Abstract:
Passive gravity balancing orthosis apparatus for assisting and training patients suffering from muscle weakness by relieving the patients afflicted member of its weight using a plurality of articulated supporting members. Relief is obtained by identifying and fixing the center of mass of the combined articulated equipment members and supported weight of the patient&#39;s member in space using a defined parallelogram mechanism and once so identified making the total potential energy for any configuration of the articulated members of the system constant. At least one zero free length spring is used to connect the center of mass to a support outside the articulated members. Additional springs connect the center of mass to the articulated members.

Description:
STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH  
       [0001]     The work leading to this invention was financed in part by the National Institute of Health (NIH) under a grant or contract No. 1 RO1 HD38582-01A2. 
     
    
     BACKGROUND OF THE INVENTION  
       [0002]     This invention relates to a method and associated apparatus for transferring the weight of a plurality of weight bearing articulated members from a first supporting point to a second supporting point and more particularly to a method and passive orthosis apparatus for rehabilitating patients suffering from muscle weakness.  
         [0003]     A vast number of people are affected by conditions that result in profound muscle weakness or impaired motor control. People with severe muscle weakness from neurological injury, such as hemiparesis from stroke, often have substantial movement limitations. One of the aims of rehabilitation after stroke is to improve the walking function. However, equipment available to facilitate this is severely limited.  
         [0004]     Several lower extremity rehabilitation machines have been developed recently to help retrain gait during walking. Lokomat® is an actively powered exoskeleton, designed for patients with spinal cord injury. The patients use this machine while walking on a treadmill. Mechanized Gait Trainer® (MGT) is a single degree of freedom powered machine that drives the leg to move in a prescribed gait pattern. The machine consists of a foot plate connected to a crank and rocker system. The device simulates the phases of gait, supports the subjects according to their abilities, and controls the center of mass in the vertical and horizontal directions.  
         [0005]     Auto-Ambulator® is a rehabilitation machine for assisting individuals, with stroke and spinal cord injuries, in leg motion impairments. This machine is designed to replicate the pattern of normal gait.  
         [0006]     A limiting feature of these machines is that they move patients through predetermined movement patterns rather than allowing them to move under their own control. The failure to allow patients to experience and practice appropriate movement prevents necessary changes in the nervous system to promote relearning of typical patterns.  
         [0007]     There is, therefore, still a need for a rehabilitation device that simulates the phases of gait, provides passive assistance, support a patient according to his/her abilities and allows the patient to move using muscle power.  
       SUMMARY OF THE INVENTION  
       [0008]     There is provided according to this invention a method and associated equipment that allows patients to use their impaired muscles to move their limbs under their own power by balancing the effects of gravity on the afflicted limbs thereby reducing the effort needed to use such limb(s). Such balancing is achieved by transferring the weight of the afflicted limbs to a support external to the limbs, such as, for example a harness worn by the patient or a supporting structure forming part of a complete training system.  
         [0009]     In its broader aspects the invention is a method for transferring the weight of articulated members of a system comprising a first supporting structure, and at least two interconnected articulated members pivotally attached to the support from the pivoting point to a new point on the supporting structure. According to the present invention, such method comprises:  
         [0000]     (1) identifying a center of mass for each of the articulated members, together with any weight that may be supported by such articulated members;  
         [0000]     (2) identifying a system center of mass representing the combined center of mass for all the articulated members;  
         [0000]     (3) calculating a scale length for each of the articulated members and a parallelogram arm attachment point at one end of said scale length; and  
         [0000]     (4) connecting the system center of mass:  
         [0000]     to the parallelogram arm attachment point on each of the articulated members with an articulated lever structure forming a parallelogram;  
         [0000]     (i) to the external support with a primary connecting structure comprising at least one spring; and  
         [0000]     (iii) to at least one of the articulated members with a secondary connecting structure also comprising at least one spring.  
         [0010]     In accordance with the present invention there is also provided an apparatus for transferring the weight of at least two interconnected articulated members from a first support to which they are pivotally attached to a second support. In addition to the interconnected articulated members, the apparatus further comprises:  
         [0000]     a parallelogram lever structure comprising articulated lever arms connecting the system center of mass to the articulated members at the end of a scale length measured from the point of attachment of the articulated arm;  
         [0000]     a primary connecting structure comprising at least one spring connecting the system center of mass to the second support; and  
         [0000]     at least one secondary connecting structure also comprising at least one spring, connecting the system center of mass to at least one of the articulated members.  
         [0011]     In a preferred embodiment, at least one spring in the primary connecting structure is a zero free length spring.  
         [0012]     Still according to this invention, the articulated members are designed to attach to and support the weight of human limbs such as a leg. In addition, both the pivotal attachment and the second support are located on a harness adapted to be worn by a human and the articulated members form an exoskeleton adapted for attachment to a human limb.  
         [0013]     Alternatively, the second attachment point may be on a fixed structure external to the harness supporting the articulated members, and the fixed structure may incorporate a treadmill or a chair. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0014]      FIG. 1  is a schematic representation of an apparatus mounted on a patient for supporting a patient&#39;s leg according to present invention.  
         [0015]     FIGS.  2 ( a ) and  2 ( b ) show the significant elements and dimensions used in calculating the parallelogram design and spring attachment points for the apparatus of  FIG. 1  in accordance with this invention.  
         [0016]      FIGS. 3   a  and  3   b  are a schematic representation of a simple practical implementation of a zero free length spring in accordance with this invention.  
         [0017]      FIGS. 4, 5  and  6  are a representation of the significant elements and dimensions used in calculating the parallelogram design and spring attachment points for an apparatus having three degrees of freedom such as would be used to assist a patient in sitting up and down.  
         [0018]      FIG. 7  shows the apparatus of  FIG. 1  forming part of a larger system comprising a treadmill.  
         [0019]      FIG. 8  is a schematic representation of a three degree of freedom apparatus implemented in a system used to assist a patient in sitting up and down.  
     
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0020]     Although the invention is illustrated and described herein with reference to specific embodiments, the invention is not intended to be limited to the details shown. Rather, various modifications may be made in the details within the scope and range of equivalents of the claims and without departing from the invention. The figures and drawings are not to scale and only include those elements that are necessary in describing and explaining the invention. Such figures are not intended to replace complete engineering drawings.  
         [0021]     The principle involved in removing the weight of the leg, for example, is to support the weight of the leg using articulated members attached to the thigh and calf and place springs at suitable mathematically calculated positions on the articulated members such that they completely balance the effect of gravity, of both the leg and members. The weight of the leg is then transferred to a support which may be a harness worn by the patient or an external structure such as a fixed support (i.e. a wall) or which may be a part of a training device such as a treadmill.  
         [0022]     Gravity balancing, according to this invention, is achieved by fixing a center of mass (COM) of the combined articulated equipment members and supported weight of the limb in space using a parallelogram mechanism and once so identified making the total potential energy for any configuration of the articulated members of the system constant using springs. The method used to make a gravity-balanced assistive device for the human body comprises the following steps:  
         [0000]     (i) Determining the combined COM of the articulated supporting members and attached parts of the human body using auxiliary parallelograms; and  
         [0000]     (ii) Selecting springs to connect to the COM such that the total potential energy of the system is invariant with configuration.  
         [0023]     The invention will next be described with reference to certain specific embodiments such as an apparatus having two degrees of freedom, and one having more than two, specifically three. The examples given are illustrative and are used herein for the purpose of explaining rather than limiting this invention.  
       Example 1  
     Two Degrees of Freedom  
       [0024]     The two degrees of freedom apparatus described is for use in full or partial support of a paretic limb i.e. a leg or a trunk, to help reduce the effect of gravity on the patient&#39;s motion. The present invention overcomes the problem of supporting the weight of the afflicted member during a dynamic activity like walking here the weight of the leg continuously shifts by balancing the weight of the leg in all configurations, thereby putting the leg in, so to speak, a state of neutral equilibrium.  
         [0025]     We will use  FIGS. 1, 2   a  and  2   b  to demonstrate the calculation of the COM and the parallelogram structure as well as the selection of springs and their points of attachment for a system comprising two articulated members. The described system provides the design for an exoskeleton device for attachment to a patient&#39;s leg to assist such patient in walking.  
         [0026]     Referring to  FIG. 1  there is schematically illustrated a basic system according to the present invention designed for use to assist leg movement of an afflicted patient during a walking cycle. The patient  10 , represented in the figure only partially, is in the process of lifting leg  14  while taking a stride. Leg  12  is on the ground. A harness  16  is strapped to the patients torso. Attached to the harness is a structure  18  that includes a primary support point  20 . Also attached and supported by the harness is a two member leg support system comprising articulated members  24  and  30 , pivotally connected to each other at articulation  28 . The two members are attached to the thigh and the calf portions of leg  14  respectively with a harness  26  and  32  (or any other attachment method) in a way that movement of the leg and articulated members is in unison. The members and attachments are strong enough to support the full weight of the leg and articulated members.  
         [0027]     Preferably, the members are constructed of lightweight material such as aluminum, and their length is adjustable to fit patient&#39;s having different length limbs.  
         [0028]     A parallelogram formed by the members and arms  34  and  36  connects the COM  38  to points  40  and  42  on the articulated members  24  and  30 . A primary spring connection  44  connects the COM to the primary support  20  on the harness  16 . A secondary spring connection  46  connects the COM to either or both members  24  and  30 . The two spring loaded mechanisms serve to transfer the weight of the leg from pivot points  28  and  22  to support  20 .  
         [0029]     In FIGS.  2 ( a ) and ( b ), line OH represents the harness, or any external structure on which the primary support point H is located. Link OA represents the length of articulated member  24  with O corresponding to the pivotal attachment  22  and A to the pivotal attachment  28 . Link AB represents the member  30 , where B is an end point to which is also transferred the weight of the foot of the patient. The joints or pivots usually contain bearings or similar heavy objects, which are approximated as point masses m p1 , m p2 , and m p3 . m p3  includes the weight of the foot.  
         [0030]     Let:  
         [0031]     l i =length of the i th  link;  
         [0032]     l* i =distance of COM of the i th  primary link from the joint of the previous link;  
         [0033]     l* ai =distance of COM of the i th  auxiliary link from the joint of the previous link;  
         [0034]     m i =mass of the ith primary link (mass of the leg segments included),  
         [0000]     m ai =mass of the ith auxiliary link,  
         [0000]     m pi =mass of the ith point mass,  
         [0000]     û i =unit vector along the ith primary link,  
         [0000]     u i =position vector from the point O to the center of mass of ith primary link,  
         [0000]     u ai =position vector from the point O to the center of mass of ith auxiliary link,  
         [0000]     u pi =position vector from the point O to the center of mass of ith point mass,  
         [0000]     s 1 =distance OD,  
         [0000]     s 2 =distance AE  
         [0000]     s 1  and s 2  determine the two legs of the parallelogram that identifies the COM. We will refer to s 1  and s 2  as the scale length. The scale length further identifies the point of connection of the parallelogram arms to the articulated members.  
         [0035]     In the preferred case where the links are made with an adjustable length, such as for example by using aluminum telescopic members, their mass remains constant, independent of their length. l* ai  is then a linear function of the length of the i th  auxiliary link.  
         [0036]     Let: 
 
 l*   1 =α 1   l   1  
 
 l*   2 =α 2   l   2  
 
 l*   a1 =β 1 ( l   1   −s   1 ) 
 
 l*   a2 =β 2   s   2  
 
         [0037]     Where α i  and β i  are the ratios between 0 and 1. The COM is given by: 
 
 R   com   =Σm   i   u   i   /Σm   I  
 
         [0038]     Where: 
 
 Σm   i   u   I   =m   1   u   1   +m   2   u   2   +m   a1   u   a1   +m   a2   u   a2   +m   p1   u   p1   +m   p2   u   p2   +m   p3   u   p3  
 
 Σm   i   =m   1   +m   2   +m   a1   +m   a2   +m   p1   +m   p2   +m   p3  
 
         [0039]     Rewriting the vectors u i  in terms of unit vectors along the primary links û i  as follows: 
 
 u   1   =l*   1   û   1 ; 
 
 u   2   =l   1   û   1   +l*   2   û   2 ; 
 
 u   a1   =s   1   û   1   +s   2   û   2   +l*   a1   û   1 ; 
 
 u   a2   =s   1   û   1   +l*   a2   û   2 ; 
 
 u   p1 =0 
 
 u   p2   =l   1   û   1 : 
 
 u   p3   =l   1   û   1   +l   2   û   2 ; 
 
         [0040]     Since point C is the center of mass of the entire system, u com =s 1 û 1 +s 2 û 2  and therefore: 
 
 s   1   =l   1 ( m   a1   +m   2   +m   p3   +m   a1 β 1   +m   p2 )/( m   1   +m   2   +m   p1   +m   p2   +m   p3   +m   a1 β 1 ) and 
 
 s   2   =l   2 ( m   2 α 2   +m   p3 )/( m   1   +m   2   +m   a2   +m   p1   +m   p2   +mp 3 −m   a2 β 2 ) 
 
         [0041]     Having thus obtained the COM the remaining step needed to obtain gravity balancing is to determine the springs. Balancing is achieved using springs as shown in  FIG. 2   b . Two springs are used in this example. One end of both the springs is connected to the center of mass of the system (COM in  FIG. 2   b ). The other end of spring  44  is connected to the primary support  20  on the harness  16 , point H in  FIG. 2 . The second spring  46  is also connected between the COM and member  24  of the articulated members which in the above example is connected to the thigh.  
         [0042]     Let x 1  and x 2  be the extended lengths of the springs with corresponding stiffness k 1  and k 2  respectively. The springs are attached to the COM making the potential energy V constant for all configurations of the articulated members. That means: 
 
 V =( k   1   x   1   2 /2)+( k   2   x   2   2 /2)+ Mgh.  
 
 x   1   2   =∥CH∥   2 =( d   1   +s   1  cos θ 1   +s   2  cos(θ 1 −θ 2 )) 2 +( s   1  sin θ+ s   2  sin(θ 1 −θ 2 )) 2  
 
 x   2   2   =∥CS∥   2   =d   2   2   +s   2   2 −2 d   2   s   2  cos θ 2  and 
 
 h=d   1   +s   1  cos θ 1   +s   2  cos(θ 1 −θ 2 ) 
 
 Substituting and simplifying yields V=C 0 +C 1  cos θ 1 +C 2  cos θ 2 +C 3  cos(θ 1 −θ 2 ), Where: 
 
 C   0 =( k   1   d   1   2 /2)+( k   2   d   2   2 /2)+( k   1   s   1   2 /2)+( k   1   s   2   2 /2)+( k   2   s   2   2 /2)− Mgd  
 
 C   1   =k   1   s   1   d   1   −Mgd  
 
 C   2   =k   1   s   1   s   2   −k   2   d   2   s   2  
 
 C   3   =k   1   s   2   d   1   −Mgs   2 . 
 
         [0043]     All the C i  are constants if the coefficients containing trigonometric variables vanish, i.e. C 1 =C 2 =C 3 =0, in which case the total potential energy is given by V=C 0  which is a constant. The potential energy thus becomes configuration invariant and gravity balancing is achieved. These conditions yield two independent equations: 
 
 k   1   =Mg/d   1  and  k   2   =Mgs   1   /d   1   d   2  
 
 and thus provide the spring constant characteristic. 
 
         [0044]     Preferably, the springs used are zero free length springs, which means that the tension in the spring is proportional to the distance between the two connection points. If the distance between the two connection points is zero, the tension in the spring is also zero.  
         [0045]     Implementation of a zero free length springs was done using springs, cable and pulleys as illustrated in  FIGS. 3   a  and  3   b . To emulate the property that the distance between the connection points is zero when the force (or tension) in the spring is zero, a pulley  50  is placed at the primary support P. A length of cable C l1 +C l2  is connected to the COM, over the pulley  50  to one end of spring  44 . The other end of spring  44  is attached to an auxiliary support point Paux preferably on the same base on which is attached the primary support P. In the case of the primary support being on a harness worn by the patient, i.e. harness  16  in  FIG. 1 , Paux is also on harness  16 . However as shown in  FIG. 7 , where the primary support is on a structure separate from the exoskeleton, the spring is also attached to this structure. The length of the cable is chosen such that the force (or tension) in the cable (and hence the force in the simulated zero free length spring) is zero when the distance between the system center of mass COM and the pulley on the primary support point P is zero.  
       Example 2  
     Three Degrees of Freedom  
       [0046]     More than two articulated members are also within the scope of this invention. The calculation of the COM and the selection of spring constants will next be illustrated in connection with the design of a 3 degree of freedom system for supporting and training device impaired subjects in sitting and getting up from a chair, with reference to  FIGS. 4, 5  and  6 .  
         [0047]     The term three degrees-of-freedom is used to refer to the motion of the body at the hip, knee, and ankle. In the present design, the device is an orthosis device with straps or other convenient attachments between the corresponding moving segments of the machine and the patient&#39;s leg. In this example, the following assumptions are made:  
         [0000]     (i) the motion of the body is in sagittal plane;  
         [0000]     (ii) both legs have the same motion during the sit to stand cycle (STS) motion; and  
         [0000]     (iii) the device links are lightweight and do not add significant mass to the moving.  
         [0048]     The human body can be modeled during sit to stand (STS) motion as having 3 degrees-of-freedom (DOF), as shown in  FIG. 4 . The sagittal plane approximation holds if both legs do not have any out-of-plane motion. Links l s (00 1 ), l t (0 1 0 2 ), and l H (0 2 0 3 ) represent the shank, thigh and HAT (Head, Arm and Trunk) segments of the human body, respectively. The head, arm and trunk of the body is considered as a “HAT” single body whose center of mass remains fixed during the sit to stand motion. The angles θ a , θ k  and θ h  are the ankle, knee and hip joint angles, respectively.  
         [0049]     To form the parallelograms one again needs to find the scaled lengths in each of the articulated members. Scaled lengths d j  are factors of geometry and mass distribution. The three scaled lengths used to form two parallelograms and to identify location of the COM C (r OC =d s b s +d t b t +d H b H ) are shown in  FIG. 5 , where: 
 
 d   s =(1 /M )( m   t   l   s   +m   H   l   s   +m   s   l   cs ) 
 
 d   t =(1 /M )( m   H   l   t   +m   t   l   ct ) 
 
 d   H =(1 /M ) m   H   l   cH  
 
 and where: 
 
 M=m   s   +m   t   +m   H . 
 
 m j =mass of a length j of the combined supporting member and attached weight; 
 
 l j =length of supporting member j; and 
 
 l cj =is the distance to a supporting member j center of mass. 
 
         [0050]     Having determined the COM of the system, the spring constants are next determined. The human body and the device is next gravity-balanced by attaching four springs to the system as shown in  FIG. 6 . The total potential energy of the system consists of gravitational (V g ) and elastic (V s ) energies due to the springs. Its expression is given by: 
 
 V=V   s   +V   g =(½) kx   2 +(½) k   1   x   1   2 +(½) k   2   x   2   2 +(½) k   3   x   3   2   −Mg*r   oc  
 
 upon substitution of 
 
 x   2   =∥PC∥·∥PC∥,  
 
 x   1   2   =∥O   1   S   1   ∥·∥O   1   S   1 ∥, 
 
 x   2   2   =∥CS   3   ∥·∥CS   3 ∥ and 
 
 x   3   2   =∥O   2   S   2   ∥·∥O   2   S   2 ∥
 
 and expanding the results thus obtained in terms of joint angles, one obtains: 
 
 Mg·r   oc   =Mg ( d   s   s   a   +d   t   s   ak   +d   H   S   akh ) 
 
 x   2 =( d   s   c   a   +d   t   c   ak   +d   H   c   akh ) 2 +( d   s   s   a   +d   t   s   ak   +d   H   s   akh   −d ) 2  
 
 x   1   2   =d   t +( l   s   −d   s ) 2 −2( l   s   −d   s ) d   t   c   k  
 
 x   2   2   =d   H   2 +( l   s   −d   s ) 2 −2 d   H ( l   s   −d   s ) c   kh  
 
 x   3   2 =( l   t—   d   t ) 2   +d   H   2 −2 d   H ( l   t   −d   t ) c   h . 
 
 Here, c i , s i , c ij , S ij , c ijk  and s ijk  stand for cos θ i , sin θ i , cos (θ i +θ j ), sin (θ i +θ j ), cos (θ i +θ j +θ k ) and sin (θ i +θ j +θ k ), respectively. Also d=∥OP∥ is the distance along the gravity as shown in  FIG. 6 , and x and x i  are deformation and k and k i  where i=1, 2, 3 are stiffness of the springs. In this above analysis, it is assumed that the undeformed length of the spring is zero. 
 
         [0051]     Setting next the coefficients of the configuration variables in the potential energy to zero, the desired stiffness of the springs for gravity balancing of the system are derived as: 
 
 k=Mg/d  
 
 k   1   =kd   s /( l   s   −d   s ) 
 
 k   2   =kd   s /( l   s   −d   s ) 
 
 k   3   =kd   t ( l   t   −d   t ). 
 
         [0052]     Again in the preferred physical implementation a zero free length spring is used behind a pulley as previously explained, where the spring force can be transmitted through a cable.  
         [0053]     Examples 1 and 2 illustrate the invention and explain the different calculations needed in order to practice the invention in two specific applications. Example 1 shows the invention as an exoskeleton worn by a patient, while example 2 discusses in general terms an arrangement for assisting a patient in sitting down and getting up.  
         [0054]     The devices shown may be part of another device. For example, as shown in  FIG. 7 , the primary weight support point  20 ′ be supported by a fixed support  50  external to the harness  16 ′ worn by the patient so that the patient does not bear any of the leg weight using a zero length spring  54  comprising a pulley  56 , a cable  58  and a spring  44 ′. As also shown in  FIG. 7  this external primary support point  20 ′ may be part of a training device such as, for example, a treadmill  52 .  
         [0055]      FIG. 8  shows in very schematic representation a chair ( 80 ) with a device according to example 2 of this invention attached. The chair and invention have been greatly simplified and most springs omitted to avoid over cluttering of the figure. The chair comprises a sitting part  68  and a back harness  66 . The system comprises two sets of articulated members one on the left side and one on the right. To avoid undue cluttering of the figure, only the primary springs  70  and  70 ′ connecting the COM springs to the frame at the primary support point P are shown. Also shown are the two sets of two parallelograms  60  and  60 ′ used on the left and right sides. The auxiliary springs connecting the COM to the articulated members have been omitted for clarity; their location and points of attachment are as illustrated in  FIG. 6 . A patient, also not shown to avoid undue cluttering, is strapped to the device and may practice sitting up and down a number of times as part of re-training of the failing muscles with his weight having been taken over the primary support.  
         [0056]     Since the springs compensate for the weight of whole body and have large extensions, the resulting calculated stiffness of the springs is high and it is hard to select springs with large extensions and high stiffness. Additionally, the size of the auxiliary parallelograms is sometimes small and it is difficult to physically fabricate them.  
         [0057]     To alleviate these problems, it is preferred to modify the design to have smaller stiffness of the springs and larger size for auxiliary linkages by: (a) Using an added ankle weight m e  leading to larger size for the parallelograms; (b) Using a body weight support (harness) to partially reduce the weight of the body as shown in  FIG. 8  where the harness is also supported by a counterweight W on a cable and pulley system  74  and  74 ′ supported on a beam  78 ; and (c) altering the location of the center of mass to reduce the stiffness of the springs.  
         [0058]     While preferred embodiments of the invention have been shown and described herein, it will be understood that such embodiments are provided by way of example only. These examples are not limiting the method and apparatus to the two specific embodiments shown and described but the method and principles taught herein may also be applied to an arm assisting device and more broadly to robotic devices involving articulated members motion as well as other variations, changes and substitutions that will occur to those skilled in the art without departing from the spirit of the invention. Accordingly, it is intended that the appended claims cover all such variations as fall within the spirit and scope of the invention.