connection to the left forearm is attached to the dorsal side of the right forearm by the other cable.

After placing and securing the patient's arms within the respective arm holders120,130, the seated patient is instructed to attempt to move both arms in the same manner. If, for example, the right arm is the unaffected arm, then movement of the right arm in a direction toward the side edge (away from the first arm holder120) causes the second arm holder130to pivot about the pivot132. This movement of the arm holder130causes a pulling of the first cable120and since the other end of the first cable120is attached to the outer edge of the first arm holder120, the first arm holder120likewise moves in a direction toward the other side edge of the device away from the second arm holder130. Similarly, when the second arm holder130moves in an opposite direction (i.e., in a direction toward the first arm holder120), the second cable is pulled and since the second cable130is attached at its opposite end to the inner edge of the first arm holder120, the first arm holder120likewise moves in a direction toward the second arm holder130.

Thus, the movements of the unaffected arm are mimicked (mirrored) in the affected arm. A number of advantages are obtained by using the motion of the unaffected (or less affected) limb to train the affected one including that the brain motor system is an integral apart of the rehabilitation process as compared to other systems, such as the robotic ones described above, where a robotic arm moves the affected limb. In addition, the device100is configured for ease of use and importantly may be used in a patient's home, and/or as a modular part of the complete workstation (see description below) in a therapeutic facility or gymnasium. This is in direct contrast to the complicated robotic systems or devices that use electrical stimulation to induce muscle contractions in an affected arm or when compared to visits to a physical or occupational therapist who must manually perform repeated movements on the affected limb alone. The large size and high cost of the above-mentioned devices required them to be stationed at a hospital, clinic or the like. Also, stroke patients have only a limited amount of therapy that is covered by a typical insurance policy and therefore since the present device is relatively inexpensive, patients can continue home-based rehabilitation without a worry or concern about insurance coverage. This and the other devices described herein also enable patients to conduct range-of-motion therapy within their own homes. Restricted range of motion, which typically occurs after a stroke, can cause pain, impair function, and increase the risk of skin breakdown and skin sores. In order to reduce these complications of stroke, range-of-motion exercises are performed on almost all stroke patients by physical therapists in the therapeutic setting. The inexpensive devices described herein could be used to supplement range-of-motion therapy patients initially receive when still covered by insurance, but more importantly enable them to continue this important therapy at home long after they are forced to leave the therapeutic setting. It will also be appreciated that the unaffected arm can equally be the left arm and the same movements described above result when the patient moves his or her unaffected arm in either a direction toward the right arm or in a direction away therefrom.

It will be appreciated that the device100is not limited to being based on a cable/pulley system to cause the desired movements described herein and in particular, to cause the driven movement of one arm by means of an active device cause a mirrored movement in the other arm by means of a passive (slave) device. For example, a system based on gears can be provided to accomplish the aforementioned motions.

More specifically, the device100is merely an exemplary embodiment that discloses a mechanism to create mirrored motions in both the unaffected arm and the affected arm. In other words the present invention is directed to a device in which a first support or holder on which an unaffected arm is placed is operatively coupled to another second support or holder on which an affected arm is placed such that when the patient moves the first support under his or her own action, the second support is driven in the same manner as a result of it being operatively coupled to the first support as opposed to being moved under the patient's action.

InFIG. 19, a device2200is disclosed and includes the base110which has one or more interior compartments (spaces)111formed therein. The device2200includes the first arm holder120and the second arm holder130with each holder being pivotally attached to the base110via a pivot shaft (rod)2202. The holders120,130thus rotate in an arc across the top surface of the base110as shown by the arrows inFIG. 19. The user's elbows are placed above the pivot rods2202and the forearms are preferably secured with straps formed of hook and loop material.

InFIG. 19, a device2200is disclosed and includes the base110which has one or more interior compartments (spaces)111formed therein. The device2200includes the first arm holder120and the second arm holder130with each holder being pivotally attached to the base110via a pivot shaft (rod)2202. The holders120,130thus rotate in an arc across the top surface of the base110as shown by the arrows inFIG. 19. The user's elbows are placed above the pivot rods2202and the forearms are preferably secured with straps2210formed of hook and loop material.

Each pivot rod is secured in the center hole of a circular pinion2220,2222, with the pinion2220being associated with the left (first) pivoting holder120and the pinion2222being associated with the right (second) pivoting holder130.

The device2200includes a pair of racks that engage the teeth of the pinions2220,2222and in particular, the device2200includes a first rack2230and a second rack2240(all pinions and racks are located within the interior space111). The racks2230,2240are elongated racks with the rack2230including a first set of teeth2232that are formed along one face or edge of the rack, while the rack2240includes first and second sets of teeth2242,2244formed on opposite faces/edges. Each pinion2220,2222engages the teeth of a rack that slides linearly in a track. In other words, the racks2230,2240slide linearly within respective tracks. The distance between the left and right pivot shafts (rods)2202and therefore, the angles of the racks2230,2240are adjusted according to the shoulder width of the user. The pivot shafts2202can be secured anywhere a along a guide channel or groove (e.g., a 5″ groove) that angles away from the user and is cut through the top face of the device2200.

A circular linking pinion2250is rotationally disposed within the interior compartment111at a location between the holders120,130. The first set of teeth2242engages the teeth of the pinion2222, while the second set of teeth2244engages the teeth of the linking pinion2250. The teeth of the linking pinion2250engage teeth of both racks in that the circular linking pinion teeth engages the teeth2232and the teeth2244. In particular, the second rack2240engages the teeth of the linking circular pinion2250on the pinion's top half, while the first rack2230engages the linking pinion2250on the bottom half. As a result, all pinions2220,2222,2250move simultaneously. Clockwise rotation of one pivoting arm120,130produced counterclockwise rotation of the other120,130. Similarly, counterclockwise rotation one arm120,130produces clockwise rotation of the other.

The result is that the motion of the unaffected arm causes a mirrored motion in the affected arm. Thus, the unaffected arm “trains” the affected arm.

It will be appreciated that other types of mechanical mechanism for linking the two holders120,130can be provided to ensure the desired motions result.

Finger and Thumb Extension/Flexion Trainer

Now referring toFIGS. 4-10, a finger and thumb extension/flexion training device (trainer)200is illustrated. As described in more detail below, the device200is designed to train individual fingers (and thumb) during a rehabilitation session and therefore is a form of isolation treatment. However, the same device200can be used to rehabilitate all fingers and the thumb of an affected hand. Similar to the device100described above, the device200is predicated on the unaffected fingers and thumb “training” the affected fingers and thumb.

The device200includes a first unit210for use with the paretic (affected) forearm and a second unit300for use with the unaffected forearm. For reasons discussed below, the first unit210can be thought of as the trainer (slave device), while the second unit300can be thought of as the facilitator or driven device.

The second unit300is simpler in terms of its construction and therefore, will be described first. The second unit300includes a box-like structure or housing310that includes a base or floor312and a pair of upstanding, spaced side walls320,330that are coupled to side edges of the base312. The base312is generally rectangular in shape to accommodate the forearm of a patient. As shown in the figures, the side walls320,330do not extend completely to a front edge314of the base312. The second unit300also includes a platform316that is elevated relative to the base312and extends thereover. In particular, the platform316is spaced above the base312and between the side walls320,330so to define an interior compartment315that is located below the platform316.

A front edge of platform316extends to or approximately to a front edge of the side walls320,330. Similarly, a rear edge319of the platform316extends to or approximately to a rear edge of the side walls320,330. The platform316can be adjustable to accommodate forearms of differing dimensions.

Each of the side walls320,330includes an arm340that extends forwardly. The arm340can be an integral part of the side wall. A distal end342of the arm340is located between a front edge314of the base312and the front edges of the platform316and side walls320,330, respectively. The arms320,330are disposed at an elevated height relative to the platform316.

The unit300includes a cross bar350on which a palm of the unaffected hand is placed. In particular, the cross bar350extends between the side walls320,330at a location that is near the front edge of the platform316. The cross bar350can be mounted to lower edges of the arms340and therefore, the cross bar350is elevated and spaced above the platform316. The cross bar350is at an angle so that the palm rests at an approximately 45° on the cross bar350.

The flat face of the cross bar350that receives the hand's palm can be coated with a foam or some other padded member for comfort.

On an underside of the cross bar350that faces the upper surface of the platform316, a plurality of cable routing members360can be provided. The cable routing members360can be in the form of eyelets or the like and include bounded openings that can receive and route a cable (cord) or the like as discussed below.

Each of the arms340can include a slot370for adjustment of the cross bar350to accommodate different sized patients. For example, the slots370are spaced across from one another and extend completely through the arm from the upper edge to the lower edge. The slots370can thus be elongated slots that receive fastening members that are coupled to the cross bar350such that the cross bar350can be moved forward and rearward within the slots370and thereby adjust the location of the cross bar350relative to the platform316.

The base312includes a front pin or shaft380that extends across the base312near the front edge of the base312. The front shaft380extends between two upstanding support members390that can be integral to the base312. In one embodiment, the front shaft380is a metal pin; however, it can also be formed as a plastic pin or from some other suitable material. As shown inFIG. 4, the front shaft380is slightly elevated above the upper surface of the base312to permit routing of the cable (cord) as described below. The front shaft380can be fixed relative to the support members390.

A securing feature is provided for making sure that the forearm is maintained along the platform316. For example, a pair of slots395can be formed in the side walls320,330above the platform316to allow a strap, such as a hook and loop strap, to be routed through one slot across the top of the forearm and then through the other slot395. The strap can securely anchor the forearm within the unit300and more specifically, the forearm is maintained along the platform316between the side walls320,330and arms340thereof.

The unit300can also have additional cable routing features and in particular, the unit300can have a lower shaft396that extends between the side walls320,330near the front edges thereof and at a location that is forward to the front edge of the platform316. As with the front shaft380, the lower shaft396can be a metal pin or it can be a plastic pin, etc., and it can be fixed relative to the sidewalls320,330. The unit300can also have a first lower cable routing member398and a second lower cable routing member399. The first lower cable routing member398is located at a lower portion of the front edge of side wall320, while the second lower cable routing member399is located at a lower portion of the front edge of the side wall330.

The first unit210will now be discussed in detail. As previously mentioned, the first unit210is for use with the paretic (affected) forearm. The first unit210can share a number of components and be constructed similar to the second unit300as will be appreciated by the drawing figures.

More specifically, the first unit210has a box-like structure or housing212that includes a base or floor214and a pair of upstanding, spaced side walls220,230that are coupled to side edges of the base214. The base214is generally rectangular in shape to accommodate the forearm of a patient. As shown in the figures, the side walls220,230do not extend completely to a front edge215of the base214. The first unit210also includes a platform216that is elevated relative to the base214and extends thereover. In particular, the platform216is spaced above the base214and between the side walls220,230so to define an interior compartment217that is located below the platform216.

A front edge219of platform216extends to or approximately to a front edge222of the side walls220,230. Similarly, a rear edge221of the platform216extends to or approximately to a rear edge223of the side walls220,230. The platform216can be adjustable to accommodate forearms of differing dimensions.

Each of the side walls220,230includes an arm240that extends forwardly. The arm240can be an integral part of the side wall. A distal end of the arm240is located between the front edge215of the base214and the front edges219,222of the platform216and side walls220,230, respectively. The arms220,230are disposed at an elevated height relative to the platform216.

The unit210includes cross bar350on which a palm of the unaffected hand is placed. In particular, the cross bar350extends between the side walls220,230at a location that is near the front edge219of the platform216. The cross bar350can be mounted to lower edges of the arms240and therefore, the cross bar350is elevated and spaced above the platform216. The cross bar350is at an angle so that the palm rests at an approximately 45° on the cross bar350relative to the platform.

The flat face of the cross bar350that receives the hand's palm can be coated with a foam or some other padded member for comfort.

On an underside of the cross bar350that faces the upper surface of the platform216, a plurality of cable routing members360can be provided. The cable routing members360can be in the form of eyelets or the like and include bounded openings that can receive and route a cable (cord) or the like as discussed below.

Each of the arms240can include slot370for adjustment of the cross bar350to accommodate different sized patients. For example, the slots370are spaced across from one another and extend completely through the arm from the upper edge to the lower edge. The slots370can thus be elongated slots that receive fastening members that are coupled to the cross bar350such that the cross bar350can be moved forward and rearward within the slots370and thereby adjust the location of the cross bar350relative to the platform216.

Securing feature is provided for making sure that the forearm is maintained along the platform216. For example, slots395can be formed in the side walls220,230above the platform216to allow a strap, such as a hook and loop strap, to be routed through one slot across the top of the forearm and then through the other slot395. The strap can securely anchor the forearm within the unit300and more specifically, the forearm is maintained along the platform216between the side walls220,230and arms240thereof.

The first unit210includes a horizontal support member260in the form of a cross bar that extends between the distal ends of the arms240. The horizontal support member260is elevated relative to the arms240in that a pair of upstanding vertical support members or legs262is provided and are attached to the distal ends242of the arms240. The horizontal support member260extends between the upper ends of the vertical support members262and is fixed thereto. As shown in the figures, the length of the horizontal support member260is greater than the distance between the outer faces of the side walls220,230and therefore, first and second ends262,264, respectively, of the horizontal support member260extend beyond the side walls220,230and are accessible. At the first end262, a first opening or bore263is formed, while at the second end264, a second opening or bore265is formed.

At and near the front edge215of the base214, a second housing270is provided and includes a pair of upstanding walls272that are coupled to the sides of the base214. A ceiling member274extends between the upstanding walls272and is elevated and spaced above the base214. The ceiling member274is a planar member that is disposed parallel to the base214. The width of the ceiling member274is not as great as the lengths of the upstanding walls272and therefore, it terminates prior thereto.

A locking mechanism280is also provided as part of the second housing270. The locking mechanism280includes a first bracket or wall282and a second bracket or wall284that is spaced from the first bracket282so as to define a gap or space285. The brackets282,284extend across the ceiling member274and are disposed parallel to one another with the bracket282being located along one edge (front edge) of the ceiling member274and the other bracket284being located along the other edge (rear edge) of the ceiling member274. The space285thus extends across the ceiling member274and can be thought of as a guide channel. The locking mechanism280includes a plurality of restraining bars290that are adjustable mounted to the brackets282,284. As shown in the figure, there are five (5) restraining bars290that each is independently adjustable and in particular, each, when in an unlocked position, can slide between an engaged position and a retracted position. More specifically, each restraining bar290is in the form of an elongated bar290(e.g., a rectangular shaped bar) that has a slot292formed therein to permit such sliding motion. A fastener295is disposed through the slot292and through the space285for locking the restraining bar290in either the engaged position or the retracted position. The fastener295can be any number of different types of fasteners that offer quick release characteristics in that the fastener295can be easily manipulated (loosened) to permit the sliding adjustment of the restraining bar290to its desired position.

In the engaged position, the restraining bar290is moved rearwardly toward the platform216as described below. Conversely, in the retracted position, the restraining bar290is moved forwardly away from the platform216.

Unlike the second unit300, the first unit210has a counter force or biasing mechanism400to provide resistance and to provide a return force as described in detail below with regard to the discussion of the operation of device200. The mechanism400includes a number of components that are pivotally coupled to one another. In particular, the mechanism400includes a first pin or shaft410that extends between the side walls220,230near the front edges thereof. The shaft410can be fixed relative to the side walls220,230and is located slightly below the underside of the platform216. The mechanism400also includes a second pin or shaft420that is coupled at its ends to the upstanding walls272and extends across the base214. The second shaft420is slightly spaced above the upper surface of the base214.

The mechanism400further includes a plurality of levers430are provided. Each lever430includes a first end432and an opposing second end434, with the second end434being pivotally coupled to the first shaft410. The lever430is an elongated bar like structure, such as a thin metal bar. The first end432is coupled to the second shaft420by means of a biasing member440. More particularly, the biasing member440is in the form of a coil spring that is rotatably attached at one of its ends to the second shaft420and is rotatably attached at its other end to the second end434of the lever430.

There are five (5) levers430that are spaced across the base214.

The mechanism400also includes a plurality of mechanical linkages450with there being one linkage450for each lever430. Each linkage450has a first end452that is pivotally coupled to a pivot point formed along the length of a respective lever430. The pivot point is located closer to the first end432of the lever. A second end454of the linkage450is pivotally coupled to a finger restrainer500that is intended to securely hold a finger. For example, the finger restrainer500can be in the form of an adjustable strap that has a loop shape and is formed of hook and loop material. The finger restrainer500can be pivotally coupled to linkage450using a ring505, as shown, that can freely move relative to both the linkage450and finger restrainer500.

Unlike the second unit300, the first unit210includes a pivotable facilitator cross bar510. The facilitator cross bar510has a first end512and an opposing second end514and can have a non-linear shape as shown. More specifically, the facilitator cross bar510can have a first portion515that terminates in the first end512and is intended for coupling to the first unit210and a second portion517that terminates in the second end514. The first and second portions515,517are not collinear but rather there is a curved center transition region519there between which causes the first and second portions515,517to lie in different planes. The facilitator cross bar510includes a top surface or edge511and an opposing bottom surface or edge513. The facilitator cross bar510generally has a stretched (elongated) S shape.

The facilitator cross bar510is rotatably coupled to the horizontal support member260at the center transition region519. In particular, a fastener525can be passed through a bore formed through the center transition region519and then through the first opening263formed at the end262of the horizontal support member260. The fastener525can be in the form of a bolt or the like or some other type of fastener that can be easily loosened and removed and also easily tightened.

In one embodiment where the left hand is the affected hand, the facilitator cross bar510is oriented so that the first portion515is located adjacent the horizontal support member260that is part of the first unit210.

The facilitator cross bar510includes a number of cable routing members to assist in cable routing as described below. For example, the first portion515can include a first set of cable routing members532that extend along the top surface511and a second set of cable routing members534that extend along the bottom surface513. In contrast, the second portion517only includes a single set of cable routing members536that unlike the first portion515, these set of cable routing members536are not located along the top surface511and bottom surface513but rather they are located along a front edge of the second portion517. The cable routing members can be in the form of eyelets or other structures that have bounded openings to permit a cable or the like to pass therethrough. Each of the sets of cable routing members532,534,536includes 4 cable routing members that are spaced apart form one another across the respective edge of the cross bar510.

The second unit300includes at least one second cable (cord)600that includes a first end602and an opposing second end604. In one embodiment, there are at least four second cables600with each finger of the unaffected hand having an associated second cable600. Each second cable600is connected to the second unit300by attaching the first end602to one of the cable routing members536and then routing the cable600downward to the front shaft380where the cable600is looped therearound and then optionally routed to the rear shaft396where it is looped therearound and then extends upwardly toward the platform316. When the cable600does not engage the rear shaft380, the cable600simply is routed upwardly from the front shaft380toward the platform316. The second end604is connected to a finger restrainer610that is intended to securely hold a finger. For example, the finger restrainer610can be in the form of an adjustable strap that has a loop shape and is formed of hook and loop material that permits attachment of the finger restrainer610to one finger.

It will be appreciated that there are four cable routing members536that are spaced apart with each cable routing member536being associated with one finger of the hand. Thus, in use, there are four second cables600that are attached at first ends thereof to the cable routing members536and are routed about the front shaft380to allow each finger to have a finger restrainer610attached thereto.

It will be appreciated that up and down movement of one finger will cause the second portion517of the facilitator cross bar510to move since the cross bar510pivots about the pivot pin (fastener525). For example, when a finger is raised by the patient, the second cable600is pulled upward due to the routing of the second cable600and since the first end of the second cable600is directly attached to the second portion517of the facilitator cross bar510(i.e., the cross bar510pivots in a clockwise direction). As described below, this pivoting motion of the facilitator cross bar510results in actuation of the second unit300which acts as a training unit.

More specifically and similar to the second unit300, the first unit210includes at least one and preferably a plurality of cables (cords)700each of which is associated with one finger. More specifically, there are four cables700, one for each of the four fingers of the affected hand. Each of the cable700has a first end702that is attached to a corresponding cable routing member534(formed along the bottom surface513) of the first portion515. An opposite second end704is connected to a finger restrainer710that is intended to securely hold a finger. For example, the finger restrainer710can be in the form of an adjustable strap that has a loop shape and is formed of hook and loop material that permits attachment of the finger restrainer710to one finger.

It will be appreciated that there are four cable routing members534that are spaced apart with each cable routing member534being associated with one finger of the hand.

The cables700thus directly attach each finger to the first portion515of the cross bar510.

When the second portion517is pulled downwardly as described above due to a healthy (unaffected) finger being raised (extended), the first portion515is pivoted upward (clockwise motion of the bar510), thereby raising the individual finger that is being rehabilitated (affected finger) since the cable700is attached therebetween. As a result, the finger motion of the unaffected hand is mirrored in the finger motion of the affected hand since the raising of unaffected finger causing extension of the affected finger.

As the finger of the affected hand is raised (a motion from the rest position ofFIG. 6to the extended position ofFIG. 7), the mechanism400is actuated due to the same raised finger being coupled to the finger restrainer500. In particular, the raising of the affected finger causes the linkage450to pivot upward about the pivot point defined along the lever430and assume a more vertical position. As the affected finger is continually raised, the linkage450is likewise raised causing the lever430to pivot upward about the first shaft410. Since the lever430is connected to the biasing member440at its other end (that is being raised), the biasing member440begins to store energy as shown inFIG. 7. This continues until the extension of the unaffected finger is completed (and the extension of the affected finger is completed).

As the unaffected finger is lowered back down toward a rest position (FIGS. 5 and 6), the force applied by the cable700is decreased due to the pivoting of the cross bar in an opposite direction (counter clockwise); however, a return force is generated by the mechanism400due to release of the stored energy of the biasing member440. In particular as the cross bar510pivot counterclockwise, the biasing member440releases its stored energy and biases “pulls” the lever430downward and since the linkage450is pivotally coupled to the lever430, the linkage450and finger restrainer500are also drawn downward. The relationship between the decrease of the force applied by the cable700and the release of stored energy causes a mirroring between the lowering motion of the unaffected finger and the affected finger. In other words, in both the raising and lowering of the unaffected and affected finger, the actions in both fingers are smooth and mirror one another and in effect, the unaffected finger trains the affected one.

As described above, any given lever430can be prevented from moving (and thereby prevent finger extension) by sliding the restraining bar290over the distal end (second end432). The present device thus allows for finger isolation since one finger can be rehabilitated at one time by moving the respective restraining bar290to the retracted position for that one finger and leaving the other restraining bars290in the extended position. It also allows for flexibility in training a few or all of the fingers, if desired, by releasing the restraining bars of more than one finger.

FIGS. 4 and 8show another aspect of the device200and in particular, these figures show that the device200can be used to train either the left hand or the right hand.FIG. 8shows the units210and300arranged where the right hand is the affected hand, whileFIG. 4shows the units210,300arranged where the left hand is the affected hand. The device200easily converts and changes between these two setups by simply removing the horizontal cross bar510from the first opening263and then pivoting the horizontal cross bar510to thereby change (reverse) the locations of the first and second portions515,517before inserting the fastener525into the second opening265as shown. The operation of the device200remains the same.

The affected thumb can also be rehabilitated with the device200. Referring toFIGS. 9 and 10, in order to rehabilitate an affected thumb, a cable (cord)900is provided and includes a first end902and an opposing second end904. Unlike the other cables, cable900has a first thumb restrainer910(e.g., adjustable strap of hook and loop material) disposed at the first end902and a second thumb restrainer920(e.g., adjustable strap of hook and loop material) disposed at the second end904. The first thumb restrainer910is attached to the thumb of the unaffected hand and the cable900is routed across the cable routing members360, down through the cable routing member398across the cable routing member399and is then routed upwardly toward the first unit210where the second thumb restrainer920is attached to the affected thumb.

As with rehabilitation of the fingers, there is a counterforce/return force mechanism for the thumb that includes some of the components of mechanism400. In particular, the lever430that is closes to the wall230is designated as the lever for use with the thumb. Instead of having the second end454directly attached to a restrainer, the second end454is attached to a first end932of a cable (cord)930that is routed upwardly into and through the cable routing members534across toward the affected thumb. An opposite second end934of the cable (cord)930is attached to a third thumb restrainer940that is attached to the affected thumb and is located adjacent the second thumb restrainer920.

FIG. 9shows a rest position of the thumbs prior to extension thereof, whileFIG. 10shows the thumbs in the extended positions. In operation, the unaffected thumb is extended in the direction indicated inFIG. 10and this causes the cable900to be pulled across the cable routing members536. As a result of the routing of the cable900, this motion causes the affected thumb to be extended in a direction toward the unit300(toward the other thumb). The extension of the affected thumb also causes the cable930to be moved along the cable routing members534and the linkage450and lever430are raised thereby causing the biasing member440to store energy.

Once the extension motion is completed, the return force mechanism causes controlled movement of the thumb as the unaffected thumb is moved in the same direction back towards the index finger (flexion). The release of the stored energy is smooth and causes the flexion of the affected thumb to mirror the unaffected thumb.

As with the previous embodiment, the rehabilitation of an affected thumb using the device200is grounded in the principle that there are a number of advantages in having the unaffected thumb “train” the affected thumb.

The above thumb motions can be continued in a successive manner as part of the rehabilitation process and the mechanisms described above will ensure a smooth controlled movement of the affected thumb that mirrors and is caused by the same motion of the unaffected thumb.

Now referring toFIGS. 35-40, a finger and thumb extension/flexion training device (trainer)4000is illustrated and is similar to the device200described previously. As described in more detail below, the device4000is designed to train individual fingers (and thumb) during a rehabilitation session and therefore is a form of isolation treatment. Similar to the device200described above, the device4000is predicated on the unaffected fingers and thumb “training” the affected fingers and thumb.

The members that are present in both devices200and4000are numbered alike and are not described in great detail again. Reference is made to the description of those members in the description of the device200.

The device4000includes a first unit4010and a second unit4020that unlike the units of the device200are preferably the same or similar in term of its construction. At the ends of the spaced arms340of each unit, a number of cross members are provided and extend across the arms340. First, a hand grip bar4030is coupled at its ends to the arms340. The bar4030can be a round bar on which the hand of the patient is rested above the platform319. The bar4030can be fixedly attached to the arms340or it can be rotatably mounted to the arms340.

The device4000includes a finger clamp frame4100that is pivotally mounted to the ends of the arms340. The finger clamp frame4100has a front frame member4102and a rear frame member4104and two side frame members4106that connect the members4104,4102at ends thereof. As illustrated, the finger clamp frame4100has a rectangular shape with a hollow center. Each of the front and rear frame members4102,4104includes a slot4110. The slot4110can be a linear slot and the two slots4110of the frame members4102,4104are spaced across from one another and axially aligned with one another.

The side frame members4106are pivotally mounted to the ends of the arms340using with a pair of rotatable links (elongated brackets)4120. The links4120can be attached to the side frame members4106using conventional techniques, such as the use of fasteners, and preferably, the links4120are attached in a manner that permits the finger clamp frame4100to be easily removed (detached from the arms340). For example, a thumb nut of the like can be used to attach the frame4100to the links4120. The links4120are mounted to the arms340about pivot points such that the entire finger clamp frame4100can pivot about the axis that extends through the pivots formed at ends of arms340. This permits the finger clamp frame4100to be raised and lowered during operation of the device4000as described herein.

Unlike the device200, the device4000includes a plurality of finger clamps4200that is best shown inFIGS. 39-40. The finger clamp4200includes a body4210that has a first end4212(top end) and a second end4214(bottom end). The body4210has an opening4215formed therein. The opening4215can have an oval or circular shape and is configured to receive and hold a finger. The body4210also includes a second through opening4217that is closer to the top end4212. The illustrated opening4217has a square shape.

At the top end4212, a first slot4240is formed and is in communication with the opening4215and a notched opening or slot4250is formed and is likewise in communication with the opening4215. The first slot4240is formed near one side and the notched opening4250is formed near the other side. The slot4240and notched opening4250are on opposite sides of the opening4217. In addition, a thru bore4260is formed and is in communication with the opening4217. The thru bore4260receives a set screw (fastener) that can enter the opening4217.

The slot4240and the notched opening4250are designed to receive an adjustable strap4270that is designed to be tightened so as to capture the patient's finger. More specifically, the patient's finger is captured between the strap4270and an upper wall (curved wall)4219of the opening4215. As the strap4270is tightened, the space between the strap4270and the upper wall4219decreases and conversely, as the strap4270is loosened, the space increases. The upper wall4219can include padding.

The strap4270can be formed of any number of different materials so long as the strap4270can flex and one end4271of the strap can be routed through the clamp by being inserted into the slot4240and pass into and through the opening4215and then up into and through the notched opening4217. The other end4273of the strap4270has an enlarged thickness that prevents it from passing into the slot4240. When installed, the strap4270has a U-shape.

The finger clamp4200has a means for releasably locking the strap4270in a desired position. More particularly, the means can be in the form of a pivotable lock member4280that is disposed within the notched opening4217. The lock member4280pivots about a pin or shaft4282that extends across the notched opening4217. The lock member4280has a locking edge4284and another edge4285that is freely accessible to the operator and can be pressed to cause an unlocking of the lock member4280. The lock member4280is biased to the closed position by biasing members4286(e.g., springs) and therefore, the locking edge4284is biased against the strap4270that passes through the notched opening4217. The lock member4280can thus be thought of as a release button since the operator manipulates the lock member4280to cause a release of the strap4270.

To adjust the position of the strap4270, the edge4285of the lock member4280is pressed to cause a pivoting of the lock member4280and the locking edge4284is removed from contact with the strap4270. The strap4270is now free to move and the operator can adjust the strap4270by either pulling the strap4270up (to tighten) or by pulling the strap4270down (to loosen).

As shown inFIG. 38, at the second end4214, a pair of spaced tabs or fingers4220is formed and each includes an opening4222. The two openings4222are axially aligned with one another. The spaced fingers4220permit each finger clamp4200to be coupled to a respective mechanical linkage450that is connected to one lever430. The mechanical linkage450is attached to the finger clamp4200by inserting one end of the linkage450between the fingers4220and then passing a fastener through opening4222in one finger4220, through an opening in the one end of the linkage450and then through the opening4222in the other finger4220. A nut or the like can be used to securely attach the fastener (e.g., a pin or shaft) to the finger clamp4200. In this manner, each finger clamp4200can be attached to the respective levers430which are themselves attached to biasing members440as described herein. The pivotable lever430can thus be raised by lifting the finger clamp4200that is directly attached thereto and conversely, the biasing member440creates a return force that lowers the lever430and the attached finger clamp4200.

It will be appreciated that the linkage450can actually be more than one linkage that is attached between the finger clamp4200and the lever430. For example, the linkage450can include a turnbuckle body451that is pivotally attached to the finger clamp4200and a clevis mount453for the turnbuckle body that is pivotally attached between the turnbuckle body and the lever430.

The finger clamp4200can also be selectively coupled to the finger clamp frame4100that is pivotally mounted to the ends of the arms340. In particular, when a respective finger clamp4200is to be coupled to the finger clamp frame4100a fastener, such as a rod or shaft is passed through the slot4110and then passes through the opening4217formed in the body of the finger clamp4200before then passing through the other slot4110. In order for the rod (shaft) to be locked in place, a set screw is inserted into the thru bore4260and is tightened such that it intimately engages and applies a force against the rod that passes through the opening4217. In addition, a nut or the like can be used to fasten (attach) the rod to the finger clamp frame4100.

It will be appreciated that when at least one finger clamp4200is coupled to the finger clamp frame4100, the movement of the finger contained within this finger clamp4200in one direction causes the entire frame4100to pivot in the same direction. For example, if the isolated finger within the finger clamp4200that is connected to the frame4100is raised, the frame4100will likewise be raised. The slots4110allow for some lateral movement of the finger clamp4200to better accommodate a particular patient.

It will also be understood that more than one finger clamp4200can be operatively coupled to the frame4100.

In accordance with the present invention, the frame4100is coupled to a shaft4300that extends through one arm340(the innermost arm340) such that when the frame4100pivots relative to and about the arms340, the shaft4300rotates. In other words, when the frame4100is raised due to a raising action of at least one finger clamp4200, the shaft4300rotates in a first direction and when the frame4100is lowered due to a lowering action of at least one finger clamp4200, the shaft4300rotates in an opposite second direction.

The shaft4300that is coupled to one finger clamp frame4100is operatively connected to the shaft4300that is coupled to the other finger clamp frame4100such that rotation of one shaft4300is translated into rotation of the other shaft4300. In this manner and similar to the mechanics of the device200, the motion of one finger causes a mirror action or motion in the other corresponding finger. For example, if the index finger of the left hand is the healthy finger and the index finger of the right hand is the affected finger, at least one finger (such as the index finger) of the left hand is mounted to a finger clamp4200that is attached to the frame4100. The affected finger (index finger) of the right hand is likewise mounted to a finger clamp4200that is attached to the other frame4100. When the healthy finger is moved, the device4000is configured so that the affected finger moves in the same manner similar to the finger motions in the device200.

In one embodiment, the two shafts4300are operatively coupled to one another by means of a gear arrangement that is constructed so that rotation of one shaft4300is translated into rotation of the other shaft4300. In one embodiment, a gear box is used to couple the two shaft4300to one another.

FIG. 34shows one exemplary first gear box3600that includes multiple operating modes. In particular, there are three settings for the gear box3600: synchronous (in-phase), synchronous (180 deg out-of-phase) (reverse), and independent. In the in-phase synchronous setting, the gear box transmits the rotational force applied by one side to the opposite side in the same direction and at the same time. In the out-of-phase synchronous setting, the gear box transmits the force applied by one side of the body to the opposite side of the body at the same time but in the exact opposite direction. In the independent setting, the two sides of the body perform independently.

There are many possible configurations of the gearing that will produce the three settings. One such configuration is illustrated inFIG. 34. In this configuration a series of either spur (shown in the drawing) or helical gears are arranged in such a manner that circular force applied at the INPUT SHAFT and therefore GEAR1can be transferred to GEAR7and therefore the OUTPUT SHAFT in one of two manners: in-phase or out-of-phase.

For an in-phase transfer, the gear box is shifted to a position that engages GEAR3and GEAR6. In this gear box setting, GEAR5is disconnected from GEAR7. A clockwise circular force applied at the INPUT SHAFT and therefore GEAR1turns GEAR2counterclockwise. The counterclockwise motion is maintained during the transfer to GEAR3and then GEAR6. Counterclockwise motion of GEAR6then causes GEAR7to turn clockwise, which returns the force to the same clockwise direction as the initial input at the INPUT SHAFT.

For the out-of-phase transfer, the gear box is shifted to a position that engages GEAR3, GEAR4, GEAR5, and GEAR6. In the out-of-phase setting GEAR3is disconnected from GEAR6, which now rotates freely with GEAR7. A clockwise force at the INPUT SHAFT and therefore GEAR1causes GEAR2and therefore GEAR3to turn counterclockwise. GEAR3causes GEAR4to turn clockwise. GEAR4causes GEAR5and therefore GEAR7and the OUTPUT SHAFT to turn counter-clockwise, which is the reverse of the initial input at the INPUT SHAFT.

The gear box can also be shifted to a position that disconnects the INPUT SHAFT from the OUTPUT SHAFT.

The connection and disconnection of the various gears can also be achieved by the use of dog clutches, which are shifted to one of three positions depending on the setting (i.e. in-phase, out-of-phase, or independent).

The gear box3600can include a selector3605that permits the operating mode of the gear box3600to be changed into any one of the operating modes, such as the three operating modes. By using the gear box3600, the rotation of the two shafts4300can be in synch or out of synch as described above. It will be appreciated that other mechanisms besides gear box3600can be used so long as the mechanism translates motion from one shaft3400to the other shaft3400in the manner described herein.

For a detailed discussion of the rehabilitative exercises and other features, such as the thumb guard, etc., see the discussion of the device200.

Now referring toFIGS. 20-22B, a finger abduction-adduction trainer (device)2300is illustrated. The device2300enables a patient with unilateral hand weakness to exercise muscles that adduct and abduct the fingers. Using this device, muscles in the palm of the unaffected hand adduct and abduct its fingers toward and away from the middle finger, and facilitate the same movements in the affected hand.

The device2300has two levels and in particular, the device2300includes a first base2310and a second base2320that is spaced above the first base2310such that a space is formed between the underside of the second base2320and the first base2310. The bases2310,2320are parallel to one another. The second base2320has a width that is less than a width of the first base2310and therefore, the second base2320only partially covers the first base2310. The hands rest on the upper level (second base2320) such that the fingers of both hands extend over the first base2310.

The working components of the device2300are disposed within the space2330and along the first base2310and similar to the other embodiments, the device2300is configured so that movement of the unaffected fingers by the user is mirrored in movement of the affected fingers. The working components includes a plurality of pivoting levers and in particular, there are eight total pivoting levers since each finger is coupled to a pivotable lever except for the middle fingers of each hand which are fixedly held. InFIGS. 20-21, there are only four pivoting levers2330for ease of illustration; however, it will be appreciated once again that there are a total of eight levers2330when the device2300is fully assembled. The levers2330are pivotally mounted at their distal ends to the second base2320to permit pivoting of the levers about a pivot point that is perpendicular to the first and second bases2310,2320.

The levers2330extend outwardly over the first base2310. In order to support and hold a finger, each of the levers2330has a finger/thumb receiving member (not shown) that is contoured and constructed (e.g., concave shaped and can include padding) so that the user's finger is received and held therein. Securement features, such as straps formed of hook and loop material, hold each finger and thumb within their respective receiving member. Since the levers2330are located below the plane of the second base2320, risers2340can be used to sufficiently support and elevate the receiving members (not shown) so that when the user' hands rest on the second base2320, the fingers/thumbs rest comfortably within the receiving members. An upper surface of the risers2340lies approximately in the plane containing the upper surface of the second base2320.

Each of the corresponding matching finger pairs (e.g., index fingers of both hands) are mechanically coupled to one another such that the abduction and adduction movements of the unaffected hand are mirrored in the affected hand. In other words, if the user abducts his/her index finger in the unaffected hand, then the index finger in the affected hand also undergoes an adduction movement due to the mechanical coupling mechanism.

The hand positions and the levers are adjustable to align the pivot point of each finger at the pivot point of its respective lever. In addition, each pivoting lever can be moved along a track2370(FIGS. 22-23) to permit accommodation of hands of different sizes. The lever can be locked in place within the track using conventional techniques including the use of a fastener.

The mechanical coupling mechanism can be any number of different mechanisms including a cable/pulley system, an arrangement of gears, etc.FIGS. 22-23illustrate a cable and pulley system andFIGS. 20-21illustrate the groundwork for the cable/pulley system and in particular, inFIGS. 20-21, the eyelets2400that are secured to the first base2310and extend upwardly therefrom are representative of where pulleys are to be located. Cables2410are coupled to the pivoting levers such that each lever has two cables2410attached thereto and more specifically, there is a front cable2410and a rear cable2410for each lever as described below. A first cable is attached to the pivotable lever in front of the pivot point (away from the patient) and the second cable is attached to the pivotable lever in the rear of the pivot point (toward the patient). The attachments front and back are equidistant from the pivot points of each lever.

InFIGS. 20-21, the cables2410attach to vertical posts2390of the levers2330. The vertical posts2390extend form the undersides of the levers2330.

The front cable of each lever is routed via two pulleys2400to the back attachment point of the lever for the contralateral finger (e.g., the cable attached to the front of the right index finger is routed to and attaches to the back of the left index finger, etc.). The vertical distance of the cable attachment along posts2390depends on the location of that particular finger in the device2300. The attachments for the pinkies are furthest from its levers2330, while the attachments for the levers2330holding the index fingers are closest to the levers2330. That is, the cable attachments for the most medially positioned homologous pair of fingers are the shortest, while the cables for most laterally positioned homologous pair are the longest.

The cables run parallel to the upper and lower bases2310,2320on their routes to the opposite side. The cables remain parallel to each other and to the bases2310,2320. The stacked arrangement of the pulleys forces the cables to remain parallel. Cables from each pair of homologous fingers travel in their own level. The horizontal distance of each attachment from each lever's fulcrum is identical to that of each attachment for that pair of homologous fingers. For example, all cables for the index fingers attach 30 mm from the fulcrums of their respective levers. This ensures that equal movements of each finger results. For example, an abduction of 10° for the right index finger produces an equal abduction for the left index finger.

It will therefore also be appreciated that the pulleys are located within different planes so that the cables likewise lie in different planes to permit cable movement without cables crossing and interfering with one another.

The cables and pulleys are thus placed in such a manner to enable the index and little fingers of the unaffected hand to product identical movements of the index and little fingers of the affected hand.

The device2300is also configured for thumb abduction-adduction. The device2300enables the unaffected thumb to produce parallel abduction and adduction movements of the affected thumb. Two cables2410are attached on opposite sides of each thumb pivoting lever2330, with one cable2410attached to the left side and one on the right side. The cable2410on the outside of the unaffected thumb is routed to a pulley2400that is horizontally mounted of the device. The pulley2400is mounted medially and posterior to the unaffected thumb. The cable2410is routed through the pulley2400away from the unaffected thumb and then through a narrow cylinder to a second pulley2400on the opposite side of the affected thumb. The cable2410is then routed through a third pulley and finally attached to the inner side of the pivoting lever on the affected thumb. The outer cable of the affected thumb is similarly connected to the inner side of the lever for the unaffected thumb.

As with the other devices disclosed herein, the device2300is cost effective to manufacture while providing the advantages discussed herein.

Now referring toFIGS. 24-25, a finger abduction-adduction trainer device2500according to another embodiment is illustrated. The device2500is similar to the device2300except for the mechanical means for moving the levers in the desired motions described above. More specifically, the device2500includes four rack and pinion gear systems2550. Once again, the middle fingers of each hand are secured to finger-shaped extensions that extend out in front of the top level (base2310).FIG. 24illustrates a gear system2550for a pair of levers2330, with it being understood that the device2500contains four such rack and pinion gear systems. The four gear systems2550are mounted at four different distances from the base2310to the base2320. The gearing systems2550replace the entire pulley and cable systems shown inFIGS. 20-21.

Each gearing system2550for each finger includes a pair of pinions2560(circular pinions with teeth) and a rack2570that is disposed within a track2580. The pinions2560are located at the pivot points of the levers2330. Abducting the finger will cause one circular pinion2560to rotate in one direction and adducting the finger will cause the second circular pinion2560to rotate in the opposite direction. These two pinions2560are linked by rack2570. The teeth of one circular pinion2560move along the top of the single rack2570, while the teeth of the second circular pinion move along the bottom of the rack2570. The rack2570is mounted on an angle in order to produce this arrangement. When the left circular pinion2560clockwise, the right circular pinion2560rotates counterclockwise and vice versa. Behaviorally, when a left finger either, abducts (rotating clockwise), the homologous right finger also abducts (which moves it moves counterclockwise).

Now referring toFIGS. 11-14, a device1000is provided and is configured to function as a forearm pronation-supination rehabilitative trainer. The device1000operates in two modes, namely, a first mode in which the device enables a stroke patient to pronate and supinate the forearm of the unaffected arm in order to facilitate the same movements in the affected forearm and a second arm, in which the device enables a patient to pronate or supinate the unaffected arm in order to facilitate the opposite movement in the affected arm.

The device1000includes a housing1010that resembles a box in that it includes an interior compartment1012that contains the working components of the device1000. The housing1010includes a front surface1014. The housing1010contains a mechanism1100that effectuates the above-described movements as described in greater detail below.

The device1000includes a pair of splints1200that are attached to the patient's arms and are designed to prevent the wrist from flexing and, extending while permitting pronation and supination of the forearm. The two splints1200are mirror images of one another since one splint1200is intended for placement on the left hand, while the other splint1200is for placement on the right hand. As shown inFIGS. 12A and 12B, each splint1200includes a first part (top part)1210and a second part (bottom part)1220that together can be assembled in a clam shaped manner in that an attachment member1230connects the first part1210and the second part1220. The top part1210is thus configured to be placed against the top portion of the hand, while the bottom part1220is configured to be placed against the bottom, palm portion of the hand. Each of the top part1210and the second part1220is open ended to permit reception of the patient's forearm and permit the fingers of the hand to extend beyond the front portions of the parts1210,1220.

The first and second parts1210,1220can be releasably and adjustably attached to one another by any number of different means including but not limited to straps1240(hook and loop material) that permits the parts1210,1220to attached to one another about the hand of the patient.

The first part1210includes a first bar1240that extends outwardly from a front end of the first part1210. The first bar1240can have a U-shape and is designed to be grasped and held in the palm of the hand. The first bar1240can have a rounded bar1242that permits the patient to comfortably grasped in the palm of the hand. The second part1220has a second bar1250that extends outwardly from the front end of the second part1220. The bars1240,1250are maintained in a generally parallel manner.

The second bar1250includes a shaft component1255that extends outwardly from the front end. For example, the second bar1250can have T-shape and a more distal bar of the second bar1250is adjustable so that it can be adjusted to be just distal to the hand when the hand is in a clenched first position. At a distal end of the shaft1255, a pinion1260is disposed and in particular, the pinion1260is in the form of circular pinion.

As shown inFIG. 11, the splints1200are fixed laterally within the housing1010. In particular, the front face1014includes a first opening1015for receiving the shaft1255associated with one splint1200and a second opening1017for receiving the shaft1255associated with the other splint1200. As shown inFIGS. 11 and 14, the shafts1255are arranged parallel to one another and are located in a horizontal plane that is parallel to a ground plane.

The mechanism1100includes a first rack1300and a second rack1400which are associated with the two modes of operation. More specifically, the first rack1300is a rack that is disposed at an angle within the housing1010and includes a first (top) rack face or surface1310and a second (bottom) rack face or surface1320. Thus, each of the surfaces1310,1320includes a row of teeth1330.

The first rack1300is used in the first mode for a pronation-pronation rehabilitative exercise. In the first mode, the angled rack1300extends at an angle between the two pinions1260of the two splints1200and as a result, the teeth of one pinion1260moves along the top surface1310of the rack1300, while the teeth of the other pinion1260moves along the bottom surface1320of the rack1300. When the left circular pinion1260rotates clockwise, the right circular pinion rotates counterclockwise. Behaviorally, when the left forearm pronates (producing clockwise motion), the right forearm also pronates (a counterclockwise motion).

Rest boxes can be provided for merely supporting the elbows of each arm. These boxes are oriented in front of the housing1010and can interlockingly be coupled thereto to prevent movement of the boxes relative to the housing.

As with the other devices, the device1000, in the first mode, is designed so that pronation of an unaffected forearm causes an identical pronation motion in the affected arm. As with the other devices, one splint and one pinion act as a drive device, while the other splint and pinion are a slave device whose motion is dependent on the motion of the drive device.

In the second mode, the device1000enables a patient to pronate or supinate the unaffected arm in order to facilitate the opposite movement in the affected arm. For example, pronating the unaffected arm will aid supination in the affected arm. This is a functional movement in many tasks as for example during folding a towel.

The first rack1300is disposed within the housing1012such that it can pivot (rotate) within the housing1012as shown by arrow1013. For example, a handle or the like (shaft) can be coupled to the first rack1300at the pivot point and be accessible along the front face1014. Thus, in order to pivot the first rack1300, the user simply grasps the handle (knob) and rotates the handle to cause rotation of the first rack1300.

The second rack1400includes only one set of teeth1405formed along a top face (surface) thereof. In addition, the horizontal second rack1400is disposed within a trough or the like1500and in particular, the second rack1400can freely travel laterally within the trough1500(between the ends thereof). The trough1500is contained within vertical guide channels1510that are formed in opposing ends of the housing1010.

The trough1500can be locked into at least a first position (retracted position) shown inFIG. 14and a second position (an engaged position) where the trough1500moves upwardly in the guide channels1510until the second rack1400engages the pinions1260. Similar to the first rack1300, the second rack1400can be moved between and locked into one of the first and second positions. The trough1500can be coupled to a handle that is accessible along the front face1014. The handle can include a knob that can be grasped and a shaft can be attached to the trough1500. The shaft can pass through a vertical slot formed in the front face1014and include locking apertures along the vertical slot to permit the shaft to move vertically and be locked into one of the first and second positions. The arrow1501shows the motion of the trough1500and second rack1400between the two positions.

The second mode is achieved by rotating the angled rack1300out of engagement and then moving the second horizontal rack1400into position (engaged position) to intersect with the teeth of both circular pinions1260. In this second mode, the circular pinions1260rotate in the same direction; that is, either both rotate clockwise or both rotate counterclockwise. This action is made possible since the second rack1400can freely move laterally within the trough1500.

Once again and as with the other embodiments, the device1000can be used by patients in home settings. The device1000is simple to use and a family member or friend can assist in the setup. The device1000is very cost effective in terms of manufacturing costs compared to existing devices that use electrical stimulation to induce muscle contractions in the affected arm and when compared to costs associated with visits to a physical therapist.

Now referring toFIGS. 30-34, a device3000is provided and is configured to function as a forearm pronation-supination rehabilitative trainer. The device3000is similar to the device1000but includes additional operating modes and different comfort features to position the patient in a more optimal rehabilitative position. The device3000includes a base plate3010that includes a front edge3012, an opposing rear edge3014, a first side edge3016, and a second side edge3018. The base plate3010is part of the overall frame of the device3000. The base plate3010includes an opening3020and a plurality of slots3030is formed therein. The slots3030are linear slots that are parallel to one another and terminate at one end proximate the first side edge3016.

The frame of the device3000also includes a vertical wall3040that is coupled to the rear edge3014such that the wall3040extends vertically and is perpendicular to the base plate3010. As shown, the wall3040can be a partially hollow structure and in the illustrated embodiment, the wall3040is a hollow rectangle frame member with a diagonal support member extending between two corners of the wall3040. Any number of different fasteners can be used to attach the wall3040to the rear edge3014.

The frame of the device3000also includes a pair of mounting vertical plates3050. Each plate3050includes a bottom end3052that attaches to the opposing side edges3016,3018and an opposite top end3054. The plates3050are attached to the side edges3016,3018at locations proximate the wall3040.

The device3000also includes a pair of elbow support members and more specifically, the device3000includes a fixed elbow support member3100and a movable elbow support member3200. The fixed elbow support member3100includes a base plate3110that has a pair of parallel tracks formed therein along side edges thereof. The base plate3110has a plurality of openings3112formed therein for receiving fasteners that pass therethrough and pass through openings3015that are formed in the base plate3010near and along the second side edge3018. The multiple openings3112,3015permit the base plate3110to be moved to adjust the degree or length of the base plate3110that extends beyond the front edge3012of the base plate3010.

The elbow support member3100includes a lower elbow plate3120that has a C-channel member3125in the formed of a rail attached thereto along an upper surface of the plate3120. The support member3100includes a second elbow plate3130that has at one end a bottom elbow pad plate3132and at an opposite end has a base plate3134. In between the two plates3132,3134, a rail (slotted C-channel)3136is provided and is complementary to the C-channel member3125such that when the two members3125,3136mate together, the second elbow plate3130can be adjusted linearly relative to the lower elbow plate3120.

The bottom elbow pad plate3132receives, a bottom elbow pad3137which is in the form of a cushion. In the illustrated embodiment, the plate3132and pad3137have a square or rectangular shape. The base plate3134provides a support surface for an adjustable elbow pad that angle of which can be varied. In particular, an upper elbow pad plate3140is pivotally attached to the base plate3134at one end thereof. For example, a hinge3141can be used to attach the pad plate3140to the base plate3134. The upper elbow pad plate3140receives and is coupled to an upper elbow pad3145(cushion). In the illustrated embodiment, the plate3140and the pad3145are rectangular shape.

The angle of the upper elbow pad plate3140and the pad3145is adjusted relative the base plate3134using a height adjusting means and in particular, the means can include a block3150that is disposed between the pad plate3140and the base plate3134and therefore, the block3150prevents the upper elbow pad plate3140from seating flush against the base plate3134. The block3150can be a tangent block that has a curved (convex) upper surface. The height adjusting means also includes a shaft3160(e.g., a jack shaft) and a hand nut3170or other structure to permit rotation of the shaft3160. The shaft3160passes through an opening (e.g., threaded bore) formed in the plate3134and rotation of the hand nut3170causes the block3150either to be raised relative to the plate3134or lowered depending upon the direction of rotation. In order to increase the angle between the upper elbow pad3145and the base plate3134, the hand nut3170is rotated in one direction to cause the block3150to be driven into contact and pivot the pad3145upward. Conversely, the pad3145is lowered by simply rotating the hand nut3170in the opposite direction.

It will therefore be appreciated that the elbow support member3100can be adjusted in several directions and in particular, the support member3100can be adjusted linearly so that it moves forward or rearward relative to the front edge3012of the base plate3010. In addition, the angle of the upper elbow pad plate3140and the pad3145can be adjusted. Both of these adjustments are designed to accommodate different sized patients and permit the patient to be comfortable when using the device3000. The patient will be in a seated position when using the device3000.

The movable elbow support member3200is similar to the fixed elbow support member3100and therefore, like elements are numbered alike. However, the support member3200includes an additional degree of adjustment. More specifically, the lower elbow plate3120of the support member3200has an outwardly extending tab3210formed along one side thereof. The tab3210can have a rectangular shape. The tab3210includes a number of openings3212arranged linearly. Fasteners3220are received within at least some of these openings3212for coupling the member3200to the base plate3010in a manner in which lateral movement and lateral adjustment of the support member3200is possible.

The fasteners3220are received within different slots3030to permit the above described adjustment. The fasteners3220can include shafts (rods) and hand nuts. To fixedly attach the support member3200to the base plate3010, the hand nuts are simply tightened. To adjust the support member3200in a lateral direction, the hand nuts are loosened and the support member3200is moved laterally (with the shafts riding within the slots3030) until the proper location is reached at which time the hand nuts are tightened.

By permitting support member3200be adjustable relative to the support member3100, the device3000accommodates different sized patients. For example, larger sized patients require the elbow support members3100,3200to be spread apart a further distance compared to a smaller patient. In an optimal rehabilitative position, the elbows of the patient are separated a comfortable distance, such as the distance between the shoulders, resulting in the elbows and arms being comfortably separated.

The device3000also includes a pair of sliding side plates3250. The side plate3250includes a plurality of slots3252formed therein. One or more of the slots3252can receive fasteners3254.

The device3000further includes a top assembly3300that includes a number of the working components of the device3000. As described herein and according to one embodiment, the top assembly3300includes a pair of handle assemblies3400that are operatively coupled to one another to permit a number of different operating modes to be selected during the rehabilitative exercise. In particular and as described below, a first operating mode is where one handle assembly3400moves in an opposite direction (opposite rotation) relative to the other; a second operating mode is a neutral position where one handle assembly3400can freely move (rotate) relative to the other handle assembly3400(i.e., the handle assemblies3400are detached from one another) and a third operating mode where one handle assembly3400moves (rotates) in the same direction as the other handle assembly3400.

The top assembly3300includes a frame that contains the various working components and can be in the form of a rectangular box like structure that has a first end3304and an opposing second end3306. The frame is thus a hollow structure that contains the working components as described below.

The handle assembly3400includes a handle back plate3410and a handle rod plate3420that is attached to one end of the back plate3410(e.g., attached at a right angle). A portion of the back plate3410includes an arm pad3430. A handle grip assembly3430is attached to and extends outwardly from the handle rod plate3420. The grip assembly3430includes a pair of spaced rods (shafts)3435that extend outwardly from the handle rod plate3420and a handle rod (shaft)3450that extends between the spaced rods3435. A hand grip pad3460is disposed about the handle rod3450. The hand grip pad3460is spaced from the plate3420by the rods3435. In use, the patient's hand and forearm are placed into the handle assembly3400such that the forearm faces and contacts the arm pad3430, with the patient's hand being disposed about the hand grip pad3460.

On the backside of the handle rod plate3420, a shaft3500is fixedly attached thereto and extends outwardly therefrom. The pair of handle assemblies3400can be thought of as a left hand assembly3400and a right hand assembly3400. Each of the handle assemblies3400is coupled to the working components in the frame3202as described below. A front face of the frame3202includes an opening through which the shaft3500of the right hand assembly3400extends. As shown in the figures, the shaft3500can be thought of as an input shaft.

One of the working components that is contained within the frame3202is a first gearbox3600that translates motion of the shaft3500of the right hand assembly3400to the shaft3500of the left hand assembly3400. The first gearbox3600is located proximate the second end3306. The working components also include a rotatable cross shaft3610that is at least partially contained within a sleeve3620. The cross shaft3610can be of a telescopic construction or another type of construction where the length of the cross shaft3610can be varied.

Within the interior of the frame3202, a second gearbox3615is disposed at or proximate the opposing first end3304. Unlike the first gearbox3600, which is fixed in place in the interior of the frame3202, the second gearbox3615is movable within the interior of the frame3202. For example, a track or the like3625can be disposed within the frame3202and the second gearbox3615is coupled thereto and movable (linearly) along the track to permit the distance between the two gearboxes3600,3615to be varied (closer or further apart). The cross shaft3610is received within an opening formed in the second gearbox3615. This end of the cross shaft3610can be thought of as an input shaft. The cross shaft3610is coupled to the shaft3500of the left hand assembly3400through the second gear box3615such that rotation of the cross shaft3610is translated into rotation of the shaft3500of the left hand assembly3400.

It will be appreciated that any number of different gear assemblies can be used so long as the rotation of the shaft3500of one of the left and right hand assemblies3400is translated into rotation of the other of the left and right hand assemblies3400. For example, the second gear box3615can include several pinion gears to translate rotation of the cross shaft3610into rotation of the shaft3500of the left hand assembly3400. The first gear box3615similarly includes gears that mesh with one another to translate rotation of the shaft3500of the right hand assembly3400into rotation of the cross shaft3610.

FIG. 34shows one exemplary first gear box3600that includes multiple operating modes. In particular, there are three settings for the gear box3600: synchronous (in-phase), synchronous (180 deg out-of-phase) (reverse), and independent. In the in-phase synchronous setting, the gear box transmits the rotational force applied by one side to the opposite side in the same direction and at the same time. In the out-of-phase synchronous setting, the gear box transmits the force applied by one side of the body to the opposite side of the body at the same time but in the exact opposite direction. In the independent setting, the two sides of the body perform independently.

There are many possible configurations of the gearing that will produce the three settings. One such configuration is illustrated inFIG. 34. In this configuration a series of either spur (shown in the drawing) or helical gears are arranged in such a manner that circular force applied at the INPUT SHAFT and therefore GEAR1can be transferred to GEAR7and therefore the OUTPUT SHAFT in one of two manners: in-phase or out-of-phase.

For an in-phase transfer, the gear box is shifted to a position that engages GEAR3and GEAR6. In this gear box setting, GEAR5is disconnected from GEAR7. A clockwise circular force applied at the INPUT SHAFT and therefore GEAR1turns GEAR2counterclockwise. The counterclockwise motion is maintained during the transfer to GEAR3and then GEAR6. Counterclockwise motion of GEAR6then causes GEAR7to turn clockwise, which returns the force to the same clockwise direction as the initial input at the INPUT SHAFT.

For the out-of-phase transfer, the gear box is shifted to a position that engages GEAR3, GEAR4, GEAR5, and GEAR6. In the out-of-phase setting GEAR3is disconnected from GEAR6, which now rotates freely with GEAR7. A clockwise force at the INPUT SHAFT and therefore GEAR1causes GEAR2and therefore GEAR3to turn counterclockwise. GEAR3causes GEAR4to turn clockwise. GEAR4causes GEAR5and therefore GEAR7and the OUTPUT SHAFT to turn counter-clockwise, which is the reverse of the initial input at the INPUT SHAFT.

The gear box can also be shifted to a position that disconnects the INPUT SHAFT from the OUTPUT SHAFT.

The connection and disconnection of the various gears can also be achieved by the use of dog clutches, which are shifted to one of three positions depending on the setting (i.e. in-phase, out-of-phase, or independent).

It will be appreciated that when there are different operating modes, different rehabilitative exercises can be performed (e.g., the hand assemblies3400rotate in same or opposite directions).

The top assembly3300is oriented at a particular degree relative to the base plate3010and in particular, the top assembly3300is oriented at 45 degrees relative to the base plate3010.

As mentioned above, the device3000has a number of features that permit the adjustment of the movable elbow support member3200and the left handle assembly3400as when a smaller patient uses the device3000. Since the left handle assembly3400moves laterally, a slide element or handle (e.g., a push rod)3490is provided and passes through an opening in one end of the frame3202and is fixedly attached to the movable second gear box3615. This permits movement (linear movement) of the handle3490to be translated into movement of the second gear box3615along the track3625to permit the distance between the two gearboxes3600,3615to be varied (closer or further apart). In order to allow for lateral movement of the shaft3500of the left hand assembly3400, the shaft3500rides within a slot formed linearly across the front face of the frame3202. In this way, all of the shafts and gears remain coupled to one another while permitting the device3000to be adjustable to accommodate different sized patients.

The operation of the device3000is similar to the device1000and is used in forearm pronation-supination rehabilitation. By maintaining the “box” (assembly3300) at a 45 degree angle or some other angle, the arm is likewise held at the same or substantially the same angle (e.g., arm is at 45 degrees).

Wrist Trainer

Now referring toFIGS. 15-16, a wrist trainer1600is shown. The wrist trainer1600enables a stroke patient to use his/her unaffected wrist (and unaffected brain) to facilitate substantially symmetrical movements with the affected wrist. The underlying principle, as discussed hereinbefore, is that rehabilitation of an affected wrist can be facilitated by increasing the participation of the brain's intact motor systems in causing the affected wrist to move.

The wrist trainer1600enables alternating wrist flexion and extension. The wrist trainer1600includes a handle1610around which the patient grasps with their hands (shoulder width apart). As shown inFIG. 15, the handle1610can be a single member in which two end portions1612,1614thereof represent the portions that are grasped by the patient. The handle1610can alternatively be two separate handle members. The trainer1600also includes a pair of connecting members1620that are attached to the handle1610in a perpendicular manner. The connecting members1620can be brackets, etc., and include distal free ends1622. Opposite ends1624are fixed to the handle1610.

The wrist trainer1600includes a center support structure1630to which the handle1610is pivotally attached. More specifically, the center support structure1630includes a pair of upstanding support members1632and a horizontal support member1634that extends between upper ends of the upstanding support members1632. The connecting members1620are pivotally attached to the center support structure1630. The connecting members1620are adjustable relative to the center support structure1630and in particular, each of the connecting members1620includes a series of openings through which a fastener is received for pivotally attaching the connecting members1620to the center support structure1630.

The wrist trainer includes first and second forearm support members1700,1710on which the forearms of the patient are placed. The forearms are secured to the support members1700,1710using securing members, such as straps formed of hook and loop material). When the forearms are placed on the support members1700,1710, the patient's hands extend forward and grasp the handle1610. In operation, the unaffected hand pivots (raises) the handle1610from a rest position to cause an extension/flexion motion in the wrist. Since the affected hand likewise grasps the same handle1610, the affected hand and wrist undergoes extension/flexion.

FIG. 17shows a wrist trainer1800according to another embodiment. The wrist trainer1800is similar to the trainer1600; however, it includes several differences. In particular, the trainer1800includes first and second handle segments1810,1820(e.g., round handles). A pair of rods or the like1830are attached perpendicularly to the handle segments1810,1820such that the handle segments1810,1820can freely pivot (swing) in an arc. A pair of central horizontal connecting rods1840is attached to the perpendicular rods1830at the center of the arc. The trainer1800also includes first and second gears1850,1860, respectively, that that links the connecting rods1840one at a time.

The trainer1800includes the first and second forearm support members1700,1710on which the forearms of the patient are placed and a support structure1870to which the connecting rods1840are attached. The attachments of the two perpendicular rods1830to the connecting rods1840are adjustable to permit differences in patient's hand and wrist size. The adjustability permits the center of the arc to be exactly between the pivot points of the left and right wrists as they extend and flex.

The first and second gears1850,1860links the two connecting rods1840so that the motion of one control the motion of the other. The first gear1850(alternation gear) causes the two connecting rods1840to move in opposite directions, while the second gear1860(synchronous gear) causes the connecting rods1840to move in the same direction. At any time, only one of the two gears1850,1860engages the connecting rods1840. The movement of the connecting rods1840then causes the handle segments1810,1820to move either alternative (if the first gear1850is engaged) or synchronous (if the second gear1860is engaged). The two gears1850,1860are mounted on a track1870that adjusts to one of the two gear engagement positions.

Now referring toFIG. 41a wrist trainer5000according to another embodiment is shown. The wrist trainer500shares many of the same components as the trainer4000and is of a modular design in that the base and the arm support platform structures are maintained. In this embodiment, the links or arms4120are not connected to the frame4100but instead the links4120are connected to a hand grip assembly5100that has a pair of side arms5110with a cross bar5120that extends therebetween. Hand grip padding5130is disposed over the cross bar5120. The side arms5110can be easily attached to the links4120using conventional techniques, such as the use of fasteners (quick release fasteners) that permit the hand grip assembly5100to be attached to the links4120. The hand bar4030is removed.

The device5000functions similar to how the device4000operates in that the patient grasps both cross bars5120(padding5130) with his or her hands. The good hand of the patient is pivoted (wrist extends and flexes) and due to the coupling between the hand grip assemblies5100and the shafts4300, the motion of the wrist in the good hand is translated into motion of the affected hand about the affected wrist. For example, if the patient pivots the hand upward and the gear box3600is set to a synchronized operating mode, then the other hand will likewise pivot upward. The other operating modes are possible, such as out of synchronized mode and neutral mode.

The coupling between the side arms5110and links4120is of a type that permits the hand assemblies5100to be adjusted in that the cross bar5120can be brought further from or closer to the arms340and platform. For example, a thumb screw (fasteners) can be used to attach the side arms5110and links4120.

The modularity between the trainers4000and5000allows the gear box3600and shafts4300to be maintained while the operator simply swaps out the finger extension components or wrist components and places the desired components in place.

Now referring toFIG. 18, a shoulder abduction-adduction trainer (device)1900according to one embodiment is illustrated. The device1900enables a patient to abduct and adduct the unaffected shoulder by raising and lowering the arm from a vertical position to a horizontal position, thereby facilitating the same movements in the affected arm and shoulder.

The device1900includes a chair or the like1910in which the patient seats. The device1900includes a main support1920that is attached to the chair1910and is generally I-shaped (e.g., a metal I-shaped structure). The main support1920thus includes a pair of upper arms1922,1923that extend outwardly from a vertical support member1924.

The device1900includes first and second arm splints1930,1940with each splint1930,1940being configured to support a respective arm. For example, the splint1930,1940is contoured (e.g., a concave arm receiving surface) to receive and support the arm. The splints1930,1940are constructed so that elbow extension/flexion are prevented. Fasteners, such as straps formed of hook and loop material, can be used to hold the arm in place and prevent bending of the elbow.

The device1900includes a mechanism1950that is coupled to the splints1930,1940to cause the controlled, mirrored abduction/adduction motions in both the unaffected shoulder and the affected shoulder. The mechanism1950can in one embodiment, as illustrated, be in the form of a cable/pulley system. The mechanism1950includes a first cable1960, a second cable1970, a first set of pulleys and a second set of pulleys.

The first set of pulleys includes a first pulley2000, a second pulley2002, a third pulley2004, while the second set of pulleys includes a fourth pulley2006, a fifth pulley2008, and a sixth pulley2010. The first pulley2000is mounted to the upper arm1922and the second pulley2002is mounted vertically to a floor or support that is disposed below the chair. The second pulley2002is mounted horizontally to the back legs of the chair. The third pulley2004is another vertically mounted pulley that is disposed approximately 12 inches lateral to the chair. The fourth pulley2006is mounted on the upper arm1923and the fifth pulley2008is mounted vertically to the floor or support that is disposed below the chair (opposite the second pulley2002). The fifth pulley2008is mounted horizontally to the back legs of the chair. The sixth pulley2010is another vertically mounted pulley that is disposed approximately 12 inches lateral to the chair opposite the pulley2004.

As described below, the cables1960,1970are attached to each splint1930,1940, one on the inner aspect of the upper arm and one on the outer aspect of the upper arm. The first cable1960is attached to an inner aspect (edge)1931of the splint1930and is routed to the pulley2008before being passed underneath the chair to the pulley2004where it is then routed to the pulley2000before being routed and attached to an outer aspect (edge)1943of the other splint1940. The cable1960is thus routed through three pulleys before being attached to the opposite aspect of the opposite splint. Similarly, the second cable1970is attached to an inner aspect (edge)1941of the splint1940and is routed to the pulley2002before being passed underneath the chair to the pulley2010where it is then routed to the pulley2006before being routed and attached to an outer aspect (edge)1933of the other splint1930. The cable1970is thus routed through three pulleys before being attached to the opposite aspect of the opposite splint. The cables1960,1970attached the inner aspects1931,1941of the splints1930,1940travel toward the floor at a generally 90 degree angle.

In operation, the patient is seated in the chair with arms at his/her sides. The cables1960,1970are attached and the patient is then instructed to lift his/her arms to shoulder height. The arrows inFIG. 18illustrate this motion. The device permits the unaffected arm to assist the affected arm in the abduction and adduction of the shoulders. The cable attachment points are such that as the unaffected arm is raised, the cable attachment to the inner aspect causes a pulling of the cable and since the cable is attached to the outer aspect of the other splint, the other splint is raised in a motion that mirrors the motion of the unaffected arm.

It will be appreciated that cable routing members (e.g., eyelets) can be provided proximate to the pulleys to assist cable routing. In addition, a cable limiter2100can be provided to limit the degree of travel of a respective cable so as to prevent the patient from overextending his/her arms. The limiter2100can be in the form of a ball that is fixedly attached to the cable at a specific location of the cable and at a set distance from the pulley. As the cable is pulled, the ball will travel toward the cable routing member (e.g., eyelet) and since the diameter of the ball is greater than the opening in the eyelet, the engagement of the ball to the eyelet prevents further movement of the cable.

As with the other devices, the device may be used by patients in the home, health/fitness clubs or in a therapeutic setting. The device is simple to use and a family member or friend can assist in the setup.

Ankle Rehabilitative Trainer

Now referring toFIGS. 26-28, an ankle rehabilitative trainer device2300(ART) is illustrated that enables a stroke patient to use her/his unaffected ankle (and unaffected brain) to facilitate almost symmetrical movements with the affected ankle. The underlying principle for the design of this device and several other devices in this series is that rehabilitation of an affected joint can be facilitated by increasing the participation of the brain's intact motor systems in causing the affected joint to move. By using the unaffected brain to move both ankles in the same manner, the hypothesis is that recovery from stroke will be facilitated either by increasing the participation of any surviving neurons on the affected brain or by increasing control of the muscles by the ipsilateral brain. Foot drop, which is the result of weak dorsiflexion, is a very common symptom of stroke patients. The trainer device2300enables the unaffected foot and ankle to train alternating dorsiflexion and plantar flexion in the affected foot and ankle.

The device2300includes two adjustable flat pedals2310,2320on which the soles of the patient's shoes rest, four adjustable crank arms2330,2340,2350,2360to which the pedals2310,2320are secured (one each for the lateral and medial sides of the pedals2310,2320), and two adjustable horizontal medial connecting rods2370,2380that are attached to the two crank arms2340,2350, respectively. In addition, the device2300includes two lateral connecting rods2400,2410, two lateral gears2420,2430that link the two connecting rods2370,2380, and two medial gears2400,2410one of which will link the connecting rods2370,2380.

The device2300also includes a floor stand2500that provides a solid base for the crank arms2330,2340,2350,2360, and two leg and knee support structures2510,2520extending from the patient to the floor on which the patient's legs rest. The medial and lateral connecting rods2370,2380,2400,2410insert into sleeve bearings2600or similar parts mounted in the vertical component of the support structure (stand2500). The sleeve bearings2600permit the lateral and medial connecting rods, the pedals, and the crank arms to rotate as one unit around the center of an arc made when the patient performs dorsiflexion and plantar flexion of his/her foot. The device2300is attached to the front of a chair2700on which the patient sits. All of the various components are adjustable by the use of set screws and rods whose length can be varied according to the patient's size. The adjustability enables the optimum positioning of the pedals, connecting rods, and gears. The optimum position is achieved when the gears and connecting rods are exactly in the center of the pivot points of the left and right ankles as they dorsiflex and plantar flex. Therefore the device2300pivots only at one point which is at the center of the arc made by the patient's ankles as they alternately dorsiflex and plantar flex. The center of the arc is typically at the medial malleolus. The patient's feet are positioned on the pedals and a band (formed of hook and loop material) is placed around the foot to secure it to the pedal. The patient's legs rest on diagonal supports. Bands, formed of hook and loop material, secure the legs to diagonal supports.

Two different gears can link the two horizontal connecting rods so that the motion of one controls the motion of the other. One gear, the alternation gear, causes the two connecting rods to move in opposite directions, while the second, the synchronous gear, causes the connecting rods to move in the same direction. At any time only one of the two gears engages the connecting rods. The movement of the connecting rods then causes the pedals to move—either alternating (if the alternating gear is engaged) or synchronously (if the synchronous gear is engaged). The gears are mounted on a track that adjusts to one of the two positions.

The device2300attaches in a modular fashion to the front of the “height-adjustable” chair2700that is also shown inFIG. 29and is for use also with device1900.

Modular Assembly

In accordance with one embodiment of the present invention, the devices disclosed herein can be part of a modular assembly where two or more devices are coupled to one another to provide a multi-limb (multi-body) part rehabilitative system.

In one embodiment of such a system, the modular assembly will be focused around a seating system where the user (patient) will be seated on a height adjustable chair which forms the base for the shoulder abduction-adduction trainer (device1900). The base for the bilateral arm trainer (device100) will be the height-adjustable table, which will be configured so that other training devices, such as the wrist trainer1600, the finger and thumb extension/flexion training device (trainer)200, etc. can be easily and lockingly coupled to the device100. For example, a front edge of the base of the device100can include coupling members that permit the direct attachment of the other devices (200,2300,1000and1600) to the base of the device100. The coupling members will be on a right angled track so that both the vertical distance from the front edge of the table and the horizontal distance between the two arms can be adjusted to the dimensions of the user.

All devices can have coupling members at their base so that a mechanical releasable coupling between the devices is achieved. For example, a device can be snap-lockingly coupled to the base of the device100and since the devices are designed to be conveniently stored, the devices can simply be detached and then placed in their storage positions.

FIG. 29is a top view of a base2800for modular assembly of various training devices disclosed herein. The base2800is in the form of a height-adjustable table for device100(FIG. 1). The table2800has adjustable locking coupling members2810on tracks2820to lock various trainer devices disclosed herein, including devices200,2300/2500,1000,1600on the surface of the device100. The user is shown sitting in the chair2700.

While the invention has been described in connection with certain embodiments thereof, the invention is capable of being practiced in other forms and using other materials and structures. Accordingly, the invention is defined by the recitations in the claims appended hereto and equivalents thereof.