Patent Publication Number: US-9895576-B1

Title: Physiotherapeutic stair and incline system

Description:
FIELD AND BACKGROUND OF THE INVENTION 
     The present invention relates to physiotherapy devices and, in particular, it concerns a physiotherapeutic system combining stairs and an incline, and in which treatment is preferably tracked and documented by use of a computer system associated with an integrated sensor set. 
     Many patients require physiological rehabilitation for various reasons. These include, for example, victims of traffic accidents, patients who have suffered from a cardiac episode or underwent a cardiac medical procedure, as well as individuals that have had a cerebral episode, invasive medical procedures, or sustained injuries of violence and the like. These patients need to receive physiotherapeutic treatment in rehabilitation wards of various institutions or by professional physiotherapists, for the purpose of a gradual return to regular life. 
     The practicing of walking, ascending and descending stairs is a central part of the rehabilitation process. The ability to ascend and descend stairs is a vital component in the assessment process performed by the medical staff when deciding whether a patient can be discharged from the rehabilitative institution to his or her home. 
     One example of a suitable device for practicing ascending and descending of stairs is described in U.S. Pat. No. 5,901,813, and is commercially available from DPE Medical Ltd. (Israel) under the name Dynamic Stair Trainer (DST). The device consists of number of stairs whose height can be altered simultaneously according to the need and ability of the current patient. 
     Stair trainers used in physiotherapy for ascending and descending stairs are preferably static during use with a uniform pitch, simulating the look and feel of conventional stairs. It is also preferable that adjustment of the height occurs through a purely vertical motion without changing the depth of the tread surface of each step, and that the steps have closed riser surfaces without overlap between steps to minimize risk of tripping. 
     A further development of DPE Medical Ltd. (Israel) is described in U.S. Pat. No. 9,381,397, which is hereby incorporated by reference as if set out herein in its entirety. 
     SUMMARY OF THE INVENTION 
     The present invention is a physiotherapeutic system combining stairs and an incline. 
     According to the teachings of an embodiment of the present invention there is provided, a system for deployment on an underlying surface, the system comprising: (a) a set of at least three horizontal tread surfaces including a first tread surface and a last tread surface; (b) a drive system mechanically linked to the set of tread surfaces and configured to displace at least two of the tread surfaces vertically so as to adjust a rise height between adjacent of the tread surfaces in such a manner as to form a set of stairs with uniform pitch for a range of different rise heights; and (c) a ramp having a first end hingedly connected to the last tread surface so as to define a walking surface from the first end to a second end of the ramp, the walking surface having a variable angle of inclination varying as a function of a vertical position of the last tread surface, wherein the drive system is configured to displace the tread surfaces to a fully-lowered state in which the set of tread surfaces are juxtaposed as a continuous flat surface, and further comprising a support configuration deployed to support the second end of the ramp over a range of motion such that, in the fully-lowered state, the second end of the ramp is supported above the underlying surface with the walking surface horizontal, the plurality of tread surfaces and the walking surface together forming a continuous horizontal walkway. 
     According to a further feature of an embodiment of the present invention, the drive system comprises a linear actuator deployed for raising the last tread surface vertically, the linear actuator being deployed outside an area of the walkway. 
     According to a further feature of an embodiment of the present invention, the continuous horizontal walkway is at a first height above the underlying surface, the system further comprising a connecting ramp having an upper edge hingedly connected to the second end of the ramp, the connecting ramp terminating at a lower edge adjacent to the underlying surface. 
     According to a further feature of an embodiment of the present invention, the drive system is configured to displace the tread surfaces so as to form the set of stairs with a plurality of rise heights substantially spanning a majority of a range from 0 cm to 18 cm. 
     According to a further feature of an embodiment of the present invention, the drive system is configured to displace the tread surfaces in a purely vertical motion, and wherein a plurality of the tread surfaces each has an associated vertical riser surface. 
     According to an additional, or alternative, feature of an embodiment of the present invention, there is also provided: (a) a set of sensors including: (i) a first sensor deployed to sense the presence of a patient on the first tread surface, (ii) a second sensor deployed to sense the presence of a subject on the last tread surface, and (iii) a third sensor deployed to sense the presence of a subject on the ramp in a region adjacent to the second end; and (b) a computer system comprising at least one processor and a non-volatile storage medium, the computer system being in communication with the set of sensors, the computer being configured to generate a data record of a patient activity, wherein the patient activity is determined at least in part from a sequence of outputs of the first, second and third sensors. 
     According to a further feature of an embodiment of the present invention, the set of sensors further comprises a rise height sensor deployed to generate an output indicative of a current rise height of the set of steps and a current inclination of the ramp, the computer being configured to perform at least two of the following: (a) on sensing of a patient at the first sensor followed by the second sensor at non-zero rise height, to identify a time from sensing of the first sensor to sensing of the second sensor as a time taken for ascending stairs at the currently sensed rise height; (b) on sensing of a patient at the third sensor followed by the second sensor at non-zero rise height, to identify a time from sensing of the third sensor to sensing of the second sensor as a time taken for ascending a slope at an inclination corresponding to the currently sensed rise height; and (c) on sensing of a zero rise height, identify a time from sensing of a patient at the first sensor to sensing of a patient at the third sensor, or the reverse, as a time taken to walk a predefined horizontal distance. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The invention is herein described, by way of example only, with reference to the accompanying drawings, wherein: 
         FIG. 1  is an isometric view of a therapeutic system, constructed and operative according to the teachings of an embodiment of the present invention, providing variable-rise steps and a variable-incline ramp, the system being shown in a fully-raised state; 
         FIG. 2  is an isometric view of the therapeutic system of  FIG. 1 , the system being shown in a fully-lowered state; 
         FIG. 3  is an isometric view of one of the steps from the system of  FIG. 1  inverted to reveal an internal mechanism; 
         FIG. 4  is a view similar to  FIG. 1  but taken from the ramp side of the system; 
         FIGS. 5A and 6A  are views similar to  FIG. 4  with selected elements removed to reveal internal components of the system; 
         FIGS. 5B and 6B  are enlarged views of the regions of  FIGS. 5A and 6A  labeled V and VI, respectively; 
         FIG. 7  is a block diagram of the system of  FIG. 1 ; 
         FIG. 8  is a schematic representation of various different modes of use of the system of  FIG. 1 ; and 
         FIG. 9  is a schematic representation of a graphic user interface presenting data recorded by the system of  FIG. 1  during a course of treatment for a give patient. 
     
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     The present invention is a physiotherapeutic system combining stairs and an incline, and corresponding methods for tracking and/or documenting therapy performed using the device. 
     The principles and operation of therapeutic systems according to the present invention may be better understood with reference to the drawings and the accompanying description. 
     Referring now to the drawings,  FIGS. 1-7  show various full or partial views of a physiotherapeutic stair training system, generally designated  10 , constructed and operative according to a particularly preferred embodiment of the present invention. 
     The structural basis of system  10  according to this particularly preferred example employs a stair structure and lifting mechanism generally similar to that of U.S. Pat. No. 9,381,397 to DPE Medical Ltd. (Israel). Thus, the device has a set  12  of at least three, and in the case shown here four, horizontal tread surfaces, individually referred to as TR 0 , TR 1 , TR 2  and TR 3 . A drive system  14  is mechanically linked to the set  12  of tread surfaces and configured to displace at least two of the tread surfaces TR 1 -TR 3  vertically so as to adjust a rise height between adjacent of the tread surfaces in such a manner as to form a set of stairs  12  with uniform pitch for a range of different rise heights. 
     A preferred hut implementation of drive system  14  is best seen in  FIG. 5A . Under each tread surface is a scissors mechanism  16 , which allows vertical movement of the tread surface while ensuring that it remains parallel to the floor. A linear drive, shown here in the form of a screw actuator  18 , is deployed in a column  20  beside top tread surface TR 3  and deployed to move tread surface TR 3  vertically. Other types of actuators, such as hydraulic or pneumatic actuators, may also be used. Two side rails  22  are pivotally linked to top tread surface TR 3  so as to be lifted at one end as the top tread surface rises. Each of the other tread surfaces has lateral projections  24  ( FIG. 3 ) which engage rails  22  as a track, thereby lifting each tread surface in proportion to the elevation of the top surface and maintaining a set of stairs  12  of uniform pitch. In  FIGS. 1 and 4 , the scissors mechanisms are hidden by a folding protective skirt  17  to prevent objects or persons from being caught in the mechanisms, the protective skirt having been removed in  FIGS. 5A and 6A  to reveal the structural details. 
     It is important for stair therapy treatment that the steps are closed steps, i.e., with closed riser surfaces, so that the toes of a patient do not get caught beneath the step. To this end, each tread surface (other than TR 0 ) is generally integrally formed with a riser surface  26  to form a step structure. Drive system  14  is preferably configured to displace the tread surfaces in a purely vertical motion, such as through the aforementioned scissors mechanisms  16 . 
     In the particularly preferred case illustrated in  FIG. 3 , each step also includes a telescopic extension portion  28  which provides an extension to riser surface  26  in the higher raised positions of the system, such as is seen in  FIG. 1 . The use of a telescopic extension portion allows the system to assume a fully lowered state ( FIG. 2 ) in which a spacing from the floor is less than the maximum rise height of the set of stairs  12  in the fully raised state. By way of example, certain particularly preferred implementations of the present invention provide an adjustable step rise up to in excess of 16 centimeters, and preferably up to at least 18 centimeters, while the tread surfaces in the fully-lowered state are preferably less than 15 centimeters above the underlying surface, and most preferably no more than about 12 centimeters above the underlying surface. 
     The system preferably also includes at least one handrail extending alongside the set of stairs  12 . In the implementation illustrated here, an adjustable-height handrail  30  is provided on each side of the set of stairs  12 , and is complemented by handrail portions  32  extending along the top tread surface, which is here extended to form an upper platform to facilitate turning around between the ascent and descent when required. The handrail may additionally or alternatively be adjustable in horizontal position, to allow adjustment of the spacing between the right and left rails. 
     Drive system  14  is preferably configured to displace the tread surfaces so as to form the set of stairs  12  with a plurality of rise heights substantially spanning a majority of a range from 0 cm to 18 cm. “Substantially spanning” in this context refers to adjustability which provides either continuous adjustment or a plurality of discrete positions which are spaced apart by no more than 2 cm, and more typically in steps of 1 cm or less. In a particularly preferred implementation, the system provides adjustment to substantially span the entirety of a range of at least 0-18 cm, thereby facilitating practice of all common step sizes. 
     The system preferably assumes a fully flattened (zero step) state, as illustrated in  FIG. 2 . In this stage, the plurality of tread surfaces are juxtaposed as a continuous flat surface. 
     The present invention makes available an additional form of activity in the form of an adjustable ramp  60  (also referred to herein as a “slope” or “incline”) for assessing and practicing the patient&#39;s ability to ascend and/or descend a slope. Ramp  60  has a first end  62  hingedly connected to the last tread surface TR 3  so as to define a walking surface  64  from first end  62  to a second end  66  of the ramp. Walking surface  64  has a variable angle of inclination varying as a function of a vertical position of the last tread surface TR 3 . 
     It is a particular feature of certain preferred embodiments of the present invention that there is provided a support configuration deployed to support second end  66  of ramp  60  over a range of motion such that, in the fully-lowered state of  FIG. 2 , second end  66  of ramp  60  is supported above the underlying surface with its walking surface  64  horizontal so that the plurality of tread surfaces TR 0 , TR 1 , TR 2 , TR 3  and walking surface  64  together form a continuous horizontal walkway. As described above, the various components such as scissor mechanisms  16  and riser surfaces  26  dictate a minimum height above the underlying surface at which the “zero” rise flat surface of the steps can be provided. If second end  66  of ramp  60  were to extend to the floor level, this would result in a small residual slope. The support configuration of this aspect of the present invention addresses this issue by ensuring that the orientation of walking surface  64  in the zero-rise state is parallel to the underlying surface, thus contributing to an extended horizontal walkway along the length of device  10 , preferably of at least 2.5 meters, and typically at least about 3 meters long. 
     The support configuration may take a wide range of forms, and may define various different loci of motion of second end  66  as the angle of the ramp varies. In a particularly simple and effective implementation as best seen in  FIGS. 6A and 6B , device  10  is formed with a pair of rails  68 , which in the case illustrated here are elements of a device frame extending along the entire length of the device, along which second end  66  slides supported by sliding bearings  70 . Sliding bearings may be preferred over rolling bearings due to the relatively large contact area and consequent spreading of load, although roller bearings may also be used. 
     In order to facilitate patients accessing ramp  60 , a connecting ramp  72  is preferably provided with an upper edge  74  hingedly connected to second end  66  of ramp  60 , as best seen in  FIG. 5B . Connecting ramp  72  terminates at a lower edge  76  adjacent to the underlying surface. “Adjacent” in this context indicates that lower edge  76  is sufficiently close to the underlying surface that a patient&#39;s foot cannot get caught beneath it. Preferably lower edge  76  is also sufficiently thin that it does not present a significant step to mount the leading edge. The leading edge is therefore preferably no more than about 3 centimeters thick, and more preferably no more than about 2 centimeters thick. In order to minimize friction as the lower edge moves along the underlying surface during vertical motion of the first end  62  of ramp  60  and corresponding horizontal motion of second end  66 , lower edge  76  of connecting ramp  72  is preferably also mounted on bearings, shown here as roller bearings  78 , which may roll directly on the underlying surface or, more preferably, on a thin inward-projecting lip  80  from rails  68 . 
     A second connecting ramp  82  it typically provided at the end of the device opposite to connecting ramp  72  to help patients mount the first step TR 0 . Step TR 0  and connecting ramp  82  are typically fixed, static components. 
     In order to minimize the height of the device above the underlying surface when fully lowered, the linear actuator  18  deployed for raising the device vertically is preferably deployed outside the area of the walkway, as illustrated, and most typically adjacent to a side of the upper platform, corresponding to TR 3 . 
     An elevation sensor or “rise height sensor”  50  ( FIG. 7 , typically implemented as a linear encoder directly measuring the platform height, or a linear or rotary encoder tracking motion of the actuator) gives an indication of the position of the platform, and hence also of the step rise, at any time. 
     As a result of the structure described above, adjustment of the height of the central platform simultaneously adjusts both the uniform step height and the angle of inclination of the slope, making available two distinct modes of therapeutic activity. The output of the elevation sensor also indicates the current angle of inclination of the slope. 
     In addition to the aforementioned components, as illustrated in the non-limiting example of  FIG. 7 , the present invention features a computer system  34  comprising at least one processor  36  and a non-volatile data storage medium  38 , typically together with networking components  40  for connection to a wired or wireless network. Computer system  34  may be any type of suitable computer, including but not limited to, a general purpose computer running suitable software under a suitable operating system, and a dedicated computer system configured by suitable hardware, software and/or firmware to perform the various functions required. In some implementations, computer system  34  may be implemented using a mobile electronics device such as a smartphone operating suitable software and in wireless communication with the various other components of the system. 
     Computer system  34  is preferably associated with, and possibly integrated with, one or more user input device  42  and a display  44 . In one preferred case, the entire computer system  34  is integrated in a “tablet” configuration with a touch-screen which serves as both the input device and the display, as illustrated schematically in  FIG. 1 . 
     Control of the up/down motion of drive system  14  may be achieved by pressing directly on up/down buttons on a controller  46  associated with drive system  14 . Additionally, or alternatively, control of drive system  14  may be achieved via the user interface of computer system  34 . 
     Computer system  34  is preferably associated with a sensor set  48  including at least one sensor deployed for measuring a parameter related to physiotherapy performed using device  10 . Preferred examples of the sensors, and corresponding modes of operation of the system, are described below. 
     According to certain particularly preferred implementations of the present invention, the device is provided with at least three sensors for sensing the presence of the patient at specific locations on the device. These sensors preferably include a first sensor  52  deployed for sensing the presence of the patient on the first (lowest) step TR 0 ; a second sensor  54  deployed for sensing the presence of the patient on the central platform TR 3 ; and a third sensor  56  deployed for sensing the presence of the patient adjacent to the bottom end of the ramp  60 . The sensors may advantageously be implemented as pressure sensors built into the surfaces on which the user steps, although any other suitable type of sensors may be used, including but not limited to: optical sensors, proximity sensors, RFID-based sensing arrangements, and image-processing-based detection. 
     The deployment of the first, second and third sensors  52 ,  54  and  56  as described herein provides valuable functionality, as the system can automatically identify and record the type(s) of activity performed during a treatment session. This is illustrated in  FIG. 8 . Specifically, the order in which the sensors detect the presence of the patient indicates what combination of stair or slope climbing or descent has been performed, as follows: 
     
       
         
           
               
               
               
               
             
               
                   
               
               
                   
                 Case 
                 Order 
                 Activity 
               
               
                   
               
             
            
               
                   
                 A 
                 1-2-1 
                 Ascend stairs; descend stairs 
               
               
                   
                 B 
                 3-2-3 
                 Ascend slope; descend slope 
               
               
                   
                 C 
                 1-2-3 
                 Ascend stairs; descend slope 
               
               
                   
                 D 
                 3-2-1 
                 Ascend slope; descend stairs 
               
               
                   
                 C or D 
                 1-2-3 or 3-2-1 
                 [Zero elevation] Walking 
               
               
                   
               
            
           
         
       
     
     In addition to identifying the type of activity performed, the time from leaving one sensor until reaching the next gives a measure of the time taken on that occasion to complete the identified activity. This information is preferably stored together with the step rise or incline gradient/angle as part of the patient&#39;s personal record of treatment and performance (using data storage and recall functionality provided by computer system  34  directly and/or via remote storage accessed via networking components  40 ), and can then be used to generate a graphic display and/or printed chart or graph of the patient&#39;s progress over a course of treatment, facilitating monitoring of the progress of treatment. By way of a non-limiting illustrative example, an on-screen display showing a patient&#39;s progress is illustrated in  FIG. 9 . 
     Parenthetically, it may be noted in  FIG. 9  that the records of “UP” activities and “DOWN” activities in each therapy session do not necessarily balance. This occurs when a healthcare professional determines that the patient should focus on one or another activity, in which case the height of the device may be reduced or zeroed between ascending and descending, and the minor activity may not be recorded. Additionally, even where data exists for all activities of ascending/descending stairs/slope, it may be preferable to selectively display only part of the data in graphic form at any given time in order to avoid over-cluttering the display. Most preferably, a graphic user interface allows the healthcare professional to select the data to be displayed, for example, displaying plots of progress for ascending stairs and slope without descents, or displaying ascending and descending stairs only. Any and all other combinations may also be used. 
     Also included in the analytical data is a record of the level-surface walking time between sensors  1  and  3  (in either direction) which records the time taken for the patient to walk a predefined distance on a flat surface, in this case, about 3 meters. Walking ability is a further important indicator of the readiness of a patient to return to independent functioning outside a healthcare environment, and many treatment environments lack arrangements for accurately measuring and recording the level-surface walking ability of a patient. The combination step-and-incline device of the present invention thus provides significant added value by providing a tool for additionally monitoring and recording the level-surface walking ability of patients. 
     The device preferably includes handrails on both sides of the device, which are subdivided into rails  32  of the central platform, rails  30  for the stairs and rails  84  for ramp  60 . The handrails preferably also extend to or beyond connecting ramps  72  and  82 . The handrails for the stairs and ramp are preferably hingedly interconnected with supports for the central platform handrails, and are mounted via pin-in-slot engagements, or some other linear-bearing arrangement, to poles near the extremities of device  10 , to accommodate changes in the length of handrail between the supports as the elevation is adjusted. The handrails are preferably supported by adjustable supports to allow for adjustment for patients of different heights, such as for adults and children. A mechanism may also be provided (not shown) to allow adjustment of the horizontal position of the handrails, and thus adjust the span between the handrails. 
     The system preferably includes or interfaces with additional components including, but not limited to, control system components, user interface components, networking components and remote computer systems, and/or additional sensors, to provide additional functionality. By way of non-limiting examples, the various sensors for weight distribution, heart rate etc. described in the aforementioned U.S. Pat. No. 9,381,397 may all be implemented to advantage in the context of the present invention. 
     It will be appreciated that the above descriptions are intended only to serve as examples, and that many other embodiments are possible within the scope of the present invention as defined in the appended claims.