Surgery – Diagnostic testing – Measuring anatomical characteristic or force applied to or...
Reexamination Certificate
2001-09-28
2003-09-02
Hindenburg, Max F. (Department: 3736)
Surgery
Diagnostic testing
Measuring anatomical characteristic or force applied to or...
Reexamination Certificate
active
06613000
ABSTRACT:
BACKGROUND OF THE INVENTION
1. Field of the Invention
The invention relates to the field of apparatus and methods using computer-controlled rehabilitation or physical therapy in combination with a computer network. More specifically, the invention relates to an Internet-based rehabilitation system for treatment of injury and disease.
2. Description of the Prior Art
Stroke is the largest single cause of major disability in our nation with approximately 730,000 Americans having a new or recurrent stroke every year. As a result of their stroke, people often lose strength, speed, and coordination in their hand and arm or other motor functions. Post-stroke rehabilitation therapy is an important process in the recovery of stroke patients who, with practice, can for example improve their ability to reach, grasp, and manipulate objects. Although rehabilitation immediately after the stroke has more significant effects, improvements even several years after a brain injury are still possible. With the assistance of a physical or occupational therapist, stroke patients are able to improve their sensory motor skills by repetitive movements. These movements help stimulate recovery of the nervous system and aid the patient in relearning how to use their limbs.
With the high cost of medical care in the country today, many patients lack the monetary means to continue hands on therapy with a professional therapist for long periods of time. As a result, the patients are forced to go home earlier following their stroke without getting the post stroke therapy necessary for continued recovery. Further, there is a lack of technology to allow the patients to do their own therapy at home.
There are several examples of prior art systems that describe computer controlled rehabilitation or physical therapy in combination with a computer network. In general, these systems describe methods by which a rehabilitation therapist can interact with a remote patient in real-time. For example, Burgess, described below, teaches a method for providing physical therapy to a remote human client that includes a communication link that provides real-time sound and video images of the patient to the therapist, and vice versa. Girone et.al. and Hogan et.al., described below, teach telerehabilitation systems that are formed by a pair of rehabilitation devices with a first device at the therapist and a second device coupled to the client's limbs. The therapist interacts in real-time with the patient by moving or feeling the movement of the first device, which moves or responds to the movement of the second device.
None of these prior art systems describe how a large number of patients could simultaneously access individualized therapy exercises remotely and autonomously from a therapist. This is significant because there is a very large number of survivors of stroke in the country who could benefit from ongoing rehabilitation exercise. Providing directly supervised therapy to this large population, even if it were done remotely, would be prohibitively costly. In addition, recent research has indicated that simple, highly repetitive exercise can improve sensory motor recovery. Such exercise can be performed without direct, moment-by-moment supervision of a therapist.
Recently, several robotic systems have been developed that physically interact with the patient to mimic the aid that would be provided by a real therapist and retrain coordinated movement (for example, see Hogan et al., below). Although preliminary trials show promise in the realms of improved evaluation and therapy, these robotic systems are not cost nor size efficient, making them impractical for common everyday home use.
Burgess, “Method and System for Providing Physical Therapy Services,” U.S. Pat. No. 6,007,459 (1999) shows in
FIG. 1
, method
10
which includes the step
12
of providing an electronic communication link between a human client and a therapist that provides real-time video, sound, and data from the client to the therapist and vice versa. Step
14
of the method involves instructing the client to move in a particular manner or to assume a sustained posture. Further, the method includes step
16
involving the requesting of feedback from the client relating to bodily sensation corresponding to the movement or sustained posture. At step
20
, the feedback is used to assess the physical condition of the client and at step
22
, remedial movements or a remedial sustained posture is communicated to the client to address the physical condition.
As shown in
FIG. 2
, in response to a preliminary diagnosis, step
32
refers the client to an interactive terminal, which links the client and remotely located physical therapist through video images and sound. As shown in
FIG. 3
, system
40
includes a communication link
42
, a first terminal
44
associated with a client and a second terminal
46
associated with a therapist.
As shown in
FIG. 4
, the system includes a goiniometer, an accelerometer, a dynamometer, reflex testing devices or other postural measurement devices coupled with the first terminal
4
.
Burgess is described generally as being performed on “a communication link” in which the therapist is remote from the patient, but interacting in real-time with the to patient.
Schenck et.al., “Therapy Apparatus Having a Passive Motion Device for Flexing a Body Member,” U.S. Pat. No. 5,746,704 (1998) describes an apparatus which is programmed or controlled to provide an upper range of motion or extension separated from a lower range of motion or flexion. When using device
10
to flex a finger
12
, the device
10
can be supported to the patient's wrist by a variety of means. As shown in
FIG. 1
, the slide guide
16
can be integral with a cast or wrist brace
92
. Accordingly, the wrist brace
92
will be formed from a lightweight plastic material. To affix the finger
12
to the carriage
14
, a connector
94
, such as a rubber band or the like can be attached to the finger
12
and wrapped around the carriage
14
, such as in an annular groove
96
formed in the outer surface
26
of the cylindrical carriage
14
intermediate the ends thereof.
Miller, “Exercise Apparatus,” U.S. Pat. No. 5,755,645 (1998) shows an exercise apparatus, which when in use requires a user grasping limb interface
8
shown in FIGS.
1
-
3
can move limb interface
8
in the directions indicated by arrows D
1
-
3
in a spherical configuration anywhere within the three dimensional resistance field
90
to exercise a full functional motion. Computer
110
can be programmed to provide resistance field
90
with separate areas of varied resistance. With reference to
FIG. 3
, limb interface
8
includes an outer yoke
120
which is secured to the distal end of arm member
18
. An intermediate yoke
122
is rotatably mounted to outer yoke
120
along an axis
121
by rotary joints
128
a
and
128
b.
An inner yoke
124
is rotatably mounted to intermediate yoke
122
along an axis
123
by rotary joint
130
. This configuration provides limb interface
8
with a gimbal joint
7
having three unbraked rotational degrees of freedom. The gimbal joint
7
allows the user's hand to be comfortably oriented at almost any position relative to exercise apparatus
10
during use.
Girone et.al., “Ankle Rehabilitation Systems,” U.S. Pat. No. 6,162,189 (2000) shows in
FIGS. 3A and 3B
detailed views of the connection of foot attachment
24
to mobile platform
25
in rehabilitation device
12
. Force sensor
36
is positioned between foot attachment
24
and mobile platform
25
. Force sensor
36
measures in real time forces applied from foot
11
to mobile platform
25
′. As shown in
FIG. 5
, controller interface
14
receives position measurement data
49
and force measurement data
39
from rehabilitation device
12
. Position and force output
57
from analog-to-digital converter
56
is received at personal computer board
58
. Pressure sensors
61
interface piston
42
of rehabilitation device
12
to generate piston pressure measurement data
60
Painter Christopher C.
Pang Clifton T.
Reinkensmeyer David J.
Dawes Daniel L.
Hindenburg Max F.
Myers Dawes Andras & Sherman LLP
Szmal Brian
The Regents of the University of California
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