Abstract:
The invention relates to an apparatus for treatment, in particular physiotherapeutic treatment, of a part of the human body, in particular an arm, comprising a holder for fixing the body part to be treated, comprising a traction element, which acts on the body part with a predeterminable tension. The tension is applied by one or more weights acting on the traction element via a tension transmitter, it being possible for the tensile force acting on the body part to be varied or stopped at the beginning, during and/or at the end of the treatment by a counteracting force applied by a motor.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     The present application is a continuation of pending International patent application PCT/EP2006/063776 filed on Jul. 3, 2006, which designates the United States and claims priority from German patent application 10 2005 032 883 filed on Jul. 14, 2005, the content of which is incorporated herein by reference. 
    
    
     FIELD OF THE INVENTION 
     The invention relates to an apparatus for treatment, in particular physiotherapeutic treatment, of a part of the human body, in particular an arm, comprising a holder for fixing the body part to be treated, in particular the lower arm in the region of the elbow, and comprising a traction element, which acts on the body part, in particular on the wrist of the arm, and by means of which a traction of a predeterminable tension, directed in the direction of extent of the body part, in particular the lower arm, is exerted on the body part, in particular the lower arm. 
     BACKGROUND OF THE INVENTION 
     Such an apparatus is already known from DE 102 14 996 A1. The apparatus has an elongated apparatus housing. A holder, a traction element and a control console are disposed on the apparatus housing. The elements listed lie one behind the other in the longitudinal extent of the apparatus housing. The holder can be manually displaced in the longitudinal extent of the apparatus housing, since it is disposed on a rail. When the desired position has been reached, the holder can be fixed on the rail by means of a lever screw. The traction element can be displaced from the holder in the direction of the control console by a gear mechanism driven by an electric motor. Consequently, a tensile force can be exerted on an arm restrained in the holder, which is also fixed to the traction element by means of a cuff, since the traction element is displaced from the holder in the direction of the control console. A lower frame is disposed underneath the apparatus housing. 
     It is an object of the invention to improve the generic apparatus advantageously in terms of its use and to increase the success of the therapy. 
     SUMMARY OF THE INVENTION 
     The object is achieved by each individual claim alone and by any combination whatever of each claim with any other claim as desired. 
     Claim  1  provides first and foremost that the tension is applied by one or more weights acting on the traction element via a tension transmitting means, it being possible for the tensile force acting on the body part, in particular on the wrist, to be varied or stopped at the beginning, during and/or at the end of the treatment by a counteracting force applied by a motor. 
     The following details are preferred: the traction cable forms the tension transmitting means. The traction cable is guided in particular over a deflecting roller. At least one weight is guided in a standing leg of the apparatus. A traction rod provided with holes is secured to the tension transmitting means, in particular to the traction cable. This traction rod passes through a multiplicity of weight-exerting plates, which are disposed one above the other and are provided with an opening. The weight-exerting plates have coupling openings for a coupling bolt to be passed through. The coupling bolt may be inserted into a coupling opening as far as and into a hole in the traction rod. The coupling bolt arrests a weight-exerting plate and those lying above it on the traction rod. A cuff associated with the traction element is provided for securing the body part, in particular the wrist. The traction element comprises a carriage on which the tension transmitting means acts on one side and a counteracting force transmitting means, in particular in the form of a cable, acts on the opposite side. The counteracting force transmitting means exerts the counteracting force on the traction element. Furthermore, the counteracting force transmitting means may displace the traction element in a motorized manner into an initial position. An electric motor acts on the traction element in order to apply the counteracting force and/or displace the traction element back. The electric motor may be a linear drive, a threaded spindle or a cable winch. The motor drive that applies the counteracting force or brings about the return displacement has a switchable freewheeling mechanism  52 , which acts on the traction element. The motor drive applying the counteracting force or bringing about the return displacement acts on the traction element via a coupling that can be released in a damped manner. 
     Such an apparatus is used for example for treating carpal tunnel syndrome. Treatment with this apparatus can obviate the need for an operation. Since operations always entail risks, treatment of carpal tunnel syndrome with the apparatus represents a good alternative. 
     Instead of a traction cable, the tension transmitting means may also be formed by a chain, a wire or a lever mechanism. For example, a traction rod could act on the carriage. Instead of the deflecting roller, a deflecting lever could then be provided. For example, the traction rod could act on an arm of an angle lever which is pivotably mounted about an axis. A further traction rod, which can be connected to weights, may be articulated on the other arm of this angle lever. It is also conceivable to transmit the tensile force hydropneumatically. For this purpose, a pneumatic cylinder may act on the carriage. The cylinder is connected by a pipeline or a flexible tube to a further pneumatic cylinder, on which the weights act. The force transmission may take place by means of negative pressure, but with preference by means of positive pressure. The weights then exert a compressive force on the cylinder and the cylinder or piston likewise exerts a compressive force on the carriage. Technically, however, these forces bring about a traction on the arm of the patient. 
     The counteracting force may also be applied to the carriage by a rope, a wire, a chain or a lever mechanism. It may also be applied to the carriage hydropneumatically. The motor drive is in this case a pump. It is also conceivable to transmit the forces via spindles or worm gear mechanisms. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The invention just described is explained in more detail on the basis of an exemplary embodiment. In the drawing: 
         FIG. 1  shows the front view of the apparatus in the starting position, which is represented partly in section, 
         FIG. 2  shows a plan view of the apparatus corresponding to viewing direction II from  FIG. 1 , 
         FIG. 3  shows a side view of the apparatus corresponding to viewing direction III from  FIG. 1 , 
         FIG. 4  shows a view corresponding to  FIG. 1 , but here the traction element has been displaced into an initial position, 
         FIG. 5  shows a view corresponding to  FIG. 4 , but here an arm has been restrained, 
         FIG. 6  shows a view corresponding to  FIG. 5 , the device now exerting a tensile force on the arm (cable  27  is substantially stress-free), 
         FIG. 7  shows a plan view of the apparatus with a restrained arm, corresponding to viewing direction VII from  FIG. 6 , and 
         FIG. 8  shows how the apparatus can be transported. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     The apparatus  1  is represented in  FIGS. 1 to 3  in the starting position. The apparatus  1  according to the invention is substantially constructed in the way described in the previously mentioned document of DE 102 14 996 A1. It substantially comprises an apparatus housing  2  with the holder  3 , the traction element  4  and the control console  5  disposed on it. A lower frame  6  is disposed underneath the apparatus housing  2 . 
     The elongated apparatus housing  2  has on its upper side a rail  7 . One end of the rail  7  lies in the end region of the apparatus housing  2 . The rail  7  extends from there to approximately the middle of the longitudinal extent of the apparatus housing  2 . In  FIG. 1 , the end of the rail  7  lies in the left-hand end region of the apparatus  1 . The holder  3  is displaceably mounted on the rail  7 . It can be displaced in the longitudinal extent of the apparatus housing  2 . By means of a lever screw  8 , the holder  3  can be fixed in any desired position on the rail  7 . In the direction of extent of the rail  7 , the latter is followed by two laterally located control buttons  9 . They are disposed approximately in the middle of the apparatus  1 . By pressing these buttons  9 , the patient can interrupt the treatment. 
     Behind the buttons  9  in the direction of extent of the rail  7  is the traction element  4 . This is constructed as in DE 102 14 996 A1. It substantially comprises a pillar  10 , a shoe  11  disposed over the latter and a cross bar  12  disposed on that. Disposed to the side of the shoe  11  is a lever screw  13 . This protrudes through an oblong hole  14  into a threaded bore of the pillar  10 . By means of the lever screw  13 , the adjusted height of the shoe  11  can be fixed. Disposed on the pillar  10  in the direction of the holder  3  is a pivot bearing  15 . The traction element  4  can be pivoted about this pivot bearing  15  when an overload preventer  16  has tripped. The overload preventer  16  may be formed by a bolt which simply shears off under excessive loading. 
     As can be gathered from  FIG. 3 , the cross bar  12  is fixed on the shoe  11  such that it is pivotably movable about a pivot point  17 . Disposed underneath the pivot point  17  is an arcuate slot  18 . The arcuate slot  18  runs concentrically with respect to the pivot point  17 . A tightening screw  19  protrudes through the slot  18  into the shoe  11 . With the tightening screw  19 , the cross bar  12  can be fixed in any desired angular position in relation to the shoe  11 . The maximum angular positions of the cross bar  12  are limited by the respective end of the arcuate slot  18 . 
     The traction element  4  is guided in a longitudinal slot  20 . The guidance of the traction element  4  in the apparatus housing  2  may be constructed for example in the way described in DE 102 14 996 A1. The cross bar  12  runs transversely in relation to the longitudinal extent of the apparatus housing  2 . 
     The control console  5  is disposed in the other end region of the apparatus housing  2 . In  FIG. 3  it can be seen that an emergency-shutdown button  21 , an initial button  22 , a starting button  23 , a buzzer  24  and a display  25  are disposed on the control console  5 . 
     In the event of a malfunction, the apparatus  1  can be immediately switched off by means of the emergency-shutdown button  21 . In order to reach the initial position ( FIG. 4 ,  FIG. 5 ) from the starting position ( FIGS. 1 to 3 ), the initial button  22  must be pressed. In order that the treatment can be started, the starting button  23  must be subsequently actuated. The display  25  indicates the individual repetitions in two digits. When a series or the entire treatment has been completed, an acoustic signal emitted by the buzzer  24  is sounded. 
     Disposed underneath the traction element  4  in the apparatus housing  2  is a carriage  26 . The traction element  4  is secured to the carriage  26 . It protrudes through the longitudinal slot  20 . By means of the carriage  26 , the traction element  4  is guided in the longitudinal slot  20 . A counteracting force transmitting means  27  acts on the side of the carriage  26  that faces the holder  3 . The counteracting force transmitting means  27  is formed by a cable. A tension transmitting means  28  acts on the other side of the carriage  26 , which faces the control console  5 . This tension transmitting means is likewise formed by a cable. Both cables  27 ,  28  run in the housing  2  and cannot be seen from the outside. 
     A motor drive in the form of an electric motor  29  acts on the cable  27 . The electric motor  29  drives a cable winch  51 . Both are disposed in the end region of the device housing  2  underneath the rail  7 . The electric motor  29  and the cable winch  51  are connected to each other via a switchable freewheeling mechanism  52 . Furthermore, the coupling between the electric motor  29  and the cable winch  51  can be released in a damped manner. 
     The cable  28  is guided by means of a deflecting roller  30  in the direction of a standing leg  31  of the lower frame  6 . The deflecting roller  30  and the standing leg  31  are disposed underneath the control console  5 . The standing leg  31  comprises a hollow body in which weight-exerting plates  32  are disposed one above the other. In the exemplary embodiment, fifteen weight-exerting plates  32  are disposed one above the other. From top to bottom, one weight-exerting plate  32  of 6 kg, six of 1 kg and eight of 1.5 kg are stacked. It is possible to choose 6 kg, from 7 kg to 12 kg in intervals of 1 kg and from 13.5 kg to 24 kg in intervals of 1.5 kg. It is possible to set a weight from 6 kg to 24 kg. The weight-exerting plates  32  have a central opening  33 . The openings  33  run in the direction of extent of the standing leg  31 , that is to say perpendicular to the direction of extent of the apparatus housing  2 . Furthermore, the weight-exerting plates  32  have coupling openings  34 . The coupling openings run perpendicular to the openings  33 , that is to say in the direction of the longitudinal extent of the apparatus housing  2 . 
     In the starting position of the apparatus  1 , a traction rod  35  provided with holes protrudes through each opening  33  of the weight-exerting plates  32 . The traction rod  35  has holes  52  at the location of the coupling openings  34 . This rod is connected to the tension transmitting means  28 . In order to connect the weight-exerting plates  32  to the traction rod  35 , a coupling bolt  36  must be inserted into a coupling opening  34  of a weight-exerting plate  32  and through a hole  52  of the traction rod  35 . The coupling bolt  36  consequently protrudes through the weight-exerting plate  32  and the traction rod  35 . As a result, the weight-exerting plate  32  through which the coupling bolt  36  passes is connected to the traction rod  35 . Furthermore, the weight-exerting plates  32  that lie above the coupling bolt  36  are carried along by the traction rod  35 . In order that the coupling bolt  36  can be inserted into the weight-exerting plates  32 , the standing leg  31  has a longitudinal slot  37 . 
     Disposed underneath the standing leg  31  is a cross beam  38  ( FIG. 3 ). As can be seen in  FIG. 1 , adjustable feet  39  are provided at the sides of the cross beam  38 . These feet can be set by means of the thread in such a way that the apparatus  1  stands securely on the floor  40 . In order for the feet  39  to then be fixed, a lock nut  41  is provided. Respectively disposed laterally of the feet  39  in the direction of longitudinal extent of the apparatus  1  is a roller  42 . The rollers  42  face toward the end of the apparatus  1  that also accommodates the control console  5 . Disposed on the standing leg  31  underneath the apparatus housing  2  is a button  43 . The button  43  makes the apparatus  1  move from the initial position ( FIGS. 4 ,  5 ) into the starting position ( FIGS. 1 to 3 ). 
     Parallel to the standing leg  31 , a further standing leg  44  is disposed underneath the holder  3 . The two standing legs  31 ,  44  are connected to each other by a connecting beam  45 . The connecting beam runs parallel to the longitudinal extent of the apparatus housing  2 . As can be seen in  FIG. 3 , the standing leg  44  has a narrower cross-section than the standing leg  31 . On the side that is facing away from the standing leg  31 , the standing leg  44  has a handle  46 . In the basic position ( FIGS. 1 to 7 ), the handle  46  runs approximately parallel to the standing leg  44 . Underneath the apparatus housing  2 , the handle  46  is articulated in a pivotably movable manner on the standing leg  44  by means of a hinge  47 . 
     In the following section, the operating mode of the exemplary embodiment is explained in more detail: 
     Starting from  FIGS. 1 to 3 , the apparatus  1  is in the starting position. In this position, the therapist can choose the weight for the treatment. For this purpose, the coupling bolt  36  has to be inserted into the desired weight-exerting plate  32 . This couples the weight of exerting plate  32  to the traction rod  35 . Likewise, the weight-exerting plates  32  that are located above the coupling bolt  36  are then also carried along by the traction rod  35 . A scale for the weight may be provided for example to be readable from the outside on the standing leg  31 . 
     In order to displace the apparatus  1  into the initial position, the initial button  22  must be actuated. By actuating the initial button  22 , the electric motor  29  is activated. The electric motor  29  acts by means of the cable winch  51  on the cable  27 . The rolling up of the cable  27  on the cable winch  51 , which is driven by the electric motor  29 , has the effect that the carriage  26  with the traction element  4  is displaced as far as possible in the direction of the holder  3 . When the traction element  4  has assumed the initial position, the electric motor  29  stops. The displacement path of the carriage  26  with the traction element  4  disposed on it is limited by the longitudinal slot  22 . In this position, an arm  48 , which is bent at right angles, can be fixed in the holder  3  by means of straps  49 . One strap  49  is placed around the upper arm and the other strap  49  is placed around the lower arm. Furthermore, a cuff  50  is placed around the wrist of the arm  48  and then secured to the cross bar  12 . In this case, the inner surface of the hand is facing upward. This position is illustrated in  FIG. 5 . There it can also be seen that the holder  3  is at a distance from the traction element  4  such that the cuff  50  is not yet exerting any tensile force on the arm  48 . The position of the holder  3  in relation to the traction element  4  can be varied on the rail  7 . The holder  3  is subsequently fixed on the rail  7  with the lever screw  8 . The height of the cross bar  12  in relation to the arm  48  can likewise be adjusted. This just requires the lateral lever screw  13  on the shoe  11  to be loosened and then the shoe  11  can be varied in its height. The height variation is limited by the length of the oblong slot  14 . Once the desired height has been reached, the shoe  11  can be fixed in its height by means of the lever screw  13 . 
     When the apparatus  1  has been set optimally for the patient, the counteracting force transmitting means  27  is slowly released by actuating the starting button  23 . This is possible, since the coupling between the electric motor  29  and the cable winch  51  can be released in a damped manner. As a result, the tensile force on the arm  48  builds up only slowly. In  FIGS. 6 and 7 , the tensile force that is applied by the weight-exerting plates  32  acts on the arm  48 . The time between starting the operation and reaching the end position ( FIGS. 6 ,  7 ) is approximately 7 seconds, with the tensile force being maintained for approximately 2 seconds. Once the time has expired, the electric motor  29  automatically switches on again and, by winding up the cable  27  onto the cable winch, displaces the carriage  26  with the traction element  4  back again into the initial position. After that, the electric motor  29  switches off and the coupling slowly releases the cable roller  51 , so that the tensile force can build up once again. This operation is repeated for example ten times. The displacement into the initial position through to renewed starting of the tractive movement takes approximately 5 seconds. 
     The repetitions are indicated on the display  25 . After completion of the ten repetitions, an acoustic signal sounds from the buzzer  24 . The apparatus  1  is again in the initial position, which is illustrated in  FIG. 5 . The position of the cross bar  12  can be changed. This is schematically represented in  FIG. 3 . As a result, the wrist can be moved into a different position. For this purpose, the tightening screw  19  must be released, and then the cross bar  12  can be pivoted about the pivot point  17 . The maximum position of the cross bar  12  is limited by the arcuate slot  18 . When the desired position of the cross bar  12  has been reached, the cross bar  12  can be fixed by means of the tightening screw  19 . After renewed actuation of the starting button  23 , the repetitions, for example ten of them, are carried out once again. After completion of the ten repetitions, the position of the cross bar  12  can be varied again. A customary treatment on this apparatus  1  provides three sets of ten repetitions. 
     The two buttons  9  allow the patient to interrupt the treatment. If the button  9  is pressed, the traction element  4  moves back into the initial position. After renewed pressing of the button  9 , the treatment is continued until the ten repetitions have been performed. If a treatment has been completed and a new patient requires a different weight, the button  43  on the standing leg  31  must be actuated from the position that is represented in  FIG. 4 . Actuating the button  43  makes the electric motor  29  displace the apparatus  1  into the position corresponding to  FIGS. 1 to 3 . Only in this position is it possible to change the weight without raising the weights. 
     In  FIG. 8  it is shown how the apparatus  1  can easily be moved. The handle  46  is pivoted about the pivot point of the hinge  47  such that the handle  46  is positioned approximately at right angles to the standing leg  44 . The handle  46  butts against the underside of the apparatus housing  2 . The apparatus  1  can then be lifted up by the handle  46 . This shifts the weight from the standing legs  31 ,  44  onto the two rollers  42 . In this position, which is represented in  FIG. 8 , the apparatus  1  can easily be displaced by means of the rollers  42 . Once the desired position has been reached, the apparatus  1  is slowly let down and the handle  46  is swung against the standing leg  44 . The apparatus  1  can then be aligned by means of the feet  39 , which are then fixed by means of a lock nut  41 . 
     As in the previously mentioned DE 102 14 996 A1, the apparatus  1  is likewise fitted with an overload preventer  16  in the traction element  4 . If for some reason any kind of excessive load is exerted on the arm  48  during a treatment, the overload preventer  16  trips and allows pivoting of the traction element  4  in the direction of the holder  3  by means of the pivot bearing  15 . As a result, the load is removed from the arm  48 . 
     In the case of the exemplary embodiment described above, the tensile force was transmitted to the carriage  26  from the traction rod  35  carrying the weights via a cable  28 . However, alternative ways in which the weight force of the weights  32  can be transmitted to the traction element  4  are also conceivable. For example, instead of the traction cable  28 , a wire or a chain may be provided. An alternative to the deflecting roller  30  is an angle lever. This angle lever may have two lever arms at right angles to each other. This angle lever can be pivoted about a pivot axis which is associated with the apex of the two lever arms. A traction rod may act on each of the two lever arms. One traction rod is connected to the traction element and the other is connected to the weights. One traction rod may act for example on the carriage  26 . The other traction rod may be the traction rod  35  carrying the weights. However, there may also be a coupling rod, which is articulated on the traction rod  35  and is connected to the corresponding arm of the angle lever. 
     As an alternative to these solutions, the weight force of the weights  32  may also be transmitted to the traction element  4  pneumatically, and in particular hydropneumatically. For this purpose, a pulling piston or a pushing piston of a piston/cylinder unit may for example act on the carriage  26 . This piston/cylinder unit is connected via flexible tubes or pipelines to a second piston/cylinder unit, which is acted upon by the weights  32 . 
     In the same way as the tensile force acting on the traction element  4  can act via different force transmitting means, the restoring force that is applied by the electric motor  29  can be transmitted to the traction element  4  via the various force transmitting means. Here, too, a wire or a chain may be used instead of a traction cable  7 . The motor  29  may drive a winding drum. However, here it may also be a linear drive. In the same way, here, too, a hydropneumatic drive may be provided for displacing the traction element  4  back in the direction of the holder  3 . For this purpose, a piston/cylinder unit may act on the traction element  4 , and in particular on the carriage  26 . Said unit may comprise a pulling piston or a pushing piston. If the tensile force is also transmitted via a piston/cylinder unit, a double-piston arrangement is suitable here. The restoring force is in this case applied by way of a pump or a second piston/cylinder unit. 
     As an alternative to the types of drive described above, a geared spindle drive may also be used. 
     All features disclosed are (in themselves) pertinent to the invention. The disclosure content of the associated/attached priority documents (copy of the prior application) is also hereby incorporated in full in the disclosure of the application, including for the purpose of incorporating features of these documents in claims of the present application.