Method for controlling a feedback device of an orthopaedic joint device and orthopaedic joint device

Abstract

The invention relates to a method for controlling a feedback device (80) of an orthopaedic joint device of a lower extremity having at least an upper part (10) and a lower part (20) in the applied state, which are articulatedly mounted against one another to be pivotable about a pivot axis (15); an actuator (30) which is coupled to the upper part (10) and to the lower part (20) and influences a movement state of the upper part (10) and / or lower part (20); a control device (40) which is coupled to at least one sensor (50) and to the feedback device (80), wherein, on the basis of sensor data of the at least one sensor (50), the position of a foot part (60) relative to the user of the orthopaedic joint device is determined and the control device (40) activates, deactivates or modulates the feedback device (80) based on the position of the foot part (60) relative to the user.

Description

[0001] Method for controlling a feedback device of an orthopaedic joint device and orthopaedic joint device

[0002] The invention relates to a method for controlling a feedback device of an orthopedic joint device of a lower extremity, having at least one upper part and one lower part in the worn state, which are pivotably mounted to one another about a pivot axis, having an actuator coupled to the upper part and the lower part and influencing a state of movement of the upper part and / or lower part, having a control device coupled to at least one sensor and the feedback device, and optionally having a foot part attached to the lower part. The invention also relates to an orthopedic joint device for carrying out such a method as described above. The orthopedic joint device has, in particular, at least one artificial knee joint formed between the upper part and the lower part.The foot part can be articulated to a lower leg part or lower leg shaft, so that the foot part forms the lower part and the lower leg shaft or the lower leg part forms the upper part. The foot part can be part of the prosthesis or orthosis or a position distal to the lower leg part of an orthosis that is located in the area of ​​the natural foot. If the orthopedic joint device has two joints, there are two upper parts and two lower parts, whereby one lower part can also simultaneously be the upper part for the other joint device. Orthopedic joint devices are in particular orthoses, exoskeletons or prostheses that have an upper part and a lower part articulated to it. In orthoses and exoskeletons, the upper and lower parts are attached to a still existing limb, for example by shells, straps, belts, cuffs or other fastening devices.Orthoses and exoskeletons can be used to guide movements, limit pivoting around a joint axis, prevent pivoting movements, or support or fix the alignment of limbs. In polycentric joints, the pivot axis is the instantaneous center of rotation, which shifts depending on the pivoting movement. In addition, orthoses can be equipped with actuators in the form of damping devices to dampen pivoting movement around the joint axis. The damping devices can be equipped with a control system so that, depending on sensor data, modified damping can be provided in the direction of flexion and / or extension. It is also known to assign energy storage devices to the upper or lower part, so that movement support can be achieved by releasing the stored energy from the energy storage device.

[0003] Prostheses replace a missing or no longer existing limb and serve to provide functionality that is as close as possible to that of the natural limb. Furthermore, prostheses serve to provide the most natural appearance possible for the prosthetic user. For example, a prosthetic upper part is designed as a prosthetic socket or as a component attached to a prosthetic socket, where the prosthetic socket serves to secure it to a limb or limb stump. The prosthetic joint, for example a prosthetic knee joint or a prosthetic ankle joint, connects the upper part to a lower part, which in turn may have further prosthetic components, such as a lower leg tube or a prosthetic foot.Particularly in orthoses, exoskeletons, and prostheses of the lower extremities, but also of the upper extremities, actuators in the form of dampers, especially hydraulic dampers or other resistance devices, are arranged between the upper and lower parts. These dampers provide different resistances in individual states or movement situations based on sensor data. Such resistance devices are often designed as linear actuators that provide a defined resistance to a flexion and / or extension movement. The resistance is changed, for example, by changing the position of valves. When the flow cross-section is reduced, the corresponding resistance to a movement increases. Passively damped, especially passively hydraulically damped prostheses or orthoses operate purely dissipatively.Energy is extracted from the movement of the upper part relative to the lower part, which can generate very high moments or forces. At the same time, passive damping in an open state—for example, when no valves are closed or throttles are activated—exhibits very low resistance. The operating range of such an orthosis or prosthesis is limited in that no energy can be directed into the movement to support it, actively counteract it, or initiate a change from a static state.

[0004] In addition, orthoses, exoskeletons and prostheses with actuators in the form of motor drives are known from the state of the art, so-called active orthoses or prostheses, in which a movement is initiated, supported or braked by activating, deactivating or modulating the drive. For this purpose, for example, stored electrical energy from a battery or an accumulator is converted in the actuator. Mechanical energy storage devices in the form of springs or pneumatic accumulators or other storage elements can also serve as energy storage devices. The active actuators, e.g. motor drives also serve to influence the movement behavior between the components of the orthosis or prosthesis, for example to brake a pivoting movement. For this purpose, motor drives can be operated in braking mode or as part of a generator circuit.

[0005] Both purely passive devices such as dampers and semi-active devices such as energy storage devices and motor drives influence the movement behavior of the upper and / or lower parts and are actuators that influence a state of motion of the upper and / or lower parts. The actuators can initiate a movement, reverse a movement, assist a movement, or resist a movement. The state of motion of the upper and / or lower parts is also influenced if a load is counteracted, a static state is maintained, or a change in a state of motion due to external forces is prevented or suppressed. This can happen, for example, if a uniform pivoting movement is to be maintained and external forces act in the direction of movement or against the direction of movement.

[0006] To control joint devices, the actuators between the upper and lower parts are activated, deactivated, or modulated. In active orthoses or prostheses, for example, drives are used to influence and / or initiate relative movement. In passive orthopedic joint devices, dampers or brakes are used to change movement resistance, for example, to slow down flexion and / or extension or to facilitate a pivoting movement by reducing movement resistance. In electronically controlled orthopedic joint devices, the actuators for influencing movement behavior are controlled based on sensor data. In addition to angle sensors, acceleration sensors, IMUs, strain gauges, or axial forces are known.The problem is that users have little information regarding the position of the components of the orthopedic joint device. Especially with prostheses, but also with orthoses for users with impaired sensory perception, information about the current position of the orthopedic joint device is lacking. Use therefore requires either a high degree of trust or visual control by the user, which makes use more laborious.

[0007] WO 2019 / 0 25.838 A1 discloses a sensor-emulator arrangement for leg prostheses, in which a sensor part in gait-typical sole sections of the sole has a sensor connected to a nerve-stimulating emulator for transmitting information to a nerve area section via a data connection and at least one controller. Each gait-typical sole section has at least two sensors, each connected to an emulator via the data connection and the controller. The emulators are designed to output independent excitation signals. This is intended to provide the patient with a more precise understanding of the processes occurring in the sole, both qualitatively and quantitatively.

[0008] The object of the present invention is to provide an orthopaedic joint device and a method for controlling a feedback device of an orthopaedic joint device, with which a user is made aware of the movement of the orthopaedic joint device of the lower extremity, so that improved control, faster learning of movement sequences and increased safety during use can be achieved.

[0009] This object is achieved by a method having the features of the main claim and an orthopedic joint device having the features of the subordinate claim. Advantageous embodiments and further developments of the invention are disclosed in the subclaims, the description, and the figures.

[0010] The method for controlling a feedback device of an orthopaedic joint device of a lower extremity with at least one upper part and one lower part in the worn state, which are pivotally mounted to one another about a pivot axis, with an actuator which is coupled to the upper part and the lower part and influences a state of movement of the upper part and / or lower part, with a control device which is coupled to at least one sensor and the feedback device, is characterized in that the position of a foot part relative to the user of the orthopaedic device is determined on the basis of sensor data from the at least one sensor and the control device activates, deactivates or modulates the feedback device depending on the position of the foot part relative to the user.The foot part is either attached to the lower part, which is the case with a prosthesis or an orthosis with a footrest, or is a part of the natural foot that is in a fixed relationship to the lower part when the orthosis is applied. After an amputation, a neurological disease or trauma, the user may have no feeling for the current position of the foot or the prosthetic foot on the affected side. This makes it very difficult to estimate where the foot is under the body, both when standing and walking. Based on sensor data from at least one sensor, the foot position in relation to the body, in particular a defined reference point on the body, is determined.The position of the foot or foot part relative to the body is important for safe movement and walking, as well as for precise control of the orthopedic joint device. The joint device is controlled, for example, by activating, deactivating, or modulating a drive and / or a passive damping device in order to change the movement behavior of the upper part relative to the lower part. Activation can also occur, for example, via myoelectric signals generated by the user through muscle contractions. The feedback signals can at least be supportive of the type and timing of the generation of the myoelectric signals. Based on the determined position of the foot part relative to the user, the feedback device is activated, deactivated, or modulated. The feedback signal from the feedback device to the body can be any type of signal transmission to the body and, in particular, can be encoded in any way.

[0011] When walking on different surfaces, when standing or performing any other movement of the lower extremities, it is important to know the position of the footrest. The current position is important for both a loaded leg with the support and the unloaded leg with the support, as the information provides information about the position of the body's center of gravity above the footrest and thus for balance. When positioning the footrest, for example when the footrest is put down, or during the swing phase, the feedback signal from the feedback device transmits the information as to whether the footrest is in the correct position. When walking, for example, it is important to know whether and how far in front of the body the footrest is at the end of a swing phase. This position is determined using at least one sensor or multiple sensors and transmitted to the user of the orthopedic device via the feedback device.

[0012] A further development of the method provides for the feedback device to be attached to the orthopedic joint device itself, to a support arranged separately on the user, or to both the orthopedic joint device and the separate support arranged on the user. Arranging the feedback device on the orthopedic joint device allows for a compact design of the entire system without the need for additional assemblies or components or additional signal transmission. Arranging it on a separate support allows for the free selection of the feedback device at the most suitable location on the user's body, without being fixed to the orthopedic joint device.Particularly for patients with a neurological disorder or sensory impairment, the placement of a feedback device on the orthopedic joint device is sometimes less suitable. By combining the feedback device on the orthopedic joint device, where possible, with a separate support attached to the user, a diverse spectrum of feedback signals can be transmitted to the user, allowing for more precise and improved feedback regarding the position of the footrest relative to the user's body.

[0013] A further development of the method provides for optical, acoustic, electrically stimulating and / or tactile feedback signals to be transmitted to the user depending on the position of the footrest relative to the user. For example, different feedback signals can be transmitted to the user for different positions. Optical signals can be used for different positions or movement sequences than acoustic signals. Acoustic signals, for example, are well suited as confirmation signals or warning signals, while electrically stimulating signals can be easily modulated due to their direct effect on the nerve and can transmit information about the course of a movement or a change in position. The same applies to tactile feedback signals, which can, for example, travel along the body as the footrest is moved relative to the user and a reference point on the user.All different feedback signals can be used individually or in different combinations of two or more such different feedback signals.

[0014] In a further development of the method, feedback signals are output to the user regarding the course of the swing phase and / or at least one feedback signal after the foot part has reached a position relative to the user. During the swing phase or a relative movement or change in the position of the foot part to the user, one or more feedback signals or a modulation of a feedback signal can be transmitted to the user so that the user receives information about the course of the foot position during the movement. If, for example, the foot is lifted, the feedback signal can run along a body part in a vertical direction or in a proximal-distal direction, for example by activating different electrodes arranged one behind the other or next to one another, vibrating elements or optical displays, or a sequence of tones that increases or changes in volume.Something similar can happen during a translational movement in the sagittal direction or within the frontal plane through a corresponding progression of feedback signals at different positions. Alternatively or additionally, different intensities can be used to communicate the progression of a movement in the stance phase and / or swing phase or even while standing to the user. Alternatively or additionally, at least one feedback signal is output once a predetermined position of the footrest relative to the user is reached. If a threshold value for a position is reached, for example when the footrest is below or in front of the user's center of gravity, a single feedback signal can be output so that the user is informed that, from this position onwards, for example, placing the footrest on the ground is uncritical or leads to a specific behavior of the orthopedic joint device.

[0015] A further development of the method provides for the position of the foot part relative to a hip pivot point, the body's center of gravity, or another reference point on the user's torso to be determined as a reference point. Using the hip pivot point as a reference point for the foot part has the advantage that, for example, the orientation and length of a leg tendon can be easily used to determine the position of the foot part. Prostheses or orthoses of the lower extremities are often provided with the distances from the knee joint axis to the hip pivot point in order to influence their movement behavior. This way, the damping behavior during walking can be influenced in a way that is adapted to the respective user. Using the body's center of gravity as a reference point makes it easier to distinguish whether it is safe or unsafe to place the foot part on the ground, for example when the foot part is moved forward when walking forward on level ground.As long as the footrest is not yet positioned in front of the body's center of gravity, i.e., in the direction in front of the frontal plane of the body's center of gravity, placing the foot on the ground may be unsafe. Alternatively, another point or area on the user's torso can be designated as the reference point for the footrest to determine whether the foot is in the correct position or in a safe position in front of the body when walking, for example, at the end of the swing phase.

[0016] A further development of the method provides for the position of the foot part relative to the user to be determined using one or more absolute angle sensors or relative angle sensors. The position of the foot part can be determined based on the known geometric dimensions of orthopedic components or on physiological conditions, such as a stump length or thigh length, in conjunction with absolute angle sensors and / or relative angle sensors. This makes it possible to easily determine the position relative to a reference point.

[0017] In particular, the position of the footrest relative to the user is determined during a swing phase, whereby the position relative to a reference point on the user is or can also be recorded during the stance phase. Detecting the position of the footrest using one or more absolute angle sensors and / or relative angle sensors has the advantage that force sensors are not required and, moreover, information about the entire movement sequence is available. Regardless of the type of movement and the phase of the movement, the angle sensors make it possible to record the position of the footrest relative to a reference point on the body.

[0018] The orientation and / or length of a leg tendon are used in a further development as the basis for activating, deactivating, and / or modulating the feedback signal. The absolute or relative position of an imaginary connection from a reference point on the body to the foot part or

[0019] A reference point on the foot part is thus used to generate the feedback signal. The leg tendon can, for example, be defined as a connecting line from the hip pivot point to a reference point on the foot part, such as the center of the foot part. In particular, the orientation of the foot part in the sagittal plane provides information about where the foot part is located in relation to the user's body or the reference point. This information is used to generate the feedback signal and can also be used to control actuators.

[0020] In addition to the position of the foot part in the sagittal plane, the position in the frontal plane and / or the distance of the foot part to a reference point on the user can be given to the user as a feedback signal. The distance of the foot part or a reference point of the foot part from a reference point on the user as a feedback signal gives the user feedback on how far the knee joint is bent or to what extent the foot part has been raised while walking. The position in the sagittal plane and / or frontal plane gives a feedback signal on how far the foot is in front of or behind the body's center of gravity or how far the foot is displaced medially or laterally to the body's center of gravity or another reference point. This helps the user to estimate where the foot part is relative to the rest of their body.

[0021] In a further development of the method, at least one translational displacement between the foot part and the user, in particular relative to a reference point on the user's torso, is used for the feedback. Both a relative horizontal and, additionally or alternatively, a vertical displacement between the foot part and the reference point on the user's torso are relevant for generating the feedback signal. In a further development of the method, different feedback signals are output depending on the position of the foot part relative to the user and / or on a threshold value of a relative displacement of the foot part to the user. A vibro-tactile feedback signal can be output to the user's soft tissue and / or bone structures. Pressures can be exerted by actuators or cuffs, and electrical stimulation, nerve stimulation, or stimulation of the central nervous system can also be carried out.In electromechanical stimulation, multiple actuators are particularly advantageous for generating the feedback signal. The feedback signal and the information about the position of the foot part can be encoded, among other things, by the location of the stimulation, the intensity of the stimulation, the frequency, and / or a temporal variation. The information can also be encoded using a pattern. When stimulating nerves or the central nervous system, complex coding can also occur, including physiological coding, in which the feedback signal can correspond to or approximate a natural feedback signal or reafference.

[0022] The position of the foot part can be represented, for example, in a Cartesian coordinate system, for example, in a coordinate system that is oriented towards the world coordinate system and moves with the user. The usual assignments of top and bottom with the reference value of the direction of gravity, front and back or anterior and posterior with regard to a normal walking direction, as well as medial and lateral or proximal and distal, apply. Alternatively, it is possible to describe the position of the foot part in terms of polar coordinates or spherical coordinates over one or more angles and distances. One or more components of this coordinate description can be transmitted to the user as a feedback signal.The position of the foot part or individual components of the position can be determined or calculated directly using the sensors, for example, through multiple integration of accelerations or via multiple IMUs and / or angle sensors and kinematic chains. Where necessary, the geometry of the orthopedic joint device, such as the prosthesis or orthosis, is also included to calculate specific points, such as the toes, the heel, or a specific position on the lateral or medial side of the foot part.

[0023] For normal walking, the position of the foot in the anterior-posterior direction, i.e. within the sagittal plane, is of particular interest. In the simplest form, a feedback signal is generated that provides information about whether the foot is in front of or behind the body or the body's center of gravity. For this purpose, a threshold value is set for the sensor signals or the sensor signal. The threshold value does not have to be exactly below the body's center of gravity, but can also be slightly in front of or behind the body's center of gravity. Alternatively or additionally, more than two sections or intervals can be created, for example a rear area, an area below the body's center of gravity, and a front area in front of the body's center of gravity. Distinguishing whether the foot is in front of or behind the body's center of gravity, for example in the swing phase, is useful for deciding whether the foot can be loaded or not.In addition, a continuous signal or a signal divided into fine sections and graded into steps can be used for the feedback, so that the position of the footrest in relation to the body can also be determined quantitatively. Using this information, users receive feedback on movement symmetry and stride length, for example. Alternatively or additionally, one or more points in time at which the footrest has passed or reached certain positions can be reported back via the feedback signal. This can provide feedback on whether a certain stride length has been reached, which can be useful during a training phase, for example. Corresponding positioning or initiation of the feedback signals can be coordinated with a change in the position of the footrest, for example. If the footrest moves from back to front, the actuation of the feedback signal also moves from back to front.The position of the foot part relative to the user's torso is a parameter that is helpful for safe movement and walking, as well as for precise control of an orthopedic joint device if necessary. The corresponding actuator can also be activated, deactivated, or modulated based on the foot position in order to influence the movement behavior of the orthopedic joint device. At the same time, the feedback signal provides the user with information about the current position of the foot part, allowing the user to adjust their movement behavior and muscle activity accordingly. The foot position is, in particular, a translational displacement in one or more spatial directions relative to the torso or another reference point.The foot position can also be manifested in one or more absolute or relative angular positions of the kinematic chain from the foot part to the body and can be used to generate feedback signals. In particular, the orientation of the leg tendon in the sagittal plane is a useful parameter for generating feedback signals. The feedback signal can be any type of signal transmitted to the body and can be encoded in different ways. The determination of the foot position or individual components relative to the torso or a reference point can be done directly via the sensors or can be determined or estimated based on the values ​​​​determined by the sensors. This can be determined, for example, via the double integration of accelerations or via one or more IMUs or angle sensors. In addition to the position of the foot part in the anterior-posterior direction in the sagittal plane orWith regard to the positions in the frontal plane in the medial-lateral direction as well as the vertical translational change, a rotation around the longitudinal axis of the lower extremity can also be used to generate a feedback signal. When standing and walking, such feedback signals can be useful so that the user is informed of a twisting of the leg at the end of the swing phase, for example due to insufficient stump guidance. The vertical position of the foot part can convey information about the ground clearance in the swing phase. It can also be useful to receive the vertical position of the foot part as feedback when stepping over obstacles. Different positions of the foot part can be encoded differently, for example in the anterior-posterior direction via the location of the initiation of the feedback signal, while in the medial-lateral direction the frequency is changed.

[0024] The feedback signals can be output continuously, with every movement and with every step. Alternatively, the signal is only output for certain movements or activities, whereby different feedback signals can be output from activity to activity or change with different movements. In one embodiment, feedback is only output when certain ranges of movement are exceeded or undercut. For example, if a step length or a certain extent of lateral movement is exceeded or undercut, a corresponding feedback signal is output. In one embodiment, a feedback signal is output when a certain activity or movement is performed several times in succession, for example multiple bilateral tilting in the stance phase or multiple, asymmetrical step lengths in the sagittal plane.In one embodiment, the feedback changes over time, for example, to adapt to typical movements or to a login. The feedback can depend on the direction and / or speed of movement, especially if feedback is to be provided when one or more thresholds are reached.

[0025] To facilitate the calculation, a reference point that is not located on or in the foot, for example, in the ankle or lower leg area, can also be used as the position of the foot part if the relationship to the foot or foot part is clear. It is important that the feedback signal allows the position of the foot or foot part to be estimated. All further developments and refinements of the method can be used and implemented in combination with one or more other developments and / or refinements.

[0026] The orthopaedic joint device for carrying out the method with an upper part and a lower part which are pivotally mounted to one another about a pivot axis, with an actuator which is coupled to the upper part and the lower part and influences a state of movement of the upper part and / or lower part, with a control device which is coupled to at least one sensor and a feedback device and with a soccer ball which is fastened to the lower part, provides that the orthopaedic joint device is designed as an orthosis or prosthesis and the feedback device is arranged on a fastening device for securing the orthosis or prosthesis to a limb of the user and / or on a separate carrier which can be fastened to the body of the user.

[0027] The feedback device can be configured as an optical, acoustic, electrically stimulating, and / or tactile viewing direction. The at least one sensor is configured in one embodiment as an absolute angle sensor, IMU, or relative angle sensor between the upper part and the lower part. Additionally, in one embodiment, a combination of an absolute angle sensor or IMU in conjunction with the relative angle sensor between the upper part and the lower part can be assigned to the control device in order to determine the relative position of the foot part to the user or a reference point on the user's torso. Based on the determination of the position of the foot part, a corresponding signal is then output via the feedback device.

[0028] Exemplary embodiments of the invention are explained in more detail below with reference to the figures. Figure 1 shows a schematic representation of an orthopedic joint device in the form of a prosthesis;

[0029] Figure 2 - a schematic representation of an orthopaedic joint device in the form of a prosthesis;

[0030] Figure 3 - a sequence of movements when crossing a step;

[0031] Figure 4 - a position determination when walking on a ramp;

[0032] Figure 5 - a position determination in the frontal plane;

[0033] Figure 6 - a schematic representation of a position determination via the thigh angle;

[0034] Figure 7 - a schematic representation of the positioning of the feedback signal for different directions of movement;

[0035] Figure 8 - the feedback device on a separate carrier in the applied state

[0036] Figure 9- a design of an orthosis with feedback elements;

[0037] Figure 10 - Frontal view of a bilaterally fitted person and a unilaterally fitted person; Figure 11 - a side view of a lower leg prosthesis;

[0038] Figure 12 - a schematic view of a stimulation device on a prosthesis;

[0039] Figure 13 - a stimulation device on an orthosis;

[0040] Figure 14 - a 2D array of feedback elements;

[0041] Figure 15 - a prosthetic socket with feedback elements;

[0042] Figure 16 - schematic representations of hip and foot positions, leg tendon orientation and feedback curves over time;

[0043] Figures 17 to 21 - different courses of feedback over time;

[0044] Figure 22 - different mappings of feedback parameters;

[0045] Figure 23 - a feedback curve in a movement phase; and

[0046] Figure 24 - different parameters for feedback.

[0047] Figure 1 shows a schematic representation of a prosthetic knee joint as part of a prosthesis, and Figure 2 shows an orthotic knee joint as part of an orthosis. The prosthetic knee joint has an upper part 10 and a lower part 20, which are pivotally mounted on one another about a pivot axis 15. In the case of a prosthetic design, a foot part 60 in the form of a prosthetic foot is arranged at the distal end of the lower part 20. In the case of an orthotic knee joint designed as an orthotic knee joint, as shown in Figure 2, the lower part 20 is designed as a lower leg splint, on which a foot part 60 is arranged, which is shown with the broken line. In the case of a KAFO (knee ankle foot orthosis), a foot part 60 is arranged on the lower part 20, on which a foot can be placed.In the embodiment as a prosthetic leg according to Figure 1, a prosthetic socket or other device for receiving a thigh stump or for securing it to a person is arranged or formed on the upper part 10. In the embodiment according to Figure 2, the orthosis is secured to a leg via fastening means 101, 201, which are designed, for example, as straps, shells, or the like, in order to removably secure the orthosis to the leg. If no component that engages below the sole of the foot is attached to the lower part 20 of the orthosis, a position distal thereto, which lies in the region of the foot, is assumed to be the reference point, which is regarded as the foot part.

[0048] An actuator 30 is arranged as a linearly acting hydraulic actuator between the upper part 10 and the lower part 20. In the illustrated embodiment, the hydraulic actuator 30 is designed with a hydraulic chamber or a cylinder that is arranged or formed in a housing or base body 31. A piston 32 is displaceably mounted in the cylinder. The piston 32 is displaceable along the longitudinal extent of the cylinder and is fastened to a piston rod 33 that protrudes from the housing or base body 31. The piston 32 divides the cylinder into chambers that are fluidly connected to one another via at least one hydraulic line. The base body 31 or the housing can be pivotally mounted on the lower part 20 at a fastening point 23 in order to prevent canting of the piston 32 during a pivoting movement of the upper part 10 relative to the lower part 20.The end of the piston rod 33 facing away from the piston 32 is attached to the upper part 10, in the illustrated embodiment to an extension arm to increase the distance from the pivot axis 15, at an upper attachment point 21. During flexion, the piston 32 is pressed downward, so that the volume of an extension chamber decreases. Correspondingly, the volume of a flexion chamber increases, reduced by the volume of the retracting piston rod 33. An electric motor 36 can be arranged in or on the housing 31 to generate pressure within one of the chambers. This electric motor drives a pump to apply pressure to the hydraulic fluid within one of the two chambers and thereby move the piston 32 within the cylinder in one direction or the other. This causes a flexion movement or, in particular, an extension movement of the orthopedic device in the form of the prosthetic leg.The electric motor 36 for driving the pump 37 is an option that can be used in one embodiment in combination with the linear damper. An alternative configuration of the actuator provides a rotary hydraulic system or an electric motor, e.g., with a gear, instead of a linear hydraulic system. A combination of several of the aforementioned actuators in conjunction with passive resistance devices is also implemented in one embodiment.

[0049] Arranged within or on the housing 31 is an adjustment drive 34, which is coupled to at least one control valve 35, via which the hydraulic resistance in the linear hydraulic system 30 can be varied if the resistance is to be controlled during use via hydraulic damping. The adjustment drive 34, like the entire actuator 30 with the motor 36, is coupled to a control device 40, which, based on sensor values, activates, deactivates, or modulates the actuator 30, and in particular the motor 36 and the adjustment drive 34, in order to provide adapted resistance and hydraulic support for an extension movement and, if necessary, a flexion movement.If the resistance device is not designed as a hydraulic damper but as a magnetorheological resistance device, the change in the resistances is not achieved by adjusting valves 35, but by activating, deactivating or modulating a magnetic field, the adjustment drive 34 is then the electromagnet or the magnetic coil.

[0050] At least one sensor 50 for detecting the spatial orientation of the lower part 20 and the upper part 10, respectively, is arranged on both the upper part 10 and the lower part 20. In particular, the sensor 50 for detecting the spatial orientation is arranged only on the upper part 10. This sensor 50, which can be designed, for example, as an IMU (inertial measurement unit), is used to determine the solid angle or the absolute angle to a fixed spatial orientation, for example, the direction of gravity, during use of the prosthetic knee joint or the orthotic knee joint. Instead of being designed as an IMU for detecting spatial positions, the sensor 50 can also detect other status data, in particular status data relating to the artificial knee joint. Status data includes, in particular, positions, angular positions, speeds, accelerations, forces, moments, as well as their progressions or changes.The determined solid angle of the upper part 10 and / or the lower part 20 or another state variable is compared with a threshold value. Upon reaching or exceeding a threshold value stored in a controller 40 for the respective sensor value or a variable derived therefrom, the adjustment drive 34 and / or the motor 36 are modulated, activated, or deactivated in order to change the flow resistance in the hydraulic system and the assist force in the extension direction by the motor 36 and the pump 37 in the actuator 30 in the hydraulic actuator configuration, the viscosity in a magnetorheological configuration, and the drive torque or braking force in an electromechanical drive.

[0051] The actuator 30 in an artificial knee joint serves to modulate a flexion movement and an extension movement in order to generate or support an appropriate or desired movement sequence. An extension movement is supported if necessary and advantageously decelerated shortly before reaching maximum extension to avoid a hard stop. In order to be able to drive the actuator 30, in particular the motor 36 and, if applicable, the adjustment drive 34, an energy storage device, in particular in the form of an accumulator, is also assigned to the actuator 30. The energy storage device can be arranged directly next to the actuator 30 or at another location in the orthopedic device where more space is available or where this appears advantageous due to the weight distribution.

[0052] One difference between the embodiment according to Figure 1 and the embodiment according to Figure 2 is that, according to Figure 2, an electromechanical drive with a motor 36 is provided, in which the electric motor 36 is coupled to a pulley, optionally via a gear mechanism. Depending on the direction of rotation of the motor 36, flexion or extension of the knee joint can then be effected or assisted via a V-belt or toothed belt. The embodiment with the drive with an electric motor 36 via a mechanical power transmission device and parallel damping via a hydraulic damper can also be used in a prosthetic knee joint. As already explained in relation to Figure 1, the resistance device in an orthosis can also be embodied by a motor, e.g. in generator mode.

[0053] The direct mechanical coupling of the electric motor 36 as part of the actuator 30 to the upper part 10 and the lower part 20 can be achieved via a power transmission device, for example via a spindle drive, so that instead of a piston rod 33, a spindle is retracted or extended from the housing 31 by turning a spindle nut driven by the electric motor. In another embodiment, the motor 36 is coupled to the upper part 10 and the lower part 20 via a gear device, for example via a planetary gear, in order to effect or decelerate a displacement of the upper part 10 relative to the lower part 20. Furthermore, the control device 40 and at least one angle detection device as a sensor 50 are arranged on the prosthesis or orthosis.The angle detection device 50 detects the relative angle between the upper part 10 and the lower part 20 and is designed, for example, as a direct angle sensor that detects the angle directly. Alternatively, the angle between the upper part 10 and the lower part 20 can be determined by evaluating the sensor data from two spatial position sensors 50. Both methods can also be used simultaneously or in a complementary manner. All sensors 50 arranged on the prosthesis or orthosis are coupled to a control device 40, and their sensor values ​​serve as the basis for controlling the actuator 30, in particular the motor 36 and the adjustment drive 34 of a resistance device if this is designed as a passive damper, or as input signals for a motor control. In the case of magnetorheological damping, the sensor values ​​serve to control the magnetic field or its variation.On the basis of the sensor data, in particular the spatial positions and / or angular positions as well as position data and data on the load, orientation, acceleration and / or deformation of other components, the actuator 30 is controlled, for example to activate, deactivate or modulate the electric motor 36 in order to generate or support a relative movement between the upper part 10 and the lower part 20, in particular to apply an extension moment in a controlled manner, but also to reduce or increase a pivoting resistance and / or to limit an end stop.

[0054] Both the prosthesis according to Figure 1 and the orthosis according to Figure 2 have a feedback device 80 coupled to the control device 40. The coupling can be wireless or wired. In Figure 2, the feedback device 80 is arranged on the fastening means 101 of the upper part 10; alternatively, it can also be arranged on the upper part 10 itself. Alternatively or additionally, a feedback device 80 or a further feedback device 80 can be arranged on the lower part 20 or the fastening means 201 on the lower leg. In Figure 1, the feedback device 80 is located on the upper part 10, which is designed, for example, as a prosthetic socket for receiving a femoral stump. Alternatively or additionally, a feedback device 80 is attached to a separate carrier, which is attached, for example, to the limb of the treated leg and / or the torso of the user.In principle, it is also possible to arrange the feedback device 80 on the contralateral side of the treated leg. The design of the feedback device 80 essentially results from the type of feedback signal generated or to be generated. If the feedback signal is to be a pressure signal or a vibration signal, corresponding signal generators or actuators are arranged at the respective location. For example, if the position of the foot or foot part relative to a center of gravity is to be communicated via a vibration signal on the thigh, several signal generators arranged in an anterior-posterior direction can be arranged on the prosthetic socket or a fastening means of the orthosis. These extend from the front of the thigh to the back of the thigh.If the foot or foot part is located vertically below the body's center of gravity or the center of gravity line, the feedback signal can be located at the level of the femur. If the foot is moved in an anterior direction, the feedback signal travels to the front of the thigh; if the foot is located behind the center of gravity line, the feedback signal travels to the back of the thigh. A corresponding arrangement and generation of corresponding feedback signals can also be achieved via electrical stimulation. A visual display can indicate the current position of the foot part 60 relative to the center of gravity line; acoustic signals can, for example, confirm whether and how far the foot part 60 is located in front of a center of gravity line, which can be indicated by different signals, signal sequences, volume levels, pitches, or the like.Figure 3 shows the movement sequence when crossing a step, divided into individual phases. In the left-hand illustration, at time tO, the supported leg with the upper part 10, the lower part 20 and the foot part 60 is at the end of the stance phase of the supported leg, the prosthetic knee joint is already flexed and the foot part 60 is almost completely unloaded and is in the so-called toe-off phase. The foot part 60, which to simplify the determination of the position of the foot part is regarded as a point-like body whose reference point 65 corresponds, for example, to the center of the foot part 60, is located below a reference point 70 on the user's torso, which in the illustrated embodiment is the body's center of gravity. The reference point 65 of the foot part 60 is located at time tO behind the body's center of gravity 70 or behind a plane parallel to the frontal plane that runs through the reference point 70.The distance between the reference point 65 on the foot part 60 and the reference point 70 is not maximum.

[0055] After the foot part 60 is raised, the upper part 10 is bent relative to the torso, and hip flexion occurs. At the same time, the lower part 20 pivots relative to the upper part 10 as part of a knee flexion. At time t1, the foot part 60 or the reference point 65 on the foot part 60 is located approximately in the plane through the reference point 70, parallel to a frontal plane. The distance of the reference point 65 from the reference point 70 is minimal, since maximum knee flexion and maximum hip flexion have occurred simultaneously.

[0056] At time t2, the foot part 60 is placed on the top of a step, the so-called heel strike occurs. Compared to the state at time t1, the lower part 20 has performed a knee extension, the unsupported leg is extended, and plantar flexion in the ankle has occurred. The distance between the reference point 65 and the reference point 70 is increased compared to the position at time t1. In the subsequent phases t3 to t5, the foot part 60 is fully placed on the step, the body's center of gravity as reference point 70 is raised via hip extension of the supported leg, and a knee extension occurs until complete knee extension has occurred at time t5. The connecting line between the reference point 65 and the reference point 70 essentially corresponds to the vertical through the reference point 70 at time t5.During the illustrated movement, the reference point 65 of the foot part 60 moves from a position posterior to the body's center of gravity 70 to anterior, with the maximum translational displacement in the horizontal direction occurring at time t2 and the maximum translational displacement in the vertical direction occurring at time t1. After the foot part 60 has been placed on the ground, the reference point 65 moves in the posterior direction back toward the vertical through the reference point 70.

[0057] The connecting line between the reference point 65 on the foot part 60, e.g. at the center of the foot at sole level or the ankle axis or another defined reference point, and the reference point, for example the body's center of gravity as reference point 70 or the hip pivot point on the torso of the body, is the so-called leg tendon 75, which is developed, for example, via the kinematic chain from the hip joint via the knee joint to the foot part 60. The distances from the hip joint to the knee joint and from the knee joint to the prosthetic foot or a specified point on the foot are known. The distance from the hip joint to the reference point 70 is also determined and set if necessary, so that the length of the connecting line between the reference point 70 and the reference point 65 on the foot part, as well as their orientation in space, can be determined from the distances and the respective angles of the upper part 10 and the lower part 20 to one another or in space.In particular, by configuring one of the sensors 50 as a spatial position sensor or IMU, it is possible to determine the position of the foot part 60 in space relative to the reference point 70 on the user's torso. Alternatively or additionally, the orientation can be estimated using relative angle sensors 50, particularly when a movement within the sagittal plane is assumed to be the main movement. Based on the position of the foot part 60 relative to the reference point 70, a corresponding feedback signal is calculated in the control device 40 and transmitted to the user via the feedback device 80 (not shown). The feedback signal can represent both the horizontal translational component of the movement and the vertical translational component of the movement of the foot part 60 relative to the reference point 70.With a horizontal component, the feedback signal travels together with the foot part 60 from back to front, i.e., from posterior to anterior. When the foot part 60 is raised, the foot part 60 moves vertically from distal to proximal or from bottom to top, and when it is lowered, the movement moves in the opposite direction. In addition to continuously or finely graduated generation of a feedback signal at different positions on the user, a corresponding feedback signal can also be generated and output when a threshold value is exceeded or when the movement is reversed. For example, if the foot part 60 reaches the vertical peak in a certain movement sequence, which can be detected by a reversal of movement due to a change in the knee angle and / or hip joint angle, a corresponding one-time signal can be output.The same applies if a translational movement of the foot part 60 has led to an exceeding of a relevant position, for example, if the foot part is located anterior to the body's center of gravity or the vertical through the reference point 70 in the walking direction. A feedback signal can also be output if the foot part 60 is maximally anterior to a reference plane, i.e., has reached an end position in the movement sequence.

[0058] Figure 4 describes the position of the foot part 60 in which it is maximally translationally positioned in front of the vertical plane through the reference point 70 and executes a heel strike. This can be determined by the sensors 50 arranged on the orthopedic joint device. A corresponding signal is output, and the user is informed that they can safely place the prosthetic foot on the prosthesis to load it without an unintentional collapse of the prosthetic knee joint being expected. Figure 5 shows a pivoting of a supported leg in the frontal plane. The supported leg is moved laterally outward within the frontal plane, which can be detected, for example, by an IMU as a sensor on the upper part 10 or the lower part 20, for example in conjunction with a knee angle sensor.A one-time feedback signal can indicate the reaching of a critical angle; alternatively or additionally, a continuous or quasi-continuous signal can be output from medial to lateral at the femoral stump or another location on the user, as indicated by the arrow. The proximal reference point 70 is the hip pivot point or another socket reference point in the illustrated embodiment.

[0059] In Figure 6, the feedback of the position of the foot part 60 relative to the reference point 70 on the torso is shown as a moving signal along the outside of the upper part 10. The position of the foot part 60 relative to the reference point 70 is determined via the leg tendon 75, as explained above. If the foot part 60 is located anterior or in front of the plane parallel to the frontal plane through the reference point 70, a feedback signal is located anterior or in front of a line formed, for example, by the femur. This is a convenient arrangement to provide the user with information about the position of the foot part 60. If the foot part 60 moves in a posterior direction, the feedback signal correspondingly moves behind or posterior to the line formed by the femur on the thigh. The course of the feedback signal is indicated in the right-hand illustration by the double arrow.

[0060] Figure 7 shows a more complex structure of multiple feedback signals. In addition to representing the feedback signal for an orientation of the foot part 60 in the sagittal plane relative to the reference point 70 by a traveling feedback signal in the anterior-posterior direction, an additional feedback signal is provided that is oriented in the longitudinal extension of the upper part 10. This second feedback signal can be superimposed on the first feedback signal and represents the orientation of the foot part 60 relative to a reference plane through the reference point 70 parallel to the sagittal plane, i.e., during a pivoting in the lateral direction or back in the medial direction. The reference point 70 can also be the hip pivot point or another body reference point.When the foot part 60 is moved according to the right-hand illustration in Figure 7, stimulation is applied along the longitudinal extension of the thigh, which is indicated by the double arrow ML in the middle illustration. When the foot part 60 is moved in the sagittal plane from anterior to posterior and back, which is shown in the left-hand illustration of Figure 7, stimulation or feedback is applied in the corresponding direction to the thigh, which is indicated by the double arrow AP.

[0061] Figure 8 illustrates an alternative or supplementary method for transmitting a feedback signal to the user. The feedback device 80 is arranged on a separate support 90 and transmits a corresponding signal to the user's torso. The support 90 is designed as a belt, strap, or cuff that is placed around the torso and, analogous to the signal configuration shown in Figure 5, implements the position of the foot part 60 in the anterior-posterior direction relative to the reference point 70 by means of a signal traveling in the anterior-posterior direction on the support 90.

[0062] Figure 9 shows a variant of the orthopedic joint device in the form of a knee-ankle-foot orthosis. Several feedback elements 80 in the form of xy arrays with corresponding stimulation devices, for example, electrodes, are arranged in the thigh region. The feedback devices 80 are designed and configured to transmit tactile information to the user about the position of the foot part 60 relative, for example, to the body's center of gravity 70 as a reference point. The position of the foot part relative to the lower part 20, for example, a pivoting about the ankle joint axis 65, can also be displayed by the feedback device 80.Figure 10 shows two frontal views of orthopedic joint devices. In the left-hand illustration, two orthopedic joint devices are attached to a user: one is a prosthetic leg with an upper part 10, a lower part 20, and a foot part 60 articulated thereto, and the other is a prosthetic foot with a foot part 60 that is arranged directly on a lower leg shaft 20. An artificial knee joint is not present on the left side of the user. Feedback devices 80 can be arranged on both orthopedic joint devices; on the right side, preferably in or on the femoral shaft 10, on the left side, in the area of ​​the lower leg shaft 20, or via a separate feedback device on the thigh of the side being treated, or on another part of the body.In the right-hand illustration of Figure 10, only one side is fitted, with a lower leg socket 20 and a foot part 60 that is pivotable about an ankle joint axis 65. Here, too, feedback devices can be arranged in or on the lower leg socket or on a separate component on the fitted or unfit limb.

[0063] Figure 11 shows a side view of a prosthetic fitting with a lower leg socket 20, a foot section 60, and the ankle joint axis 65. The feedback device on the lower leg socket 20 provides the user with feedback about the position of the foot section 60 relative to a reference point, for example, about the position in front of or behind a reference plane or about the degree of tilt of the foot section around a distal foot point 66, around which the foot section rolls during the walking movement at the end of the stance phase. Instead of a distal foot point, a foot pivot point, COP, or instantaneous center of rotation can be used.

[0064] Figure 12 shows an orthopedic joint device in the form of a prosthetic leg with an upper part 10 as the prosthetic socket and a lower part 20 as the lower leg part with the prosthetic knee joint, so that the lower part 20 can be pivoted about the pivot axis 15. Figure 13 shows a corresponding orthotic device with a thigh cuff 10, a lower leg cuff 20, and an orthotic knee joint, which allows the upper part 10 and lower part 20 to be pivoted relative to each other about the pivot axis 15. In both embodiments, a nerve is stimulated via the respective feedback device 80 using electrodes that act directly on and stimulate a nerve. In the left-hand illustration, a cuff electrode surrounds a nerve in the thigh, with the electrode being implanted together with the emulator.Communication with a corresponding control or activation unit can be wireless, so that, based on sensor values ​​or other evaluations of the foot position, corresponding feedback can be provided directly by stimulating a nerve via the feedback device 80. In the right-hand illustration, stimulation also occurs, however, not via a cuff electrode, but via stimulation of the spinal cord via electrodes arranged laterally on the spinal cord and generating a corresponding sensation. As an alternative to the fully implanted feedback device, it can also be partially implanted, namely only the electrodes, so that the emulator is connected to the electrode via a cable outlet. In addition to feedback about the foot position, proprioceptive sensations can also be simulated or other types of sensations can be encoded and generated via the electrodes.

[0065] Figure 14 shows a single view of a feedback device 80 in the form of a prosthetic liner that is worn in a femoral socket and pulled over the stump in the applicable position. In addition to a mechanical fixation of the prosthetic socket to the stump, for example, using suction socket technology, a plurality of feedback elements are integrated into the prosthetic liner, which operate, for example, vibrotactilely or with electrical stimulation. The feedback elements extend over the length and circumference of the prosthetic liner and thus form a field or a 2D array. The feedback elements are coupled, for example, via a distal pin, to devices for generating feedback signals. These can be arranged, for example, in a lower part of a leg prosthesis (not shown), and send electrical signals to the feedback elements depending on the foot position or other stimulation criteria.The feedback elements, which are represented as points that are offset and spaced from one another on the liner, can be coded differently to indicate the foot position or to generate stimulation in the thigh. The longitudinal extension, for example, codes the lateral foot position. If the foot is stretched outwards in the lateral direction, stimulation is carried out in the distal area, for example at B. If the foot is offset inwards or medially, stimulation is carried out in the proximal area, for example at D. Positioning in the anterior-posterior direction is represented by different stimulation in the circumferential direction. If the foot is at the front in the sagittal plane without a medial-lateral offset, the electrode at A is activated. If the foot is in the swing phase far behind the frontal plane without a medial-lateral offset, the electrode at C is activated.Stimulation at position E, for example, can occur when abduction occurs with a simultaneous forward step. Such a feedback device 80 corresponds to the mapping of the foot position in two spatial directions, with the foot position being located at the center of the field of feedback elements when standing in the starting position.

[0066] In Figure 15, a prosthetic socket with feedback elements is arranged circumferentially at approximately the same height or at the same distance from the distal end of the socket. The feedback elements P1 to P4 are positioned at a distance from one another on the socket, with the feedback element P1 being arranged furthest posterior laterally on the socket and the feedback element P4 being arranged furthest anteriorly. The value X is a function of the foot position or the leg tendon in relation to a reference point on the body. A value X equal to 0, for example, corresponds to a foot position behind the body, as is the case in Figure 3 at time t0, for example. The value X equal to 1 corresponds to the foot position in front of the body, as is the case in Figure 3 at time t2, for example.The feedback of the respective position can be provided in discrete positions from P1 further back to P4 further forward, whereby, in particular, by superimposing the control of the feedback elements P1 to P4, the impression of a continuous shift of the feedback signals depending on the value X can be created. The increase or decrease in the intensity of the stimulation to generate a feedback signal can be achieved, for example, by reducing or changing the voltage in a vibration motor or the intensity of the stimulation of an electrode.

[0067] Figure 16 shows temporal progressions during walking on a level surface. The upper diagram shows the horizontal absolute position of the hip XH and the position of the foot XF in the absolute system relative to the foot point in the anterior-posterior direction, with forward movement being represented as a positive value. At time t0 the heel is placed on the ground as part of a heel strike; time t1 denotes toe-off, and time t2 the second heel strike. The upper curve shows that during steady walking on a level surface the reference point of the hip moves almost uniformly forward, while after the heel strike the foot no longer moves forward.

[0068] In the middle illustration of Figure 16, the orientation of the leg tendon cpl and the relative position of the foot to the hip or torso in the forward-backward direction is shown as AXF. During the stance phase from t0 to t1, the relative position of the foot to the hip changes, i.e. the foot is initially anterior to the hip and moves posteriorly as the gait progresses, which is indicated by the falling curve AXF. After the toe-off, the foot is placed again in front of the hip joint, which is illustrated by the rise in the curve and the positive value. The orientation of the leg tendon is initially negative after the heel strike and then changes to a vertical position where it intersects the t-axis. The leg tendon then bends forward until the toe-off and is then pivoted forward at the hip pivot point during the swing phase until the second heel strike occurs.The lower curve of Figure 16 shows two parameters, XX and Xcp, as variations of the feedback signals. These two functions depend on the leg tendon, indicated by Xcp, and the relative foot position, AXF. Both parameter curves are linearly dependent on the magnitude curves, with certain characteristics of the feedback signals being controlled based on these parameters, such as the position of the feedback signal, the intensity of the feedback signal, the frequency, and so on.

[0069] Figure 17 shows the progression of feedback intensity through the value X during walking when a limit value AXF,1 is exceeded at time t3. With such a feedback device or such a design of the feedback device, the user is given feedback as to where the foot is located under the body during the swing phase only at a specific time by means of a comparatively intense feedback signal. At time t3, from which the foot moves forward under the body during the swing phase and is sufficiently far in front of the body for it to be placed on the ground, the feedback signal is emitted so that the user knows or feels that the prosthesis or orthosis can be loaded. The feedback can depend on the gradient of the value AX or its direction. For example, no feedback is given if the foot swings from front to back or from front to back.Anterior to posterior is the signal, but the opposite direction occurs when the foot is moved from back to front. Such a signal can also occur depending on the movement situation, for example, only during the swing phase and not during the stance phase.

[0070] Figure 18 shows the saturation of the feedback parameter X starting at a certain value. For example, up to a certain point in time or from certain points in time, no changes in the intensity or level of the feedback signal occur, for example when the foot is particularly far forward, i.e. before time t0 or after time t3. The same applies when the foot is relatively far back behind the center of gravity or another reference line, in the illustrated embodiment between times t1 and t2. The position and intensity of the feedback can be changed proportionally between the two limit values ​​of the foot position depending on the foot position; if the limit values ​​are exceeded or undershot, no further change in the intensity or position of the feedback takes place, the feedback remains constant.

[0071] Figure 19 shows a possible feedback signal when the hip is tilted to the side. A sideways tilt of the leg, where the entire leg or just the thigh or lower leg is sufficient, is observed during the stance phase. If ip is 0, there is no sideways tilt; the leg is in a vertical position. If ip is negative, this corresponds to the hip swerving laterally relative to the foot; the hip tilts outwards in response to loading, e.g., in the case of a problem with muscle control. If ip is positive, the hip is moved medially, and the foot or the foot part of the user is slightly further laterally than in the vertical position of the leg. The lower illustration in Figure 19 shows the parameter for the feedback X as a function of the sideways tilt or the inclination of the leg in the frontal plane.If a threshold value ip1 is exceeded, feedback X is provided, which is proportional to the lateral tilt. The intensity of the feedback signal increases with a greater tilt to one side. This allows for feedback on incorrect walking, and gait correction can be performed during walking. As an alternative to hip tilt, the feedback can indicate a relative lateral position of the foot relative to the torso or hip.

[0072] Figure 20 shows that feedback X is only provided in a certain range of a foot position, namely in a limit value range AXF,1 and AXF,2, which is located in particular around the zero point. Outside the limit values ​​AXF,1 and AXF,2, no feedback or stimulation takes place; if necessary, stimulation or feedback with a constant intensity can take place for a time ΔT, in the illustrated embodiment between t1 and t2 and between t4 and t5. Thus, a feedback signal is output over a certain period of time after the limit values ​​have been exceeded. In the illustrated embodiment, a signal is generated in the middle stance phase and in the swing phase, when the foot is passed under the body.

[0073] Figure 21 shows how a feedback signal X is generated based on both the position of the COP (center of pressure), denoted by XXCOP, and the relative foot position, denoted by XXF. The COP position, for example, is only returned as feedback during the stance phase, i.e., from t0 to t1, while during the swing phase the relative foot position is also used as the basis for stimulation. The COP is not defined for the swing phase, so no feedback signals can be output to the user in this regard. The feedback parameters XXCOP and XXF can be mapped to different feedback characteristics, for example, with regard to the XY position on a field or array of electrodes or vibration generators, with regard to a position and amplitude, or the like.

[0074] Figure 22 shows different mappings of the feedback parameter X and the features f of the respective feedback. The features f1 can be, for example, the intensity, the frequency, the position, or a curve. In addition to a direct coupling between f1 and X1, in which the respective relationships are linearly coupled, features can depend on multiple parameters X1 and X2, for example as a product, a logical AND, as a non-linear, piecewise continuous relationship, or the like. As a supplement or alternative, the X values ​​can be adjusted by multiple features f1 and f2, for example by the amplitude and frequency, for example as a continuous or piecewise continuous function of a parameter. Combinations of these are also possible. Figure 23 shows how a feedback signal is applied only in one movement phase or as a function of other determined parameters.In the illustrated embodiment, feedback is provided only during the swing phase and depends on the load on the treated side. Only when the treated side is not loaded, i.e., the axial force FZ is 0 and a certain hamstring angle cpl is present, is time t1 assumed to be given, i.e., toe-off is considered to be fulfilled, so that the feedback signal X is output depending on the hamstring angle.

[0075] Figure 24 shows the dependence of feedback X on foot speed relative to the hip or torso. AXF denotes the relative foot position to the hip or torso, AVF is the foot speed relative to the hip and torso, each for one step from heel strike to heel strike. The lower curve shows the different parameters for the feedback, which can be used together or individually. Xv is the feedback as a function of foot speed, whereby the absolute value of the foot speed is assumed as the parameter here. XX denotes the dependence of the stimulation on foot position, the parameter XX, V denotes the feedback as a function of foot position and relative foot speed.Such feedback control works in the sense of a predictive control in order to be able to adapt the feedback X in advance at high movement speeds in order to take into account the reaction time in the human processing or perception of the feedback.

Claims

Patent claims 1 . Method for controlling a feedback device (80) of an orthopedic joint device of a lower extremity, having at least one upper part (10) and one lower part (20) in the worn state, which are pivotably mounted to one another about a pivot axis (15), having an actuator (30) which is coupled to the upper part (10) and the lower part (20) and influences a state of movement of the upper part (10) and / or the lower part (20), having a control device (40) which is coupled to at least one sensor (50) and the feedback device (80), characterized in that the position of a foot part (60) relative to the user of the orthopedic joint device is determined on the basis of sensor data from the at least one sensor (50), and the control device (40) activates, deactivates, or modulates the feedback device (80) depending on the position of the foot part (60) relative to the user.

2. Method according to claim 1, characterized in that the feedback device (80) is attached to the orthopaedic joint device and / or to a support (90) arranged separately on the user.

3. Method according to claim 1 or 2, characterized in that optical, acoustic, electrically stimulating and / or tactile feedback signals are transmitted to the user.

4. Method according to one of the preceding claims, characterized in that feedback signals are output to the user about the course of the swing phase or stance phase and / or at least one feedback signal is output after reaching a position of the foot part (60) relative to the user.

5. Method according to one of the preceding claims, characterized in that the position of the foot part (60) relative to a hip pivot point, the body center of gravity or another reference point (70) on the torso of the user is determined as a reference point (65) for the foot part (60).

6. Method according to one of the preceding claims, characterized in that the position of the foot part (60) relative to the user is determined via one or more absolute angle sensors (50) and / or angle sensors (50).

7. Method according to one of the preceding claims, characterized in that the position of the foot part (60) relative to the user of the orthopaedic joint device is determined during a swing phase.

8. Method according to one of the preceding claims, characterized in that the orientation and / or length of a leg tendon is used as a basis for the activation, deactivation and / or modulation of the feedback signal.

9. Method according to one of the preceding claims, characterized in that the position of the foot part (60) in the sagittal plane, frontal plane and / or the distance of the foot part (60) to a reference point on the user is output to the user as a feedback signal.

10. Method according to one of the preceding claims, characterized in that at least one translational displacement between the foot part (60) and the user, in particular to a reference point (70) on the torso of the user, is used for the feedback.

11. Method according to one of the preceding claims, characterized in that different feedback signals are output depending on the position of the foot part (60) relative to the user and / or on a threshold value of a relative displacement of the foot part (60) to the user.

12. An orthopaedic joint device for carrying out the method according to one of the preceding claims, characterized in that it is designed as an orthosis or prosthesis and the feedback device (80) is arranged on a fastening device (101, 201) for fixing the orthosis or prosthesis to a limb of the user or on a separate support (90).

13. Orthopaedic joint device according to claim 12, characterized in that the feedback device (80) is designed as an optical, acoustic, electrically stimulating and / or tactile feedback device (80).

14. Orthopaedic joint device according to claim 12 or 13, characterized in that the at least one sensor (50) is designed as an absolute angle sensor, IMU or relative angle sensor between the upper part (10) and the lower part (20).

15. Orthopaedic joint device according to claim 12 or 13, characterized in that at least one absolute angle sensor or an IMU and one relative angle sensor (50) are assigned between the upper part (10) and the lower part (20) of the control device (40).

Images