Hand orthosis

Abstract

The invention relates to a hand orthosis comprising: a support (20) which is secured to a main body (10) that itself is form-fittingly secured to a metacarpus; at least one finger receiving portion (30) which is located distally from the support (20), for securing to at least one finger; and a coupling device (40) which connects the support (20) and the finger receiving portion (30) when the hand orthosis is worn and which mounts the finger receiving portion (30) in such a way that it can be pivoted relative to the main body (10), wherein the coupling device (40) has a curved guide link (45) along which the finger receiving portion (30) is movably guided.

Description

[0001] Hand orthosis

[0002] The invention relates to a hand orthosis with a carrier which is fixed to a base body for form-fitting attachment to a metacarpal, with at least one finger receptacle arranged distal to the carrier for form-fitting attachment to at least one finger and a coupling device connecting the carrier and the finger receptacle in the applied state of the hand orthosis, which pivotably mounts the finger receptacle relative to the base body, as well as a carrier with a finger receptacle and coupling device for forming a hand orthosis.

[0003] Patients with pathologically increased muscle tone, for example due to a stroke or other damage to the central and / or peripheral nervous system, may suffer from impairments in hand motor skills. The fingers may not be able to achieve their full range of motion due to the damage; for example, there is the so-called swan neck deformity, in which full extension of the fingers is not possible and flexion is restricted. The thumb may also be restricted in terms of its position and positional mobility relative to the other fingers.

[0004] To address these problems, various hand orthoses or devices are known, which either prevent the flexion of individual joints or control flexion and extension.

[0005] From WO 2022 / 043843 A1, a hand orthosis in the form of an exoskeleton is known, comprising a support that can be attached to the wrist or hand and has a section that can be positioned near a metacarpophalangeal (MCP) joint. An elongated motion unit is attached to the support and has a plurality of adjacent, movable links positioned along a longitudinal axis. A compliant layer extends through the motion unit along its longitudinal axis, as does a first cable located within a first recess and connected to the motion unit. A second cable is arranged within a second recess and connected to the motion unit. At least one finger receptacle for holding two fingers is attached to the motion unit. Movement of the two cables produces a corresponding extension or flexion.

[0006] The object of the present invention is to provide an improved hand orthosis that, in particular, avoids contraction due to pathological increase in muscle tone and tendon shortening when opening the hand.

[0007] This problem is solved by a hand orthosis with the features of the main claim and a support with the features of the dependent claim. Advantageous embodiments and further developments of the invention are disclosed in the dependent claims, the description, and the figures.

[0008] The hand orthosis, comprising a support attached to a base body for form-fitting fixation to the midhand, with at least one finger receptacle positioned distal to the support for form-fitting fixation to a finger, and a coupling device connecting the support and the finger receptacle when the hand orthosis is applied, which pivots the finger receptacle relative to the base body, is characterized by the coupling device having a curved guide track along which the finger receptacle is slidably guided. The curved guide track allows for the provision of an external pivot joint, thereby improving the guidance of the finger or fingers positioned in the finger receptacle. The guide track can be located between two fingers, next to a finger, or over a finger to guide individual fingers as needed.A positive locking connection of a finger to the finger receptacle includes, in particular, the placement or placement of the fingers on shells, frames, curved receptacles, clamps, clips, or similar devices, and their fixation either by the devices themselves or by separate fastening means. A positive locking connection also exists if the finger receptacle prevents relative movement in at least one translational degree of freedom. The carrier that secures the finger receptacle to the base body can be a single piece or multiple pieces and, in particular, may allow for a detachable connection of the carrier, the coupling device, and the finger receptacle to the base body.The coupling device with its curved guide track allows for the design of a modular hand orthosis that maps the pivot point of a finger joint, particularly through a circular structure, thus avoiding incongruities due to mismatched pivot points or axes. This also reduces the tendency to cause pathological increases in muscle tone, which can occur with guided movements involving mismatched pivot points or axes. When applied, the finger holder is moved along the curved guide track, which reduces and ideally eliminates the forces exerted on the biological system. Furthermore, the curved, external guide track facilitates both the alignment and the application of the finger holder, especially since the finger holder is detachably mounted to the coupling device.

[0009] In one embodiment, the coupling device is designed exclusively as a curved guide track and thus exhibits a curvature from the support to the finger receptacle. The curvature of the guide track is preferably designed such that the finger receptacle follows a movement around the corresponding finger joint, particularly the metacarpophalangeal joint, without generating any constraint forces. Alternatively, a cantilever is arranged or formed on the coupling device, which can also be straight, for example, to bridge a greater distance from the support to the finger joint. This may be necessary, for instance, if the base body is located relatively far proximally due to particular anatomical requirements.

[0010] In one embodiment, two finger receptacles are arranged on opposite sides of the guide track, allowing both finger receptacles to pivot together along the guide track. This makes it possible to position the guide track, for example, between two adjacent fingers, such as the index and middle fingers or the little and ring fingers, whose metacarpophalangeal joints are often pivotable about axes that are close together. This allows for a comparatively small number of guide tracks and coupling devices to guide the fingers in the finger receptacles. Alternatively or additionally, several finger receptacles can be arranged on one side of the guide track; for example, the guide track can be positioned between the middle and ring fingers, and the little finger can be moved together with the middle finger's finger receptacle.Then three finger grips would be guided along a common curved guide track on a coupling device. In one embodiment, the coupling device is guided ulnarly, and finger grips for the little finger and middle finger are attached to it radially oriented.

[0011] Advantageously, the guide track is guided around an axis that, in the applied state, coincides with the axis of rotation of a finger joint, particularly a metacarpophalangeal joint. The guide track can be designed as an internal or external guide, for example, formed by a click-lock or click mechanism. An internal guide is, for example, a tube or rod that passes through a sliding element on the finger receptacle, which is formed or arranged on the finger receptacle. The sliding element slides along the outside of the guide track and guides the finger receptacle along the curved guide track. An external guide is a cam track or other profile guide within which a sliding element, for example, a cam track or the like, is guided. The internal guide can also be a hollow cross-section in which a coupling element is arranged that is coupled to the finger receptacle.

[0012] The finger support is designed as a 3-point attachment, ring, or clamp to accommodate one or two or more finger joints. In a 3-point attachment configuration, the finger support is, for example, formed with two palmar-closed arches, each of which rests palmarly in the area of ​​a finger joint and forms a bridge in the area of ​​a finger joint, thus preventing or at least hindering flexion.

[0013] In one embodiment, the finger receptacle is coupled to an actuator attached to or connected to the base body via a coupling element. This coupling element can transmit tensile and / or compressive forces, thereby enabling flexion and / or extension of the finger connected to the finger receptacle. The actuator can be motor-driven or manually operated. For example, a clamping device is connected to the coupling element to counteract contraction. To allow displacement, the actuator or clamping device is then released accordingly.

[0014] In one embodiment, a locking device is mounted on the base body, and the locking device is coupled to the finger receptacle via a coupling element. This makes it possible to fix the respective finger or fingers in the desired position even without an actuator, preventing further movement and movement in the locked direction. The locking device is designed to be releasable, in particular designed to be releasable in such a way that it can be unlocked even under increased muscle tone. In a further embodiment, the locking device is designed to allow pivoting movement along the guide track in one direction and to automatically lock in the opposite direction.For example, opening a hand is always possible, but unwanted flexion and unwanted closing of the hand, for example due to a sudden stimulus or spasticity, are prevented.

[0015] In one embodiment, the locking device features a switch that allows the locking direction to be alternated. This makes it easy to adapt to the specific medical condition and the individual needs of the patient.

[0016] The locking device can be designed as a locking wedge, locking roller, locking slide, ratchet, or locking coupling. The coupling element is flexible in one embodiment and guided within the coupling device, advantageously coupled to an actuator or a clamping device. The coupling element can be designed as a push-pull cable or a pull-pull cable, thus allowing for a lightweight design and flexible routing with respect to the respective guide path and radius of curvature.

[0017] In one embodiment, the base body is designed to surround the thumb's metacarpophalangeal joint and at least part of the metacarpal bone when in place. The base body is particularly dimensionally stable and fixes the thumb's metacarpophalangeal joint in a fixed position or at least significantly restricts its displacement, thus ensuring hand function. Positioning the base body over at least part of the metacarpal bone, especially on the back of the hand, facilitates access to the attachment points for the wearer. Other components, such as the tensioning device and / or an actuator, are also attached to the base body.

[0018] In one embodiment, the support is attached dorsally to the base body of the hand orthosis when it is in place, and can be secured, particularly in a repeatedly releasable manner, thus facilitating the application of the hand orthosis. First, the base body is positioned on the hand. Then, for example, the finger receptacles, along with the coupling device, are attached to the respective affected fingers. Finally, the support, which is located at the proximal end of the coupling device, is secured to the base body. Various fastening elements can be used for this purpose, such as screws, click connections, clip connections, click fasteners or click mechanisms, clamping devices, or the like.The base body can, for example, have elongated holes or several holes, threads or the like arranged at discrete intervals from each other, in order to fix the coupling device to the base body via the carrier at different points and in an individually adjustable manner.

[0019] The base body has an ulnar insertion opening for easier positioning on the hand, so that, for example, the thumb can be inserted through the ulnar insertion opening together with the metacarpus and the base body can be attached to the hand.

[0020] In one embodiment, the finger receptacle is coupled to the coupling device via a connecting element. This connecting element can, for example, form the sliding piece, the guide block, or the sliding receptacle for the inner guide. In one embodiment, the connecting element is detachably connected to the finger receptacle to allow for easy adjustment with the coupling device. This makes it possible to first fix the finger receptacles to the respective fingers and then connect the finger receptacle to the connecting element. The connection can be made, for example, via clip connections, screw connections, or clamp connections.

[0021] In one embodiment, the connecting element is tiltable relative to the guide track and can be moved from a moving position to a locking position. This makes it possible to prevent relative movement of the finger receptacle relative to the guide track by tilting it with the connecting element. The connecting element can also be integrally formed with the finger receptacle(s). Thus, a second finger receptacle can be positioned distal to the first finger receptacle, which is mounted directly on the guide track, so that two finger receptacles are formed or mounted on the connecting element.

[0022] The second finger receptacle is, for example, arranged distal to the first finger receptacle and pivotably mounted on it. In one embodiment, the second finger receptacle is coupled to the guide track via a force transmission element, so that a displacement of the first finger receptacle along the guide track causes the second finger receptacle to pivot about a second pivot axis, which is spaced apart from the first pivot axis. The second pivot axis is formed on the first finger receptacle or the connecting element. Thus, displacement of the distal finger segment relative to the medial finger segment is possible when the entire finger is moved around the metacarpophalangeal joint. In one embodiment, the guide track is rotatably mounted on the support to facilitate alignment with the individual patient.

[0023] In one embodiment, the base body has receiving elements arranged or formed for the variable reception of the carrier, for example, elongated holes.

[0024] The invention also relates to a carrier with a coupling device and a finger receptacle, as described above. All features of the carrier, as well as the coupling device and finger receptacle, can be implemented in the combinations and further variants described above. With such a carrier, it is possible to attach a module interchangeably to the base body, thereby creating a modular hand orthosis. Depending on the clinical picture or degree of impairment, different modules can be interchangeably attached to a single base body that covers or encloses part of the metacarpal bone to ensure the best possible care for the patient.

[0025] Exemplary embodiments of the invention are explained in more detail below with reference to the figures. Reference numerals denote identical components. For clarity, not all reference numerals are shown in all figures. The figures show:

[0026] Figure 1 - a schematic representation of a hand with a hand orthosis applied;

[0027] Figure 2 - a detailed view of a finger scan with a guide track;

[0028] Figure 3 - another, perspective view of Figure 2;

[0029] Figure 4 - a schematic representation of a coupling device with external guidance;

[0030] Figure 5 - a sectional view of Figure 4; Figure 6 - a variant of the coupling device with a boom and a flexible guide track;

[0031] Figure 7 - a flexible, internal coupling element;

[0032] Figure 8 - a variant with a second finger receptacle on a first finger receptacle and locking device;

[0033] Figure 9 - a detailed view of a locking device;

[0034] Figure 10 - a detailed view of a flexible connecting element;

[0035] Figure 11 - a connecting element with an internal guide;

[0036] Figure 12 - a connecting element according to Figure 11 in mounted position on a coupling device; as well as

[0037] Figure 13 - schematic representations of different coupling elements.

[0038] Figure 1 shows a schematic representation of a hand orthosis with a base body 10 to which a support 20 is attached in the dorsal region. The base body 10, which at least partially encompasses the metacarpal joint both dorsally and palmarly, has receiving elements 12 for attaching the support 20. In the illustrated embodiment, the receiving elements 12 are designed as elongated holes into which fastening elements, such as screws, clamps, or the like, are inserted to secure the support 20 to the base body 10. The position of the support 20 on the base body 10 is thus variably adjustable and can be adapted to the individual patient. A coupling device 40 extends distally from the support 20; in the illustrated embodiment, this coupling device is designed as an internal guide in the form of a bent tube or a bent rod.The coupling device 40 can be adjusted and fixed in the carrier 20 in both translational and rotational directions to adapt its position and orientation. The fixing can be positive-locking or clamping. A connecting element 34, designed as a sliding body or sliding receptacle, is arranged at the distal end of the coupling device 40, which is configured as a curved guide track 45. A recess is formed in the connecting element 34 into which the guide track 45 is inserted, thus allowing the connecting element 34 to be slidably mounted on the guide track 45. In the illustrated embodiment, the coupling device 40 has a circular cross-section, allowing the connecting element 34 to rotate about the coupling device 40. Rotation is not possible with a non-rotationally symmetrical cross-sectional shape.

[0039] In the illustrated embodiment, the connecting element 34 is formed integrally with two finger receptacles 30, which are explained in more detail in Figure 2. An actuator 50 is arranged on the base body 10 proximal to the support. This actuator is designed either as a motor drive or as a clamping device to accommodate a coupling element (not shown) for transmitting or absorbing forces. The coupling element can optionally transmit tensile and / or compressive forces, as will be explained later. Even without a coupling element, the connecting element 34, and thus also the finger receptacles 30, which are arranged or formed on the connecting element 34, are guided along the curved guide track 45 on the coupling device 40.

[0040] Figure 1 shows that the coupling device 40 is positioned between two fingers, in this embodiment between the index and ring fingers of the left hand. This makes it possible to achieve a slim and unobtrusive design for the hand orthosis. Two finger receptacles 30 are arranged on the coupling element 40: a radial finger receptacle 30 oriented towards the thumb for the index finger and an ulnar finger receptacle on the opposite side of the coupling device 40 for the middle finger. The coupling device 40 is designed and bent such that the guide track 45 has a pivot point that coincides with, or substantially coincides with, the pivot point or axis of rotation of the metacarpophalangeal (MCP) joint.With such a design it is possible to achieve an optimized movement phase of the finger receptacles 30, so that no or only slight incongruities occur in the movement paths between the finger receptacle 30 and the finger joints of the corresponding finger around the metacarpophalangeal joint or MCP joint.

[0041] Figure 2 shows a detailed view of Figure 1, illustrating the circular arc-shaped or approximately circular arc-shaped guide track 45 of the coupling device 40 and the connecting element 34, on which two finger receptacles 30 are formed. The finger receptacles 30 are designed as a three-point support and each is formed as a double U-shaped frame that rests palmarly against the proximal and medial phalanges of the corresponding finger and extends ulnarly and radially upwards along the finger. The dorsal arcs are connected to each other, resulting in a dorsal contact at the top of the connecting bridge in the region of the medial joint, thus preventing flexion at the PIP joint. This prevents the fingers from being moved into a so-called swan position during action against spasticity and the associated contraction of the finger tendons.The coupling device 40 is designed as an internal guide, which is guided in a recess within the connecting element 34. To apply the orthosis, the affected fingers, for example the index and middle fingers, are inserted into the two finger receptacles 30, and the coupling device 40, together with the carrier 20, is attached to the proximal base body 10. Locking can be automatic via a click-lock mechanism; Figure 1 shows an actuating element on the upper side of the carrier 20, which allows for unlocking.

[0042] Figure 3 shows a bottom view of the finger receptacle 30 with the connecting element 34. The guide for the coupling device 40 formed in the connecting element 34, which is designed as a rod-shaped or tubular guide track 45, is visible, as is the double-curved design of the finger receptacles 30.

[0043] Figure 4 shows a variant with an external guide for the connecting element 34 and the associated finger receptacles 30 (not shown). With an external guide, the connecting element 34 is attached to an internal coupling element 70, which is guided in a guide track or slide. In the illustrated embodiment, the coupling element 70 is guided within a curved tube. The tube has a radius at the center of which the axis of rotation 5 is formed. The finger receptacles 30 pivot around this axis when the coupling element 70 is moved in one direction or the other, or when the fingers are flexed or extended. The external guide has a straight extension 44 and then transitions into the curved guide track 45.

[0044] Figure 5 shows a sectional view of the embodiment according to Figure 4. The outer guide is designed as a hollow cross-section, in the illustrated embodiment as a hollow round tube with spherical components inserted therein, which are assembled to form a coupling element 70. The coupling element 70 is essentially compression- and tension-resistant and flexible, so that it can be moved in both directions along the curved guide track 45.

[0045] Figure 6 shows another variant of the coupling device 40 with the straight cantilever 44, the curved guide track 45, and the two finger receptacles 30, which is mounted on the coupling element 70 guided within the guide track 45 via a connecting element 34. The connecting element 34 can be designed as a separate component or alternatively, it can be formed integrally with the finger receptacles 30. The connecting element 34 can also be permanently connected and formed integrally with the coupling element 70. In the illustrated embodiment, shown in detail in Figure 7, the coupling element 70 is designed as a flexible component comprising spherical elements connected to each other via solid-state joints.This design allows for further design options; for example, the fingers can perform abduction or adduction through a corresponding internal configuration of the material transversely to the flexion direction around the axis of rotation 5. An external mechanism can be arranged on the coupling element 70, such as an actuator in the form of a motor, a spring accumulator, a damper, or a locking device, which can be designed as a ratchet or locking clutch. The locking device can be activated discretely or continuously, so that the respective fingers, which are arranged in the finger receptacles 30, can be actively and / or passively driven or fixed in specific positions and released again as needed.

[0046] Figure 8 shows a further embodiment in which the coupling element 70 is coupled to the connecting element 34 and finger receptacles (not shown). In the illustrated embodiment, the coupling device 40 is designed as an external guide within which the coupling element 70 is guided in a recess. The lower part of Figure 8 shows the assembly in cross-sectional view. A further connecting element 34 is arranged on the proximal connecting element 34, which is guided directly on the guide track 45, for example, in the form of a cam guide. This further connecting element 34 is mounted on the proximal connecting element 34 about a further pivot axis 5. The distal connecting element 34 or the distal finger receptacle is coupled to the guide track 45 and the coupling device 40 via a force transmission element 55.When the proximal finger receptacle 30 is pivoted downwards about the pivot axis 5 of the MCP joint, the proximal end of the force transmission element 55 remains stationary. The second, distal connecting element 34 is pivoted downwards counterclockwise together with the proximal connecting element 34, thereby tensioning the force transmission element 55 and allowing the distal connecting element 34 or the distal finger receptacles 30 to pivot about the distal pivot axis 55 on the proximal connecting element 34. Thus, a pivot about the PIP pivot axis is achieved simultaneously with a pivot about the MCP pivot axis.

[0047] At the proximal end of the coupling element 70, a locking element 60 is formed in the form of a linear toothing, into which corresponding locking elements, for example on the base body 10 or on another stationary component, can engage. Alternatively to the linear ratchet mechanism, the locking device can be designed as a locking wedge, locking roller, locking slide, or locking coupling.

[0048] Figure 9 shows the locking device 60 in the form of a rotary ratchet mechanism coupled to an elastically mounted locking element 66. The locking device 60 can be moved into a release position by means of a release element, a push button, a switch, or similar device. In one embodiment, the teeth of the locking device are designed and arranged such that locking always occurs in a first pivoting direction of the finger receptacle or connecting element 34, while movement is always possible in the other, second direction.

[0049] Figure 10 shows the flexible design of the connecting element 34, which has a cam block with a corresponding curve for guidance in the coupling device. The flexible design of the connecting element 34 allows abduction or adduction of the finger receptacles 30 or of a single finger receptacle.

[0050] Figure 11 shows a variant of the possibility for abduction or adduction, in which, instead of a flexible design of the connecting element, the abduction or adduction is formed via the round hole guide 340 in the connecting element 34.

[0051] Figure 12 shows this design in a perspective overall view with the connecting element 34, the two finger receptacles 30 and the coupling device 40.

[0052] Figure 13 shows two variants of the coupling element 70; in the left variant, the coupling element 70 is designed as a pull-pull cable, while in the right illustration, the coupling element 70 is designed as a pull-push cable with solid body joints.

Claims

Patent claims 1. Hand orthosis with a carrier (20) which is fixed to a base body (10) for form-fitting attachment to a metacarpal, with at least one finger receptacle (30) arranged distal to the carrier (20) for attachment to at least one finger and a coupling device (40) which connects the carrier (20) and the finger receptacle (30) in the applied state of the hand orthosis and which pivotably mounts the finger receptacle (30) relative to the base body (10), characterized in that the coupling device (40) has a curved guide track (45) along which the finger receptacle (30) is slidably guided.

2. Hand orthosis according to claim 1, characterized in that the coupling device (40) is designed as a curved guide track (45) or the guide track (45) is arranged on a boom (44).

3. Hand orthosis according to claim 1 or 2, characterized in that two finger receptacles (30) are arranged on opposite sides of the guide track (45).

4. Hand orthosis according to one of the preceding claims, characterized in that several finger receptacles (30) are arranged on one side of the guide track (45).

5. Hand orthosis according to one of the preceding claims, characterized in that the guide track (45) is guided around an axis (5) which, in the applied state, coincides with an axis of rotation of a finger joint.

6. Hand orthosis according to one of the preceding claims, characterized in that the guide track (45) is designed as a tube, rod or cam guide.

7. Hand orthosis according to one of the preceding claims, characterized in that the finger receptacle (30) is designed as a 3-point support, ring or brace.

8. Hand orthosis according to one of the preceding claims, characterized in that the finger receptacle (30) is coupled to the coupling device (40) via a connecting element (34).

9. Hand orthosis according to one of the preceding claims, characterized in that the finger receptacle (30) is coupled to an actuator (50) coupled to or attached to the base body (10) via a coupling element (70).

10. Hand orthosis according to one of the preceding claims, characterized in that a locking device (60) is mounted on the base body (10) which is coupled to the finger receptacle (30) by a coupling element (70).

11. Hand orthosis according to claim 10, characterized in that the locking device (60) allows pivoting movement in one direction and automatically locks in the opposite direction.

12. Hand orthosis according to claim 11, characterized in that a changeover switch (66) is associated with the locking device (60) which changes the locking direction.

13. Hand orthosis according to claim 11, characterized in that the locking device (60) is designed as a locking wedge, locking roller, locking slide, ratchet or locking coupling.

14. Hand orthosis according to one of claims 9 to 13, characterized in that the coupling element (70) is flexibly designed and guided in the coupling device (40).

15. Hand orthosis according to one of the preceding claims, characterized in that the base body (10) surrounds the base joint of the thumb and at least a part of the metacarpus when applied.

16. Hand orthosis according to one of the preceding claims, characterized in that the carrier (20) is attached dorsally to the base body (10) in the applied state of the hand orthosis.

17. Hand orthosis according to one of the preceding claims, characterized in that the base body (10) has an ulnar insertion opening (12).

18. Hand orthosis according to claim 8, characterized in that the connecting element (34) is designed to be bendable and / or pivotably mounted on the coupling device (40).

19. Hand orthosis according to one of the preceding claims, characterized in that the connecting element (34) is tiltable relative to the guide track (45) and can be moved from a moving position to a locking position.

20. Hand orthosis according to one of the preceding claims, characterized in that a second finger receptacle (30) is mounted on the finger receptacle (30) or the connecting element (34).

21. Hand orthosis according to claim 20, characterized in that the second finger receptacle (30) is coupled to the guide track (45) via a force transmission element (55).

22. Hand orthosis according to one of the preceding claims, characterized in that the guide track (45) is rotatably mounted on the support (20).

23. Hand orthosis according to one of the preceding claims, characterized in that the base body (10) has receiving elements (12) for variable reception of the wearer (20).

4. Carrier (20) with coupling device (40) and finger receptacle (30) according to one of the preceding claims for attachment to a base body (10) to form a hand orthosis.

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