Body-worn orthotic devices

Abstract

A body wearable brace, for example for resisting involuntary movement, adapted to allow a user wearing the brace on his / her arm to dynamically move his / her upper arm, forearm, wrist and hand, the brace comprising an upper arm piece, a hand piece, an elbow flexion-extension joint rotatable about a first axis of rotation relative to the upper arm piece, a forearm pronation-supination joint rotatable about a second axis of rotation relative to the forearm pronation-supination joint and the elbow flexion-extension joint, an extension element extendable longitudinally, and a wrist flexion-extension joint rotatable about a third axis of rotation, a first part of the wrist flexion-extension joint being directly or indirectly connected to the extension element and a second part of the wrist flexion-extension joint being directly or indirectly connected to the hand piece.

Description

Detailed Description of the Invention 【0001】 The present invention relates to a body-wearable device adapted to allow a user wearing the device on their arm to dynamically move their upper arm, forearm, and wrist joints, and, for example, simultaneously reduce involuntary movements of the user's arm. [Background Art] Spanish Patent Application ES2260986 describes a device for controlling pronation and supination movements of the forearm, which can adjust the relative rotational movement of the wrist joint with respect to the axis of the forearm. The known device suppresses involuntary movements such as essential tremors and is also adapted to still allow the user to perform voluntary movements over a wide range of motion. That is, the known device, like the present invention, allows dynamic movement of the arm of the user wearing the device. This is in contrast to devices that statically fix the position of the user's arm, which, for example, may help the user extend their arm but do not allow the user the freedom of movement for performing daily activities. 【0002】 The known device includes a main bar attached to the user at two points: one point on the ulna near the ulnar prominence and one point on the wrist joint near the ulnar side. At the attachment point on the ulna near the ulnar prominence, rotational movement is allowed but longitudinal movement is not. Also, at the attachment point to the wrist joint, longitudinal movement of the main bar is allowed but rotational movement is not. For this purpose, the main bar has an upper part used as a linear guide and a rounded bottom part. The upper part passes through a sliding part that does not allow rotation of the main bar, and the lower part is inserted into a bearing held axially. The known device is attached to the user by a wrist joint strap and a band located on the forearm. The bar is connected to the wrist joint strap via the sliding part and to the band via a forearm support for bearing support. 【0003】 While known devices may help suppress involuntary forearm movements in patients with essential tremor, attaching these devices to the user's wrist, forearm, and upper arm can be difficult, especially for patients with tremor disorders. 【0004】 The object of the present invention is to overcome this drawback, at least in part. [Overview of the prefecture] To this end, the present invention provides a body-worn orthosis adapted to allow a user, wearing the orthosis on their arm, to dynamically move their upper arm, forearm, wrist, and hand. The orthosis comprises an upper arm piece for connecting the orthosis to the user's upper arm, a hand piece for connecting the orthosis to the user's hand, an elbow flexion-extension joint (EFE joint), a forearm pronation-supination joint (FPS joint), an extension element, and a wrist flexion-extension joint (WFE joint). The EFE joint comprises a first part fixed to the upper arm piece and a second part rotatable about a first axis of rotation relative to the upper arm piece, allowing elbow flexion and extension. The FPS joint comprises a first part fixed to the second part of the EFE joint and a second part rotatable about a second axis of rotation relative to the first part of the FPS joint and the second part of the EFE joint, allowing for forearm pronation and supination. The extension element extends longitudinally and comprises a first part and a second part that is movable longitudinally relative to the first part. The first part of the extension element is fixed to the second part of the FPS joint. The WFE joint comprises a first part and a second part that is rotatable about a third axis of rotation relative to the first part, allowing for flexion and extension of the wrist. The first part of the WFE joint is directly or indirectly connected to the second part of the extension element, and the second part of the WFE joint is directly or indirectly connected to the hand piece. To wear the device, the user simply needs to connect the upper arm piece to their upper arm and the hand piece to their hand. The user does not need to connect straps or the like to their forearm to wear the orthosis. 【0005】 The extension element may have one or more intermediate sections between the first and second parts, allowing the user to put on and wear the orthosis without having to manually adjust it to the user's forearm length beforehand. Furthermore, the extension element can compensate for any misalignment between the rotational axis of the user's elbow and the first rotational axis of the EFE joint. When combined with the EFE joint, FPS joint, and WFE joint, the extension element allows for elbow flexion / extension, forearm pronation / supination, and wrist flexion / extension, while simultaneously providing support for the user's hand. Thus, the orthosis provides at least three degrees of freedom of movement. 【0006】 The orthosis may help reduce involuntary movements during elbow flexion-extension, forearm pronation-supination, wrist adduction-abduction (WAA), and / or wrist flexion-extension, while allowing dynamic arm movement when the device is worn. EFE involuntary movements, FPS involuntary movements, WAA involuntary movements, and WFE involuntary movements may include EFE tremor, FPS tremor, WAA tremor, and WFE tremor, respectively. 【0007】 Tremor is an involuntary, roughly sinusoidal vibration in a body part, primarily occurring in the upper limbs, including the upper arm, forearm, and wrist. Most upper limb tremors manifest as elbow flexion / extension tremors, forearm pronation / supination tremors, wrist abduction / adduction tremors, and / or wrist flexion / extension tremors. The dominant tremor frequency varies between 3 Hz and 7 Hz, but secondary elements at higher frequencies can range from 8 Hz to 12 Hz. Tremor frequency generally does not change substantially over time, for example, by only about ±0.5 Hz or less in 10 seconds. However, the amplitude of the tremor can change significantly in a short period of time. The dominant frequency accounts for a significant portion (around 86%) of the tremor's energy and is the most interfering to work. Therefore, the effects of higher harmonics are negligible. 【0008】 The second axis of rotation generally forms an angle between 0 and 25 degrees, preferably between 5 and 15 degrees, with respect to an axis substantially perpendicular to the first axis of rotation. The third axis of rotation is generally substantially perpendicular to the second axis of rotation. 【0009】 Because the orthosis is portable, the user can wear it without additional support such as a stand to support the weight of the orthosis. The total weight of the orthosis is typically less than 2 kg. 【0010】 In one embodiment, the orthosis is designed so that, when worn, there is no portion of the orthosis that completely encloses a portion of the forearm close to the user's elbow. In this way, the expansion / contraction of the forearm muscles does not affect how the orthosis is worn, and blood flow through the forearm is not restricted by the orthosis. 【0011】 In one embodiment, the orthosis is fitted to remain completely separate from the user's forearm during use. Therefore, to wear the orthosis, only the upper arm portion needs to be attached to the user's upper arm and the hand portion to the user's hand. Since the user does not need to fit any part of the orthosis to their forearm, the orthosis can be relatively compact and / or lightweight compared to, for example, the orthosis described in ES2260986. Furthermore, by ensuring that the orthosis remains separate from the forearm, it is possible to avoid the orthosis compressing sensitive areas of the user, such as the carpal tunnel. 【0012】 In one embodiment, the upper arm piece extends along the longitudinal direction of the upper arm for at least one-quarter of the length of the user's upper arm when worn. The orthosis is adapted to transmit forces resulting from (involuntary) movements of the forearm or hand, for example, exerted by the hand against the hand piece, to the user's upper arm via the extension element and the upper arm piece. 【0013】 In one embodiment, in a projection onto a plane perpendicular to the longitudinal direction, the third rotation axis is spaced at a distance of at least 0.7 cm, preferably less than 7 cm, and preferably between 2 cm and 5 cm, from the first part of the extension element. This prevents the user wearing the orthosis from having their wrist flexed and being hindered by contact between their wrist and the extension element or the WFE joint. 【0014】 In a further embodiment, the WFE joint is a double joint comprising a pair of coupled joints. This mechanism prevents the rotary joint from rotating independently and allows only coordinated movement of the joints. As a result, the coordinated movement allows the extension element to remain near the user's arm while the user's wrist flexes and extends within the hand piece. 【0015】 In one embodiment, in a projection view onto a plane parallel to and passing through the second axis of rotation, the longitudinal direction of the extension element is at an angle between 0 and 30 degrees with respect to the second axis of rotation, preferably between 0 and 15 degrees, and more preferably between 5 and 12 degrees, for example, 10 degrees. When the longitudinal direction is at a non-zero angle with respect to the second axis of rotation, the shortest distance from the extension element to the hand piece is shorter than the shortest distance from the second axis of rotation to the hand piece, thereby allowing the extension element to remain near the user's forearm during use. 【0016】 In one embodiment, the first part of the extension element is fixed so as to be rotatable relative to the first part of the FPS joint, and rotation of the second part of the extension element about an axis parallel to the longitudinal direction of the extension element relative to the first part of the WFE joint is substantially prevented. In this way, involuntary movements of the wrist and / or forearm, such as tremors, are reduced. 【0017】 In one embodiment, the hand piece is provided with a wrist adduction-abduction joint (WAA joint), the WAA joint comprising a first part and a second part rotatable about a fourth rotation axis relative to the first part. The WAA joint is connected between the hand piece and the second part of the extension element and allows adduction and abduction of the user's wrist. For example, the WAA joint may allow both adduction and abduction over a 45-degree range from the neutral position of the wrist. The first part of the WAA joint may be fixed to the second part of the extension element, and the second part of the WAA joint may be fixed to the first part of the WFE joint, thereby interconnecting the extension element and the WFE joint. Alternatively, the first part of the WAA joint may be fixed to the second part of the WFE joint, and the second part of the WAA joint may be fixed to the hand piece, thereby interconnecting the WFE joint and the hand piece. 【0018】 In one embodiment, an EFE fitting, WFE fitting, FPS fitting, and / or WAA fitting includes a motion resistance element adapted to resist the rotation of the first part of the fitting relative to the second part of the fitting when the torque is below a threshold. Typically, the motion resistance element allows the fitting to rotate over its entire range of motion when a torque exceeding the threshold is applied to the fitting in question. 【0019】 In one embodiment, the EFE joint, WFE joint, FPS joint, and / or WAA joint comprises a motion resistance element adapted to resist the fast rotation of the joint more than the slow rotation of the joint. The motion resistance element typically allows the joint to rotate throughout its entire range of motion and can exert greater resistance to the joint when the first and second parts of the joint rotate relative to each other at a faster speed than when they rotate relative to each other at a slower speed. This allows for more effective attenuation of high-speed motion (e.g., tremors with frequencies of 2 Hz or higher) than voluntary motion. 【0020】 In one embodiment, the EFE joint, WFE joint, FPS joint, and / or WAA joint are provided with a damper, such as a fluid damper, liquid damper, and / or friction damper, to dampen the rotation of the first part of the joint relative to the second part of the joint. The damper may also be a motion resistance device as described with reference to the earlier embodiments. If the EFE joint, WFE joint, FPS joint, and / or WAA joint are equipped with a damper, each helps to absorb any EFE involuntary motion, WFE involuntary motion, FPS involuntary motion, and / or WAA involuntary motion. 【0021】 For example, when a friction damper is used, it can substantially hinder the motion of the first part of the joint relative to the second part when the torque between the first and second parts of the joint is below a predetermined threshold, and otherwise allow the motion of the first part of the joint relative to the second part. When a fluid damper or liquid damper is used, the damper may have a damping coefficient that dampens faster motions more than slower motions. 【0022】 The following table illustrates appropriate threshold ranges for cases where a friction damper is provided in the joint, and where a fluid damper or liquid damper is provided in the joint. 【0023】 [Table 1] 【0024】 In one embodiment, the extension element is provided with a movement resistance element adapted to resist the translational movement of the first part of the extension element relative to the second part of the extension element. When a friction damper is provided in the extension element, the force threshold exerted longitudinally between the first part and the second part to move the first part and the second part relative to each other is within the range of 5 N to 30 N. When a fluid damper or a liquid damper is provided in the extension element, their damping coefficients at 0.05 m / s are preferably within the range of 100 N / (m / s) to 600 N / (m / s). The movement resistance element typically allows the first and second parts of the extension element to move longitudinally along the entire range of its operating range. 【0025】 In one embodiment, the EFE joint, the WFE joint, the FPS joint and / or the WAA joint are not biased. That is, the joint does not force the elbow, forearm and / or wrist joint into a fixed position. This can be achieved, for example, by ensuring that the movement resistance element or the damper is not biased either. 【0026】 In one embodiment, the first part of the extension element is movable relative to the second part of the extension element over a distance of at least 2 cm longitudinally, preferably a distance between 2 cm and 30 cm, more preferably a distance between 4 cm and 18 cm. 【0027】 In one embodiment, in order to enable smooth sliding of the second part relative to the first part, the extension element is provided with one or more bearings such as roller bearings and / or low-friction bearings such as polytetrafluoroethylene bearings. For example, the extension element may be formed as a sliding rail comprising a low-friction plastic guide carriage element within a guide rail. 【0028】 In one embodiment, the extension element has a first member including a first portion of the extension element and a second member including a second portion of the extension element, and the first member and the second member are, for example, beams. The second member is substantially freely slidable along the longitudinal direction with respect to the first beam, and preferably, the second member rotates integrally with the first beam. The extension member may include one or more intermediate members between the first member and the second member, and the intermediate member is, for example, a beam. 【0029】 In one embodiment, the brace is adapted such that when worn by a user, the user's forearm can rotate substantially freely inwards and outwards over a range from at least 90 degrees of pronation to at least 90 degrees of supination of the user's forearm, and / or the user's wrist joint can bend and extend substantially freely over a range from at least 45 degrees of flexion to at least 60 degrees of extension of the user's wrist joint. When the user's forearm is not pronated or supinated, the forearm is defined to be in a neutral position with respect to pronation and supination, and when the user's wrist joint is not bent or extended, the wrist joint is defined to be in a neutral position with respect to bending and extension. The dynamic movements allowed by the brace include substantially free pronation and supination of the user's forearm and substantially free bending and extension of the user's wrist joint. Preferably, when the user is wearing the brace, the brace does not limit the degree to which the user's elbow can bend / extend, and thus, the brace also allows substantially free bending / extension of the user's elbow. 【0030】 In one embodiment, the upper arm piece, the EFE joint, the FPS joint, the extension element, the WFE joint, the WAA joint and / or the hand piece can be configured to be used for the user's right arm and left arm. In this way, the same components can be used to construct a brace for left-handed use and a brace for right-handed use. Typically, one or more components will have at least one plane of symmetry to achieve this. 【0031】 In one embodiment, the upper arm piece is provided with a first mounting element and a second mounting element spaced apart from the first mounting element. The first part of the EFE joint is attached to the upper arm piece by either the first or second mounting element. Typically, if the upper arm piece has a plane of symmetry, the first and second mounting elements will be located on opposite sides of that plane of symmetry. 【0032】 In one embodiment, the upper arm piece comprises a shell adapted to be positioned on the triceps side of the user's upper arm during use. The shell opens on the biceps side of the user's upper arm, allowing insertion of the user's upper arm through the opening. Thus, the shell does not interfere with the contraction or relaxation of the user's biceps. Typically, the shell has a substantially U-shaped cross-section, thereby allowing the shell to be positioned on a portion of the user's upper arm. The U-shaped shell reinforces the upper arm, and the stretching element may provide assistance in reducing FSP tremor. 【0033】 The upper arm piece may further be provided with an upper arm strap adapted to be positioned above the inside of the user's elbow and around a portion of the user's arm below the lower part of the biceps muscle, and adapted to connect to a shell. The strap and shell together are adapted to hold the upper arm piece in place relative to the user's upper arm. Preferably, the upper arm piece further comprises a magnetic clasp for holding a portion of the upper arm strap in place relative to the shell. A suitable magnetic clasp is described in US10617179B2, which is incorporated herein by reference in its entirety. When the strap is positioned around the user's arm and the clasp is closed, the strap will hold the upper arm piece in place relative to the upper arm. When the strap is loose and the clasp is open, the user can easily position their upper arm within the upper arm piece. 【0034】 In one embodiment, the shell of the upper arm piece is made of a substantially rigid material that has sufficient rigidity to maintain its shape while worn by the user. For example, the shell of the upper arm piece may be made of a rigid plastic material. 【0035】 In one embodiment, the hand piece comprises a shell having a substantial rigid portion that is adapted to support the ulnar and dorsal sides of the user's hand during use and is simultaneously positioned at a distance from the radial side of the user's hand; or a shell having a substantial rigid portion that is adapted to support the radial and dorsal sides of the user's hand during use and is simultaneously positioned at a distance from the ulnar side of the user's hand; or a shell having a substantial rigid portion that is adapted to support either the radial or dorsal side of the user's hand during use and is simultaneously positioned at a distance from the ulnar side of the user's hand. 【0036】 In either case, the shell has an opening, and once the user puts on the upper arm piece, the user can easily place their hand inside the shell through the opening by bending their elbow. The substantial rigid part ensures that the hand is securely supported by the aforementioned rigid part when the hand is normally positioned inside the hand piece during wear. 【0037】 The hand piece may be further provided with one or more straps. The straps are, for example, wrist straps and / or palm straps, each of which is positioned around the user's wrist or palm to connect to the shell. Preferably, the hand piece has one or more magnetic fasteners, such as those described in, for example, US10617179B2, for holding a portion of one or more straps in place relative to a substantial rigid part of the shell. 【0038】 In one embodiment, the hand piece comprises a rigid element configured to receive the back of the user's hand, and a strap for holding the rigid element in that position on the hand. 【0039】 In one embodiment, the substantially rigid portion of the handpiece shell comprises a deformable metal sheet that allows the shape of the handpiece to be adjusted to the user's hand. The rigid portion will not deform substantially during normal wear, but it allows the shell to fit to the user's hand. Preferably, the shell further comprises one or more layers of plastic. The plastic layers are, for example, laminated stacks of plastic covering the metal sheet. The inner top surface of the plastic layers may comprise a layer of cloth and / or a layer of foam. The cloth and / or foam layers are removablely attached to the handpiece and can be washed separately. 【0040】 In one embodiment, the orthosis is entirely passive. Therefore, no actuators or other electrical components, actively driven electronically, hydraulically, or pneumatically, are provided on the device to rotate the components of the device around the first, second, third, and / or fourth rotation axes. Passive devices can be configured to be simple and cost-effective and can be used without the user needing to carry an external power source. The total weight of a passive orthosis is typically less than 1 kg, for example, less than 0.5 kg. 【0041】 In one embodiment, the orthosis is provided with one or more sensors for sensing the relative position of one component of the orthosis with respect to the other component, and / or the torque applied between one component of the orthosis and the other component. For example, a sensor can sense the relative position of the first part of an EFE joint, FPS joint, WFE joint, and / or WAA joint with respect to the second part. An extension element may be provided with a sensor for sensing the relative position between the first and second parts of the extension element. Examples of suitable sensors for EFE joints, FPS joints, WAA joints, and WFE joints include a rotary encoder for detecting the angle and / or rotational speed between two components of these joints, and a torque sensor for measuring the torque between the two components of these joints. An inertial measuring unit (IMU) may be provided on the orthosis (e.g., on the shell of the upper arm piece, and / or on the shell of the hand piece). For example, each of the EFE joint, FPS joint, extension element, WAA joint and / or WFE joint may be provided with i) a sensor for sensing the relative position between the first and second parts of the joint, ii) a sensor for measuring the torque between the first and second parts of the joint, and / or iii) a sensor for measuring the absolute acceleration or absolute angular velocity of the hand portion and / or upper arm portion. 【0042】 The sensor data obtained from the sensors in this embodiment can be used to analyze the user's motion patterns. For example, each of one or more EFE, FPS, WAA, and WFE fittings may be provided with a rotary encoder for detecting the rotation angle of the first part of the EFE fitting relative to the second part of the EFE fitting around a first rotation axis, the rotation angle of the first part of the FPS fitting relative to the second part of the FPS fitting around a second rotation axis, the rotation angle of the first part of the WAA fitting relative to the second part of the WAA fitting around a second rotation axis, and the rotation angle of the first part of the WFE fitting relative to the second part of the WFE fitting around a third rotation axis. 【0043】 In one embodiment, the EFE joint, FPS joint, WAA joint, WFE joint and / or extension element are provided with actuators for forcing the first and second parts of the joint to an adjustable position while the orthosis is being worn by the user. Suitable actuators include electronically, hydraulically, or pneumatically powered actuators. Actuators are, as is known to those skilled in the art, for example, electric motors and piezoelectric elements. Actuators may be used to cause the user wearing the device to experience a simulated tremor and / or to set the degree of motion to be attenuated by the joint. If the orthosis is also provided with the aforementioned sensors, actuators may be used to compensate for some of the involuntary movements sensed by the sensors or to generate desired movements for the rehabilitation of stroke patients. 【0044】 In one embodiment, the extension element is provided with a linear actuator for driving the linear motion between the first and second parts of the extension element. 【0045】 In one embodiment, the EFE joint, FPS joint, WAA joint, WFE joint and / or extension element is provided with an actuator to restrict involuntary movement and, at the same time, allow voluntary movement. Suitable actuators include, in addition to the aforementioned electronically, hydraulically, or pneumatically powered actuators, electronically, hydraulically, or pneumatically powered motors, dampers, brakes and / or clutches that can restrict movement but cannot force movement to drive extension / flexion of the user's elbow, pronation / supination of the user's forearm, extension / flexion of the user's wrist, and / or adduction / abduction of the wrist. The actuator may be adapted to resist the rotation of the first part of the joint relative to the second part of the joint more when the first part of the joint rotates relative to the second part of the joint at an angular velocity greater than a threshold than when the first part of the joint rotates relative to the second part of the joint at an angular velocity less than a threshold. For example, the threshold may be set to an angular velocity of approximately 12.6 rad / s, thereby attenuating tremors of 2 Hz or higher more effectively than lower-frequency movements. Preferably, the orthosis is equipped with one or more of the aforementioned sensors to obtain a measure of whether the movement is voluntary or involuntary. 【0046】 In one embodiment, the orthosis comprises an EFE joint, an FPS joint, an extension element, a WFE joint, and a hand piece, wherein the FPS joint has a first part incorporated into the housing of the EFE joint and a second part configured to rotate around a second rotation axis R2 relative to the first part. The second part of the FPS joint is incorporated into the extension element. The orthosis further comprises a shaft extending between the first and second parts of the FPS joint, and the extension element can be moved along the shaft to adjust the length of the orthosis. [Brief explanation of the drawing] 【0047】 The present invention will be described in more detail below with reference to the accompanying drawings. Similar reference numerals refer to similar structures. [Figure 1A]These are isometric views of the orthotic device according to the first embodiment, one showing the straps of the orthotic device in the open position, allowing the user to wear the orthotic device, and the other showing the straps of the orthotic device in the closed position for attaching the orthotic device to the user. [Figure 1B] These are isometric views of the orthotic device according to the first embodiment, one showing the straps of the orthotic device in the open position, allowing the user to wear the orthotic device, and the other showing the straps of the orthotic device in the closed position for attaching the orthotic device to the user. [Figure 1C] Figure 1A shows an exploded view of the orthosis, and Figure 1A shows an exploded view of the same orthosis with the straps omitted. [Figure 1D] Figure 1A shows an exploded view of the orthosis, and Figure 1A shows an exploded view of the same orthosis with the straps omitted. [Figure 2A] This figure shows the details of the cross-sectional side along plane P. [Figure 2B] Figure 1A shows a detailed view of the orthosis, illustrating the state in which the first part of the FPS joint is rotated relative to the second part of the FPS joint. [Figure 3A] Figures 3A and 3B are diagrams showing examples of orthotic devices according to the present invention, each illustrating an orthotic device equipped with an actuator and a sensor that can be optionally equipped to the orthotic device. [Figure 3B] Figures 3A and 3B are diagrams showing examples of orthotic devices according to the present invention, each illustrating an orthotic device equipped with an actuator and a sensor that can be optionally equipped to the orthotic device. [Figure 4A] Figures 4A and 4B show details of an alternative hand piece equipped with a wrist adduction / abduction (WAA) joint. [Figure 4B] Figures 4A and 4B show details of an alternative hand piece equipped with a wrist adduction / abduction (WAA) joint. [Figure 5A] Figures 5A and 5B show, respectively, an alternative hand piece according to the present invention worn by a user, and a diagram detailing the hand piece. [Figure 5B] Figures 5A and 5B show, respectively, an alternative hand piece according to the present invention worn by a user, and a diagram detailing the hand piece. [Figure 6A] Figures 6A and 6B are isometric views of an orthotic device according to one embodiment, and a broken view of an extension element applied to the orthotic device. [Figure 6B] Figures 6A and 6B are isometric views of an orthotic device according to one embodiment, and a broken view of an extension element applied to the orthotic device. [Figure 7] This is a broken diagram of an alternative mechanism for a wrist flexion-extension joint according to one embodiment. [Modes for carrying out the invention] 【0048】 Figure 1A shows an orthosis 1 according to the present invention, having open straps 20, 83 so that a user can put on the orthosis. Figure 1B shows the same orthosis worn on the user's right arm, having a closed strap. The orthosis comprises an upper arm piece 10 having a substantially rigid shell 11. The substantially rigid shell 11 has a soft cloth or foam 13 on its inner surface. The upper arm piece is worn on the user's upper arm 101, just above the user's elbow 102. An upper arm strap 20 is provided to hold the upper arm piece in place on the user's upper arm. The upper arm strap 20 includes a magnetic clasp 24 that engages with a clasp holder 14. The clasp holder 14 is made of a ferrimagnetic or ferromagnetic material and is mounted on the shell 11. Because the shell 11 has a substantially U-shaped cross-section, when the clasp 24 is released and the upper arm strap 20 is moved laterally so that it separates from the clasp holder 14, the shell 11 can be fitted onto a portion of the user's upper arm 101. Once the shell 11 is fitted in this manner, the user can position the clasp 24 near the clasp holder 14, and at the same time, the magnetic clasp 24 will automatically align and engage with the holder 14, as shown in Figure 1B. 【0049】 The orthosis 1 further comprises a hand piece 80 having a shell 81. The shell comprises a substantially rigid plastic portion 81a for providing structural rigidity to support the user's hand on the dorsal side 105 and ulnar side 106 of the user's hand, a deformable intermediate metal layer 81b that can be molded to some extent to the shape of the user's hand, and an inner surface soft cloth or foam 81c for contact with the user's hand. The shell 81 opens at the radial side 107 of the user's hand, allowing the user to easily position their hand inside the shell 81. The flexible wrist and palm strap 83, shown in the open position in Figure 1A, has an opening for the user's thumb and can be closed as shown in Figure 1B. The strap 83 is equipped with a magnetic clasp 84a that automatically aligns and interlocks with metal rivets 84b on the shell 81. 【0050】 As shown in Figure 1B, when the strap is closed, the shell 81 remains separated from the radial side of the hand while making contact with the dorsal and ulnar sides of the user's hand. 【0051】 An elbow flexion-extension (EFE) joint 30 is attached to the upper arm piece 10, allowing the user's elbow to flex or extend around a first rotational axis R1. A forearm pronation-supination (FPS) joint 40 is connected to the EFE joint 30 and allows pronation or supination of the forearm 103 around a second rotational axis R2. The first part 51 of an extension element 50 is connected to the FPS joint 40. The extension element 50 is adapted to extend or contract along its longitudinal direction L, which typically extends substantially along the longitudinal direction of the user's forearm during use. The extension element can extend or contract based on the movement of the user's arm. Therefore, the length of the element 50 will easily be adapted to a suitable length for the user, even when the user is wearing the upper arm piece and hand piece. The extension element 50 also improves the degree to which the user can freely flex or extend their wrist. Such movements are typically to change the distance from the hand piece 80 to the FPS joint 40. To allow the user's wrist to flex and extend, a wrist flexion-extension (WFE) joint 60 is attached to the second part 52 of the extension element. The WFE joint allows the hand piece 80 to rotate around a third rotation axis R3 relative to the extension element 50. In the shown embodiment, the first part 61 of the WFE joint is fixed to translate and rotate integrally with the second end 52 of the extension element 50. That is, the first part 61 of the WFE joint is directly attached to the second end 52 of the extension element 50. The second part 62 of the WFE joint 60 is fixed to translate and rotate integrally with the rigid shell 81 of the hand piece 80. That is, the second part 62 is directly attached to the hand piece 80. 【0052】 Figures 1C and 1D show exploded views of the same orthosis 1 and exploded rear views of the orthosis 1 with the straps omitted, respectively. As can be seen from Figure 1A, when the orthosis in Figures 1A to 1D is for right-handed users, the EFE joint 30 includes a first part 31 that is fixed to the shell 11 at a first mounting point 12a. The same orthosis can be configured for left-handed users by instead attaching the first part 31 to a second mounting point 12b, removing the second part 62 of the WFE joint 60 from the first part 61 of the WFE joint, reversing the second part and the hand piece 80 attached to the second part, and then reattaching the second part to the first part. This is possible because both the upper arm piece 10 and the hand piece 80 have a symmetrical shape, similar to the EFE joint, FPS joint, and WFE joint. 【0053】 Therefore, the same upper arm portion, EFE joint, FPS joint, WFE joint, and the same extensible element 50 can be used to manufacture orthoses for left-handed or right-handed individuals. Optionally, an orthosis manufactured for right-handed individuals can be adapted for left-handed individuals, and vice versa. 【0054】 As further shown in Figures 1C and 1D, the FPS joint 40 includes a friction damper 43 positioned between the first part 41 of the joint 40 and the second part of the joint 40. The damper 43 helps reduce tremors by substantially preventing the rotation of the first part 41 relative to the second part when the torque between the first part 41 and the second part is below a predetermined threshold. 【0055】 The WFE joint 60 includes a liquid damper 63 positioned between the first part 61 and the second part 62 of the WFE joint. The liquid damper 63 dampens the rotation of the first part relative to the second part more when the first part rotates around the third rotation axis at a higher angular velocity relative to the second part than when the first part rotates around the third rotation axis at a slower angular velocity relative to the second part. 【0056】 Figure 2A shows a cross-sectional side view along plane P in Figure 1B. Plane P is perpendicular to the longitudinal direction L and faces the hand piece 80. It can be seen that the third rotation axis R3 is spaced at a distance d from the nearest part of the extension element 50 (in this case, the nearest side of the first part 51). Referring to Figures 1A to 1C, the first part of the WFE joint 60 has a concave inner surface 61a that curves from the second part 52 toward the third rotation axis R3, facing the user's wrist during use. This allows the user to flex their hand without their wrist contacting the extension element 50. The roller bearing 53 between the first part 51 and the second part 52 helps to ensure that the first part can slide substantially freely along the longitudinal direction of the extension element 50 relative to the second part. 【0057】 Figure 2B shows details of the FPS joint 40 of Figure 1A in its rotated position. Here, the second part 42 of the joint is in a rotated position, rotated by an angle of approximately 45 degrees around the second rotation axis R2 relative to the first part 41, in order to allow for approximately 45 degrees of pronation of the forearm. 【0058】 Figure 3A shows a further embodiment of the orthosis according to the present invention. The orthosis comprises actuators 36, 46, and 66 in the form of electric motors. Motor 36 is fixed to the upper shell of the arm piece 10 and is positioned to rotate the second part 32 of the EFE joint around a first rotation axis relative to the first part 31. Motor 36 is powered and controlled via conduit 17a. Conduit 17a includes a conductor and is connected to an electronic control unit 16. The rotation of the second part 42 of the FPS joint around a second rotation axis relative to the first part 41 of the FPS joint can be driven by motor 46. Motor 46 is similarly attached to the shell of the upper arm piece 10 and transmits the force for the aforementioned rotational drive through a schematicly shown gearbox 47. Motor 46 is powered and controlled via conduit 17b. Conduit 17b includes a conductor and is similarly connected to an electronic control unit 16. Motor 66 is mounted in a WFE fitting and is adapted for rotational driving of the first part 61 of the WFE fitting relative to the second part 62 about a first rotation axis. Motor 66 is also connected to the electronic control unit 16 via a conduit 17c equipped with a conductor. A battery may be incorporated into the electronic control unit to supply power to motors 36, 46 and 66, and additionally or alternatively, the control unit 16 may be connected to an external battery. 【0059】 The orthosis shown in Figure 3A is suitable for generating movement of the user's elbow, forearm, and wrist, and can be used, for example, to mimic tremors, to control motors to compensate for tremors, or to introduce rehabilitation movements. 【0060】 Figure 3B shows an embodiment of an orthosis according to the present invention, the orthosis being equipped with sensors. In particular, the EFE fitting is provided with a rotary encoder 35 for determining the rotational position of the first part 31 of the EFE fitting relative to the second part 32 of the EFE fitting about a first rotation axis. The encoder is connected to an electronic control unit 18 via conduit 19a. The electronic control unit 18 is adapted to receive sensor data and, optionally, to store, transfer, and / or process the sensor data. To measure the rotational position of the first part 41 of the FPS fitting relative to the second part 42 of the FPS fitting, the FPS fitting is provided with a rotary encoder 45 connected to the electronic control unit via conduit 19b. The WFE fitting is provided with a rotary encoder 65 for determining the rotational position of the first part 61 of the WFE fitting relative to the second part 62 of the WFE fitting. The encoder 65 is connected to the electronic control unit 18 via conduit 19c. Additionally, inertial measuring devices 15 and 85 are provided on the shell of the upper arm piece 10 and the shell of the hand piece 80, respectively, and are connected to the electronic control unit 18 via conduits 19d and 19e. 【0061】 The sensor allows the operation of the joint to be determined while the user is wearing the orthosis. When the embodiments of Figures 3A and 3B are combined and the orthosis is equipped with both an actuator and a sensor, it will be understood that the electronic control unit 16 may be adapted to control the motor to compensate for involuntary movements based on data received from the electronic control unit 17 that receives the sensor data. 【0062】 Figures 4A and 4B show details of a hand piece that can be used with the orthosis of Figure 1A. The orthosis further comprises a wrist adduction / abduction (WAA) joint 90. The WAA joint 90 has a first part 91 and a second part 92 that is rotatable about a fourth rotation axis R4 relative to the first part 91, allowing adduction or abduction of the user's wrist. The first part is attached to the second end 52 of the extension element 50. The WAA joint may be provided with a damper, a sensor and / or an actuator. In this embodiment, the first part 61 of the WFE joint 60 is indirectly connected to the second end of the extension element via the WAA joint 90, and the second part of the WFE joint 60 is directly connected to the hand piece, i.e., fixed to rotate and translate integrally with the shell 81 of the hand piece 80. 【0063】 Figures 5A and 5B show an alternative hand piece 80' as it is fitted to a user, and details of the hand piece 80', respectively. The hand piece 80' can be used in place of the hand piece 80 in the orthosis according to the present invention. The hand piece 80' comprises a substantially rigid shell 81' for supporting the ulnar side of the user's hand. A flexible strap 82' defines a first opening O1 into which the user can insert their thumb, and a flexible strap 82' defines a second opening O2 into which the user can insert their other four fingers. A strap 83' may be fixedly attached to the strap 82', or it may be detachably attached to the strap 82', for example, using Velcro® or similar. 【0064】 Figures 6A and 6B show an isometric view of the orthosis 100 according to one embodiment, and a broken view of the extension element applied to the orthosis, respectively. 【0065】 The orthosis 100 according to the second embodiment comprises an EFE joint 130, an FPS joint 140, an extension element 150, a WFE joint 160, an upper arm piece 10, and a hand piece 80, and the orthosis 100 is similar to the orthosis of the embodiment shown in Figure 1A. 【0066】 Referring to the embodiments shown in Figures 1A to 5B, and similarly to what has been described above, the upper arm piece 10 is connected to the EFE joint 130, the FPS joint 140, the extension element 150, the WFE joint 160, and the hand piece 80 to form the orthosis 100 between the upper arm of a person and the hand of that arm. 【0067】 The FPS joint 140 comprises a first part 141 incorporated into the housing of the EFE joint 130, and a second part 142 configured to rotate around a second rotation axis R2 relative to the first part 141. The first part 141 preferably includes the rotation damper described above with reference to the first embodiment. 【0068】 In this embodiment, the second part 142 of the FPS joint 140 is incorporated into the extension element 150 such that the extension element rotates along its longitudinal axis about a second rotation axis R2. 【0069】 A shaft 152 extends between the first part 141 and the second part 142 of the FPS joint 140, and an extension element 150 moves along it to allow user-induced movement of the WFE joint relative to the FPS joint and the EFE joint. 【0070】 The shaft 152 coincides with the longitudinally symmetric axis of the extension element 150 and provides a pivot function for rotating the second part 142 of the FPS joint about the second rotation axis R2 relative to the first part 141. 【0071】 The extension element 150 comprises a shaft 152 and slider mechanisms 154, 156, and 157. The slider mechanisms 154, 156, and 157 comprise a pair of sliders 154 parallel to each other along the longitudinal direction L of the extension element 150, an inlet linear bearing 157, and a sliding linear bearing 156, all housed within the housing 155. To guide the shaft 152 into the housing 155, the shaft 152 is supported by the inlet linear bearing 157. The inlet linear bearing 157 is installed inside the housing 155 at an opening 158 into which the shaft 152 enters the housing 155. 【0072】 The end 153 of the shaft 152 located inside the housing 155 is coupled to a sliding linear bearing 156 which is slidably connected to a pair of parallel sliders 154, thereby allowing the end 153 of the shaft to slide along the longitudinal direction of the extension element 150, and making it possible to adjust the length of the extension element between the EFE joint 130 and the WFE joint 160. 【0073】 In one embodiment, the first part 141 of the FPS joint 140 is configured to include a rotary bearing 143 and preferably a rotary damper 144 for damping rotations associated with the tremor of the extension element caused by forearm pronation-supination (FPS) rotation. 【0074】 The flange 145 is positioned between the rotating bearing 143 and the rotating damper 144. 【0075】 In one embodiment, the WFE joint 160 is configured to have a detachable mounting plate 162 that connects to the hand piece 80. The detachable mounting plate 162 allows for connection to and disconnection from the hand piece. This allows the orthosis 100 to be attached to a person's arm relatively easily. 【0076】 In a further embodiment, the WFE joint 160 is preferably configured to have a damper (not shown) for damping vibration-related motion with respect to the extension element 150 of the hand piece 80. 【0077】 Figure 7 shows a cross-sectional view of an alternative mechanism for a wrist flexion-extension joint according to one embodiment. 【0078】 The alternative mechanism 170 embodies a double joint 172 between the extension element 150 and the hand piece 80. The double joint 172 is positioned to connect the extension element and the hand piece, thereby allowing the hand piece to move relative to the extension element. 【0079】 The double joint comprises a housing 174, a first shaft 181, a second shaft 191, and a first swivel joint 180 and a second swivel joint 190, each rotatable around axes 181 and 191. The first shaft 181 and the second shaft 191 are mounted in the housing 174 parallel to each other with a predetermined distance between them. The swivel joints 180 and 190 are coupled to each other by meshing teeth on a pair of gear segments 182 and 192. For coupled rotation of the swivel joints, it is also desirable that an alternative mechanical coupling be used between the swivel joints 180 and 190. 【0080】 Optionally, each of the rotary joints 180 and 190 is fitted with the corresponding dampers 184 and 194. The dampers 184 and 194 are, for example, fluid, liquid, or friction type. During use of the orthosis, the dampers 184 and 194 are configured to dampen undesirable movement of the hand piece 80 relative to the extension element 150. 【0081】 The mechanism 170 prevents the rotary joints from rotating individually, allowing only the coordinated movement of joints 180 and 190. As a result of the coordinated movement, the extension element remains near the user's arm while the user's wrist joint within the hand piece flexes and extends. Because the first and second joints are connected, the rotation of the hand piece around the second joint 190 causes additional rotation around the first joint in the same direction. 【0082】 In this embodiment, the hand piece 80 is configured to receive the back of the user's hand. The hand piece is attached to the hand by one or more straps (not shown) that can be connected to slots 195 of the hand piece 80. 【0083】 In summary, the present invention provides a wearable orthosis, for example, for resisting involuntary movements, which is adapted to allow a user wearing the orthosis on their arm to dynamically move their upper arm, forearm, wrist, and hand. The orthosis comprises an upper arm piece, a hand piece, an elbow flexion-extension joint, a forearm pronation-supination joint, an extension element, and a wrist flexion-extension joint. The elbow flexion-extension joint comprises a first part fixed to the upper arm piece and a second part rotatable about a first axis of rotation relative to the upper arm piece. The forearm pronation-supination joint comprises a first part fixed to the second part of the elbow flexion-extension joint and a second part rotatable about a second axis of rotation relative to the first part of the forearm pronation-supination joint and the second part of the elbow flexion-extension joint, allowing for pronation and supination of the forearm. The extension element extends longitudinally and comprises a first part and a second part that is movable longitudinally relative to the first part. The first part of the extension element is fixed to the second part of the forearm pronation-supination joint. The wrist flexion-extension joint comprises a first part and a second part that is rotatable about a third rotation axis relative to the first part. The first part of the wrist flexion-extension joint is directly or indirectly connected to the second part of the extension element, and the second part of the wrist flexion-extension joint is directly or indirectly connected to the hand piece. 【0084】 The present invention has been described above with reference to several exemplary embodiments as shown in the drawings. Modifications and alternative implementations of some parts or elements are possible and fall within the scope of protection as defined in the appended claims.

Claims

[Claim 1] A wearable orthotic device (1) is fitted so that the user wearing the orthotic device on their arm can dynamically move their upper arm, forearm, wrist, and hand. The brace includes an upper arm piece (10) for connecting the brace to the user's upper arm, At least on the back of the user's hand, a hand portion (80) for connecting the orthosis to the user's hand, An elbow flexion-extension joint (EFE joint) (30) comprising a first part (31) fixed to the upper arm piece (10) and a second part (32) rotatable about a first rotation axis (R1) relative to the upper arm piece, allowing flexion and extension of the elbow, A forearm pronation-supination joint (FPS joint) (40) comprising: a first part (41) fixed to the second part (32) of the EFE joint; and a second part (42) rotatable about a second rotation axis (R2) relative to the first part (41) of the FPS joint and the second part (32) of the EFE joint, thereby allowing pronation and supination of the forearm; The aforementioned orthotic device is An extension element (50) extending in the longitudinal direction (L) comprises a first part (51) and a second part (52) movable along the longitudinal direction (L) relative to the first part (51), wherein the first part (51) of the extension element is fixed to the second part (42) of the FPS joint (40), A wrist flexion-extension joint (WFE joint) (60) further comprising a first part (61) and a second part (62) rotatable relative to the first part about a third rotation axis (R3), allowing flexion and extension of the wrist, wherein the first part (61) of the WFE joint is directly or indirectly connected to the second part (52) of the extension element, and the second part (62) of the WFE joint (60) is directly or indirectly connected to the hand piece (80), The orthosis (1) is fitted so as to be completely separated from the user's forearm during use. [Claim 2] The orthotic device (1) according to claim 1, wherein in a projection view onto a plane perpendicular to the longitudinal direction (L), the third rotation axis is spaced at a distance (d) between 0.7 cm and 7 cm from the first part of the extension element. [Claim 3] Orthotic device (1) according to claim 1 or 2, wherein the first portion (51) of the extension element is fixed so as to be rotatable with respect to the first portion (41) of the FPS joint, and rotation of the second portion (52) of the extension element with respect to the first portion (61) of the WFE joint about an axis parallel to the longitudinal direction (L) of the extension element is substantially prevented. [Claim 4] Orthosis (1) according to any one of claims 1 to 3, further comprising a wrist adduction-abduction joint (WAA joint) (90), the WAA joint comprising a first part (91) and a second part (92) rotatable about a fourth rotation axis (R4) relative to the first part, the WAA joint being connected between the hand piece (80) and the second part (52) of the extension element, allowing adduction and abduction of the user's wrist. [Claim 5] Orthotic device according to any one of claims 1 to 4, wherein the EFE joint, WFE joint, FPS joint and / or WAA joint comprises a motion resistance element adapted to resist rotation when the rotation of the first part of the joint relative to the second part of the joint is at a torque below a threshold (1). [Claim 6] Orthotic device (1) according to any one of claims 1 to 5, wherein the EFE joint, WFE joint, FPS joint and / or WAA joint comprises motion resistance elements adapted to resist the fast rotation of the joint more than the slow rotation of the joint. [Claim 7] Orthotic device (1) according to any one of claims 1 to 6, wherein the EFE joint, WFE joint, FPS joint, WAA joint and / or extension element are provided with a fluid damper, liquid damper and / or friction damper for damping the motion of the first part of the joint relative to the second part of the joint. [Claim 8] Orthotic device (1) according to any one of claims 1 to 7, wherein the WFE joint (170) is a double joint comprising a pair of joined joints (180, 190). [Claim 9] Orthotic device according to any one of claims 1 to 8, wherein the first part of the extension element is movable relative to the second part of the extension element over a distance of 2 cm to 30 cm along the longitudinal direction (1). [Claim 10] Orthotic device according to any one of claims 1 to 9, wherein the orthotic device is fitted so that, when worn by the user, the user's forearm can pronate and supinate substantially freely over a range of at least 90 degrees of pronation to 90 degrees of supination, and / or so that the user's wrist can flex and extend substantially freely over a range of at least 45 degrees of flexion to 60 degrees of extension (1). [Claim 11] Orthotic device according to any one of claims 1 to 10, wherein the extension element comprises a first member and a second member, the second member being substantially free to slide relative to the first part along the longitudinal direction (1). [Claim 12] Orthotic device (1) according to any one of claims 1 to 11, wherein the upper arm piece, the EFE joint, the FPS joint, the extension element, the WFE joint, the WAA joint and / or the hand piece may be configured to be used on the user's right arm and left arm, the upper arm piece is provided with a first attachment element (12a) and a second attachment element (12b) spaced apart from the first attachment element, and the first portion of the EFE joint is attached to the upper arm piece by either the first attachment or the second attachment. [Claim 13] Orthotic device (1) according to claim 12, wherein one or more of the upper arm piece, the EFE joint, the FPS joint, the extension element, the WFE joint, the WAA joint and / or the hand piece have at least one plane of symmetry. [Claim 14] Orthosis according to any one of claims 1 to 13, wherein the upper arm piece comprises a shell fitted to be positioned on the triceps side of the user's upper arm during use, the shell opening on the biceps side of the user's upper arm to allow the user's upper arm to be inserted through the opening, the upper arm piece is provided with an upper arm strap fitted to be positioned around a portion of the user's arm above the inside of the elbow and below the biceps, and fitted to connect with the shell, and the upper arm piece comprises a magnetic fastener for holding a portion of the upper arm strap in a predetermined position relative to the shell (1). [Claim 15] Orthotic device according to any one of claims 1 to 14, wherein the hand portion comprises a shell having a substantially rigid portion that is positioned spaced apart from the radial side of the user's hand while being fitted to support the ulnar and dorsal sides of the user's hand during use. [Claim 16] Orthotic device according to any one of claims 1 to 14, wherein the hand portion comprises a shell having a substantially rigid portion that is fitted to support the dorsal side of the user's hand during use and is positioned spaced apart from the ulnar and radial sides of the user's hand (1). [Claim 17] Orthotic device according to any one of claims 1 to 14, comprising a shell having a substantially rigid portion that is positioned spaced apart from the ulnar side of the user's hand while being fitted to support the radial and dorsal sides of the user's hand during use, the hand piece being provided with one or more wrist straps and / or palm straps, each of the wrist straps and / or palm straps being positioned around the user's wrist or palm to connect to the rigid portion of the shell of the hand piece, and the hand piece being provided with one or more magnetic fasteners for holding portions of the one or more straps in a predetermined position relative to the substantially rigid shell of the hand piece (1). [Claim 18] Orthotic device (1) according to claim 17, wherein the rigid shell of the hand piece comprises a deformable metal sheet for adjusting the shape of the hand piece to the user's hand. [Claim 19] An orthotic device according to any one of claims 1 to 18, wherein the orthotic device is configured to move passively in response to the user's actions (1). [Claim 20] Orthotic device according to any one of claims 1 to 18, wherein the orthotic device is provided with one or more sensors (15, 35, 45, 65, 85) for sensing the relative position of one part of the orthotic device with respect to the other part of the orthotic device, and / or torque applied between one part of the orthotic device and the other part of the orthotic device, and the EFE joint, the FPS joint, the WAA joint, the extension element and / or the WFE joint is provided with actuators (36, 46, 66) for forcing the first and second parts of the joint to an adjustable position, or the EFE joint, the FPS joint, the WAA joint, the extension element and / or the WFE joint is provided with actuators for allowing and / or assisting voluntary movement while restricting involuntary movement. [Claim 21] Orthotic device (1) according to claim 4, wherein the first part of the WAA joint is fixed to the second part of the extension element, and the second part of the WAA joint is fixed to the first part of the WFE joint.

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