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 two coupling elements (42, 44), each of which is pivotably mounted on both the support (20) and the finger receiving portion (30).

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 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 such 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 is also sometimes restricted in terms of its position and positional mobility relative to the other fingers.

[0004] Furthermore, people affected by a stroke or, for example, brachial plexus palsy are often unable to move the hand on the affected side intentionally; in most cases, grasping and holding objects is difficult. This has various causes depending on the specific condition. In cases of pathologically increased muscle tone, the fingers of the affected hand are, in most cases but not exclusively, forced into a flexed position from which patients are unable to open the hand, or can only do so with the support of the healthy hand or with assistance from a person nearby. In brachial plexus palsy, there is an avulsion and / or damage to the nerves exiting the cervical vertebrae, leading to an inability or impairment of voluntary control of the fingers of the affected hand.

[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] US Patent 2020 / 0375687 A1 discloses a supportive exoskeleton comprising a glove and a platform positioned radially adjacent to the index finger via a fastening strip in the region of the metacarpophalangeal joint. A three-segment splint is articulated to the platform. The individual segments are coupled to each other by means of struts such that flexion of the metacarpophalangeal joint results in flexion of the medial and distal interphalangeal joints. A tab for securing the finger is located on the distal segment. A corresponding design is provided for the thumb. Actuators for motorized repositioning of the splints are located on both the platform and the thumb.

[0007] The object of the present invention is to provide a hand orthosis in which the impaired fingers follow the anatomically predetermined movement pattern of nature, in order to exert the lowest possible stress on the tendons and muscles and to minimize the constraint forces exerted on the body. This object is achieved 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 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 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, is characterized in that the coupling device has two coupling elements which are each pivotably mounted on the carrier and the finger receptacle and in particular pivot the finger receptacle corresponding to the pivoting movement of the coupling elements.The arrangement of the coupling elements, which are designed in particular as connecting rods, multi-part coupling elements with partially rigid and partially elastic components, or elements transmitting compressive and tensile forces with solid-state joints or other joints, forms a coupling mechanism that closely replicates the anatomical grasping trajectory of the human finger. This ensures optimal guidance of the finger within the finger receptacle, so that no or only minimal constraint forces are transmitted from the finger receptacle and the hand orthosis to the hand or fingers. The fingers are fixed to or within the finger receptacle, in particular by being placed on it, inserted, clamped, and / or secured to the finger receptacle with fastening devices. The finger receptacle is designed, for example, as a shell, ring, frame, or support. The corresponding pivoting movement, in which flexion occurs, for example,The fact that the metacarpophalangeal joint also causes flexion around the proximal interphalangeal joint results in a simultaneous pivoting movement of the proximal and medial phalanges when the hand is closed or opened. In one embodiment, this is achieved by intersecting coupling elements, and in an alternative or supplementary embodiment, by movable coupling element mounts. The intersecting arrangement of the coupling elements allows for anatomically correct guidance within a four-joint coupling and a very thin and unobtrusive design, so that the support with the finger receptacle can be positioned between two fingers and / or laterally next to a finger. This makes it possible to treat different indications with the hand orthosis and to enable differentiated grip patterns.The intersecting guide allows the bearing points of the coupling elements to be positioned immobilely on the carrier, while the coupling elements are pivotable about axes that are radially spaced apart from each other. Due to the spacing of the essentially parallel axes resulting from the intersecting guide, the distal bearing points of the coupling elements on the finger receptacle describe different circular paths, so that, with rigid or quasi-rigid coupling elements, the corresponding flexion or extension of the finger receptacle relative to the coupling elements is achieved. In an alternative or supplementary embodiment, at least one coupling element bearing is mounted in a displaceable manner, so that by rotating or shifting at least one coupling element bearing, in particular the one on the carrier, a corresponding coupling of the movement of the finger receptacle with the pivoting of the coupling elements relative to the carrier can be achieved.With a movable or rotatable bearing point, changing the position of the bearing points relative to a starting position causes the finger receptacle to rotate around one of the distal bearing points. This makes it possible to guide the two coupling elements not crossing, but, for example, parallel to each other.

[0009] In one embodiment, the coupling elements are attached to bearing blocks of the beam and / or the finger receptacle. The bearing blocks establish a connection between the coupling elements and the finger receptacle, or between the finger receptacle and the beam. The coupling elements can be mounted on the bearing block(s) via rigid joints and / or rotatably about axes on the bearing blocks. The bearing blocks can be part of the beam or finger receptacle and be formed integrally with them, or they can be manufactured separately and attached to them.

[0010] Multiple finger receptacles can be arranged on opposite sides of the distal support block, allowing the support with the coupling elements to be positioned between two fingers. Even with a coupling device positioned next to a finger, it is possible to secure multiple fingers to the finger receptacle. For example, in an ulnar arrangement, the little finger and ring finger can be secured together. Alternatively or additionally, with a radial arrangement of the coupling device next to the index finger, it is possible to couple the index and middle fingers to the finger receptacle. Similarly, when the coupling device is positioned between two fingers, two fingers can be secured to a single finger receptacle on one side of the coupling device.

[0011] In one embodiment, the coupling elements are arranged between two projections of a bearing block, so that the coupling elements are protected by the projections. This reduces the risk of objects becoming trapped between the intersecting coupling elements.

[0012] The finger support can be designed as a ring, bowl, support surface or brace, for example as a double U-shaped bent frame, so that a 3-point support of a finger is achieved, with which flexion around the corresponding finger joint is blocked or hindered.

[0013] In one configuration, the coupling elements are arranged side by side; alternatively, one coupling element is passed through the other coupling element, resulting in special protection in the area of ​​the intersecting coupling elements.

[0014] In one embodiment, the finger receptacle is coupled to an actuator, which is connected to or attached to the base body, via a force transmission element. The force transmission element can initiate, restrict, modulate, or prevent movement of the finger receptacle. The actuator can be a motor drive, a manual drive, a clamping device, an energy storage device, and / or a damper.

[0015] To prevent relative movement of the finger receptacle to the base body, one embodiment incorporates a locking device on the base body and / or the support, which is coupled to the finger receptacle, the coupling element, or a bearing block via a force transmission element. The locking device provides a clamping or positive locking action, preventing movement in either direction. This allows fingers to be actively and / or passively fixed in specific positions. Preferably, the locking device enables stepless locking, allowing the hand to be held open or closed in any desired position.

[0016] In one embodiment, the locking device allows pivoting in one direction and automatically locks pivoting in the opposite direction. Such a locking device is, for example, a ratchet that can be locked in one direction and has free play in the other. With this design, the patient is able to grasp objects independently, as the ratchet function is used to keep the hand open. In cases without pathological muscle tone increase, such as brachial plexus palsy or when the muscle tone increase is comparatively low, a technical solution must allow not only the hand to be held open but also the object to be grasped and gripped. This is achieved with a bidirectional ratchet. Such a locking device preferably includes a switch that reverses the locking direction.This allows the patient to adjust the direction in which the locking mechanism should engage and the direction in which it should release. However, a locking mechanism that only engages when the hand is closed can also be useful if the hand can be held open without support.

[0017] The locking device is designed in the form of a locking wedge, locking roller, locking slide, ratchet or locking coupling.

[0018] The force transmission element is designed to be flexible and is coupled to a clamping device, such as a spring or an elastomer element, to ensure sufficient force transmission without play. In particular, the force transmission device is rigid in its flexible design to enable precise transmission of tensile forces.

[0019] In one embodiment, the base body, when applied, surrounds the thumb's metacarpophalangeal joint and at least part of the metacarpal. The base body can also be multi-part and include a dimensionally stable, at least partially fingerless orthotic glove to which the support is attached. In one embodiment, the support is attached dorsally to the base body when the hand orthosis is applied. The base body has fastening devices that allow for variable positioning. This ensures that the support is positioned correctly on the patient. The support can be rotatably mounted in the base body and fixed in the correct orientation, for example, using a clamping device. Another embodiment provides for the support to be slidably adjustable and fixed in a specific position, for example, by means of elongated slots on the base body.

[0020] To make it easier to apply the hand orthosis, the base body has an ulnar insertion opening, so that the thumb can be easily inserted into the base body and, if necessary, fixed there.

[0021] At least one of the coupling elements can be spring-mounted or designed to limit force and increase or maintain the clamping effect over a longer period. Furthermore, the spring-mounted design or bearing of the coupling elements, or of a single coupling element, reduces the mechanical stress on the individual components.

[0022] The invention also relates to a carrier with the coupling device and the finger receptacle, as described above, for attachment to a base body in order to form a hand orthosis, in particular a modular hand orthosis.

[0023] Exemplary embodiments of the invention are explained in more detail below with reference to the figures. The same reference numerals denote the same components. For the sake of clarity, not all reference numerals are shown in the figures.

[0024] They show:

[0025] Figure 1 - a fitted hand orthosis; Figure 2 - a detailed view of a support with coupling device;

[0026] Figure 2a - a detailed representation of a locking device;

[0027] Figure 3 - a variant of figure two with finger shots;

[0028] Figure 4 - a variant with solid joints on the coupling elements;

[0029] Figure 5 - a variant with a coupling element passing through it;

[0030] Figure 6 - a variant with a solid body joint and a swivel joint;

[0031] Figure 7 - a design with two supports and a drive;

[0032] Figure 8 - a variant with a radially arranged coupling device;

[0033] Figure 9 - a bottom view of Figure 8;

[0034] Figure 10 - a variant with a locking device;

[0035] Figure 11 - a schematic representation of a switching device;

[0036] Figure 12 - a schematic representation of a bidirectional coupling;

[0037] Figure 13 - a variant with a multi-part base body;

[0038] Figure 14 - a stepless locking device

[0039] Figure 15 - Variants of the coupling device;

[0040] Figure 16 - a variant of the locking device; as well as

[0041] Figure 17 shows another variant of the coupling device. Figure 1 shows a hand orthosis with a base body 10, which in the illustrated embodiment is arranged or formed on a glove 100. The glove 100 can be part of the base body 10, or the base body 10 can be manufactured separately from the glove 100 and either attached to the glove 100 or arranged directly on a hand and attached there. The base body 10 is, for example, designed as a clamp that can be attached to the hand or the glove 100 with a preload force. In one embodiment, the base body 10 is permanently attached to the glove 100, with the clamp-like base body 10 having a radial insertion opening 12.If the base body 10 is assembled or formed together with the glove 100, which is made of a dimensionally stable material and at least restricts or even prevents the mobility of the thumb's metacarpophalangeal joint, the insertion opening is preferably oriented ulnarly. The glove 100 is predominantly fingerless; only the thumb is enclosed within the glove 100.

[0042] The base body 10 is positively fixed to a mid-hand and is made, for example, of a dimensionally stable plastic, a fiber-reinforced composite material, or a metal. A support 20 is arranged on the base body 10 and is advantageously interchangeable. For this purpose, fastening devices such as elongated holes, bores, threads, or other recesses or projections are arranged or formed on the base body 10, with which the support 20 can be fixed and secured in the desired position on the base body 10. In the illustrated embodiment, the base body 10 is arranged radially next to the metacarpophalangeal (MCP) joint of the index finger and forms a bearing block 24 with two pivot axes to which two coupling elements 42, 44 of a coupling device 40 are pivotably attached.The coupling device 40 connects the carrier 20 to a finger receptacle 30, which, in the illustrated embodiment, is guided around the medial phalanges of the index and middle fingers. The finger receptacle 30 is designed as a ring or loop. A bearing block 34 is also arranged or formed on the finger receptacle 30, which also has two pivot axes 36 on which bearing recesses at the distal ends of the coupling elements 42, 44 are pivotably mounted. The two coupling elements 42, 44 are attached to the bearing blocks 34, 24 such that they cross each other. The coupling element 44, which is attached to the carrier 20 at the palmar pivot axis, is arranged at the dorsal attachment point and the dorsal pivot axis 36 on the bearing block 34 of the finger receptacle 20.The second coupling element 42, which is attached to the support 20 on a dorsal pivot axis at the bearing block 24, is fixed to the bearing block 36 of the finger receptacle 30 on the palmar pivot axis 36. This causes the two coupling elements 42, 44 to intersect in the region of the proximal finger joint. The intersecting guidance of the coupling elements 42, 44 results in flexion of the finger around the metacarpophalangeal joint (MCP joint) due to the four-joint coupling, causing the finger to curl overall. This aids in grasping an object.

[0043] The mechanism formed by the coupling elements 42, 44 replicates the anatomical gripping trajectory of the human finger. The kinematics are implemented via conventional rotary joints, with axes formed on the bearing blocks 24, 34, on which the coupling elements 42, 44 of the coupling device 40 are mounted in recesses. Alternatively, bores can be arranged on the bearing blocks 24, 34, and projections or pins can be formed on the coupling elements 42, 44. The coupling elements 42, 44 can also be attached to the bearing blocks 24, 34 via separate axle bolts. Rotary joints with rigid axes offer high stability, allowing for a very slim overall design. This makes it possible to position the support 20 with the coupling device 40 both next to a finger and between two fingers.Alternatively or together with conventional rotary joints, the coupling elements 42, 44 can also be formed or attached to the bearing blocks 24, 34 via solid body joints, which simplifies assembly and may result in greater compliance of the overall system, so that the carrier 20 with the coupling device 40 can adapt more easily to the patient's needs.

[0044] Figure 2 shows the support 20 without the base body. Attachment to the base body can be achieved via the holes within the base body 20 on one side of the base body next to the hand, or via corresponding fastening devices dorsally on the base body. In addition to the coupling device 40 with the two coupling elements 42, 44, which in the illustrated embodiment are designed as struts or rods and are essentially tensile and compression rigid, a force transmission element 70 is additionally arranged on the bearing block 34. In the illustrated embodiment, this force transmission element is designed as a rope, cord, or cable. The force transmission element 70 is essentially flexible and is attached at one end to the support 20, while the other end is fixed to the bearing block 34. The force transmission element 70 is tensioned by a spring as part of a tensioning device 80.The tensioning device 80 includes a spring and a deflection pulley. The force transmission element 70 is guided in or on the support 20 in a guide, above which a locking device 60 in the form of a locking roller is provided. The locking roller is profiled or toothed on its outer surface and is movably mounted on an inclined contact surface above the force transmission element 70. The tensioning device 80 keeps the force transmission element 70 under constant tension. Due to the deflection by the deflection pulleys in the tensioning device 80, the path traveled by the cable is twice as long as the path of the spring, thus saving installation space. The locking device 60 allows one hand to be moved towards extension using the contralateral hand or an assistant; extension movement is always possible.As soon as an external force, symbolized by the upward-pointing arrow, ceases and / or spasticity or increased muscle tone acts in the flexion direction, the locking device 60 clamps the rope, preventing flexion movement. To release the force transmission element 70 for the flexion direction, the locking device 60, or the locking element, locking wedge, locking roller, or the like, must be released from the rope by an external force. This can be achieved by applying force to a pin running through the center of the locking roller, which is guided by a corresponding recess in a housing on the carrier 20 and can be held securely in two positions. In the permanently unlocked state, increased muscle tone can act unhindered, and the hand can be closed, for example, to grasp an object.Alternatively, in the unlocked position, springs acting in the flexion direction can be activated, causing the fingers to be flexed due to the spring force. Depending on the medical indication, the device can also be designed so that flexion is free and extension can be blocked. Figure 2a shows an enlarged version of the locking device 60. Here, too, a toothed locking roller is mounted in a guide within a housing. When the force transmission element 70 is pulled to the right, the locking roller or the locking device 60 is moved along the downwardly inclined contact surface and pressed onto the force transmission element 70. This prevents further movement of the force transmission element 70 to the right. Conversely, when the force transmission element 70 is moved to the left, the locking device 60 is released, allowing movement in this direction at all times.Depending on the orientation of the inclined contact surface or via a corresponding switching device, it is possible to select the direction of movement of the force transmission element 70 that is blocked. For a hand orthosis, it is thus possible to either block or always allow flexion or extension. In order to grasp various objects in everyday life, the necessary gripping force must be applied. Patients with brachial plexus palsy are often no longer able to do this, which is why the hand orthosis is designed to provide not only correct finger movement but also holding force or positioning. The desired movement can be achieved via energy storage devices or actuators, and the finger position can be maintained in the desired position by the locking device or by spring force.In patients with increased muscle tone, it is often necessary to first open the hand and hold it open in order to then position an object between the fingers or between the fingers and thumb. In certain cases, grasping can be achieved by simply releasing the fingers, as the increased muscle tone provides the necessary gripping force.

[0045] It is advantageous to have a switchable freewheel or a switchable locking device 60 that allows free movement in one direction and locking in the other, but can be freely switched as desired. In the case of plexus palsy, the flexion direction would be free to close the hand with the contralateral hand, while the extension direction is locked to maintain grip strength and the previously grasped object. In the case of a stroke patient with a relatively strong increase in tone in the flexion direction, which is usually the case, the switchable locking device 60 preferably operates in the opposite way. To open the flexed fingers, they are extended with the contralateral hand. The extension direction is not locked by the locking device 60. The flexion direction, however, is locked by default to keep the fingers open.

[0046] Figure 3 shows a variant of the carrier 20 with the coupling device 40 and the finger receptacle 30. The finger receptacle 30 has two rings formed on the bearing block 34, into which the respective fingers are inserted. The two ring-shaped finger receptacles 30 are attached to opposite sides of the bearing block 34 or are integrally formed with it. The bearing block 34 has two proximally oriented projections 342, 344, between which a space is formed in which the two coupling elements 42, 44 are inserted and pivotally mounted, intersecting each other. By arranging the two coupling elements 42, 44 directly next to each other and between the two projections 342, 344, maximum protection against the pinching of objects or skin between the two moving coupling elements 42, 44 is achieved.Here too, the coupling device 40 provides a 4-joint gear arrangement, which, in the case of flexion at the metacarpophalangeal joint, causes flexion at the proximal interphalangeal joint (PIP). The bearing is implemented via conventional swivel joints on axles or bolts.

[0047] Figure 4 shows the same basic structure as Figures 2 and 3; however, the support 20 and the coupling device 40 are formed integrally, and the coupling elements 42 and 44 are attached to the support 20 via solid hinges or film hinges. In the illustrated embodiment, the coupling element 42, which is arranged palmar to the support, extends through the other coupling element 44 and is located on the dorsal side of the bearing block 34, in particular integrally formed therein or attached in another manner. Solid hinges are also formed there, which simplifies manufacturing and results in increased compliance in both the abduction and adduction directions.

[0048] Figure 5 shows a variant of the design according to Figure 4 with the two

[0049] Coupling elements 42, 44 are guided in a crossing manner, with the coupling element 42, which is attached dorsally to the support 20, passing through the coupling element 44, which is attached palmarly to the support 20. This configuration reliably prevents pinching between the two crossing coupling elements 42, 44. The connection of the coupling elements 42, 44 of the coupling device 40 to the support 20 and the bearing block 34 is also achieved here via rigid joints; alternative configurations are possible. The force transmission element 70 is attached to the palmar end of the bearing block 34 and can be coupled to an actuator (not shown) or a locking device.

[0050] Figure 6 shows hybrid configurations for the mounting of the coupling elements 42 and 44 on the support 20 and the bearing block 34, respectively. While the palmar mounting of the coupling element 42 on the support side is designed as a solid-state joint, the dorsal mounting of the coupling element 44 is designed as a conventional pivot joint with pins and pin receptacles. The bearing block 34 is formed integrally with the two finger receptacles 30. This allows the advantages of both joint designs to be combined: increased torsional stiffness is achieved through the use of conventional pivot joints with a stable connecting rod, while adaptability and adjustability are achieved through the connection via solid-state joints.

[0051] Figure 7 shows an embodiment of the hand orthosis with the base body, two supports mounted dorsally on it, and two finger receptacles 30, each arranged on the support 20 via a corresponding coupling device 40. This holds a total of four fingers in the finger receptacles 30. The finger receptacles 30 are connected via force transmission elements 70, which are guided in the supports 20, to a drive 50, which is arranged proximal to the supports 20 either on the base body 10 or on a proximal extension. The respective supports 20 are arranged between two fingers: one between the little finger and the ring finger, and the other between the index and middle finger. The actuator 50 extends or flexes the support blocks or finger receptacles 30, depending on their arrangement and design on the support block or finger receptacle 30.Figure 8 is a variant of Figure 7, in which the support 70 is arranged radially next to an index finger, and the finger receptacle 30 encompasses two fingers: the index and middle fingers. The little and ring fingers are housed in a sleeve 350 and fixed to the base body 10. The force transmission elements 70 enable flexion and extension, as two force transmission elements 70 are attached to the bearing block or the finger receptacle 30. The corresponding movements can be initiated or assisted by reversing the movement of the drive 50. The sleeve 300 can be detachably attached to the base body 10. In particular, the sleeve 300 is designed as a separate component of the hand orthosis and can facilitate putting on the hand orthosis, as the fingers held within it remain extended and do not obstruct the application of the hand orthosis.

[0052] Figure 9 shows a bottom view of an embodiment according to Figure 8. The hand orthosis, with the base body 10 and the glove 100 attached to it, encompasses the metacarpus and the thumb. Radially to the index finger, the support 20 is arranged with the coupling device 40, the bearing block 34, and the finger receptacle 30, which is designed as a brace. The sleeve 300 is designed as a so-called hemifinger glove and can be attached to the glove 100 by means of fastening devices 310. The attachment on the dorsal side of the glove 100 is also achieved by fastening elements, for example, hook-and-loop fasteners.

[0053] Figure 10 shows a variant of the carrier 20 with a different integrated locking device 60. The locking device 60 has a slide that is guided within the carrier 20 and on which a double-tooth switch is slidably mounted. The double-tooth switch engages either at the top or bottom in a corresponding toothed section, so that a pivoting movement of the bearing block 34 is blocked in one direction or the other via the rigid force transmission element 70. In the upper view of Figure 11, which shows the locking device 60 in detail, the double-tooth switch is engaged with the upper toothed section in the carrier 20 and blocks an extension movement by blocking the movement of the slide in the proximal direction.In the lower view of Figure 11, the double-tooth switch is engaged with the lower row of teeth, allowing a displacement movement in the proximal direction to the left. The lower row of teeth is thus designed to lock in a flexion direction, while extension movement can always be performed freely. The upper row of teeth is oriented in the opposite direction, so that extension is blocked and flexion is always allowed. When the double-tooth switch is in a middle position, movement is possible in both the flexion and extension directions at any time. The double-tooth switch is actuated, for example, by a pin projecting laterally from the carrier 20.

[0054] Figure 12 shows different positions: the maximally expanded position in the upper left illustration and the maximally flexed position in the upper right illustration. The four lower illustrations show different positions of the double-tooth switch and the movements possible with them. In the first position, the double-tooth switch is spring-loaded in an upper position, in which the teeth are oriented to allow forward or rightward movement. This enables flexion of the finger receptacle 30. The spring holds the double-tooth switch out of engagement with the lower teeth. When a flexion movement is performed, the double-tooth switch tilts about a pivot axis against a spring force and slides to the next position in the teeth. Extension remains blocked in this position.In the final position 5, shown in the lower right illustration, the slider is positioned maximally distally and the double-tooth switch is in its final gear engagement position. To reverse this, the double-tooth switch must be moved downwards and engaged with the lower tooth row, or completely moved into a release position.

[0055] Figure 13 shows an embodiment of the hand orthosis with a dimensionally stable glove 100, a base body 10 mounted dorsally on it, and supports 20 attached or formed dorsally on the base body 10. The supports 20 have a locking device 60 corresponding to the embodiment shown in Figure 2, and the force transmission element 70 is connected to the bearing block 34, to which the finger receptacles are attached on both sides. Flexion is effectively prevented by the locking device 60, while extension can occur at any time. Figure 14 shows another variant of the locking device in which the force transmission element 70 is designed as a spring steel band. The locking device 60, in the form of a locking ball or locking roller, is arranged in a housing with an inclined contact surface 65 and rests on the force transmission element 70.A movement of the power transmission element 70 to the right causes the locking ball or roller to move to the right and be displaced against the contact surface 65. The angled contact surface clamps the power transmission element 70. Movement to the right is blocked, while movement to the left is always free. In the lower illustration, a release element 75 is coupled to a slide for unlocking the locking device 60. This slide allows the locking ball or roller to be moved from the locked position to a release position. This slide switch makes it possible to keep the locking device 60 permanently in the release position, thus allowing movement in both directions. This design allows for stepless locking of the movement of the power transmission element 70 in one direction only.The concept can be designed to be either rotational or translational. This results in a continuous locking mechanism and allows for the finger grips to be fixed in any desired position.

[0056] Figure 15 shows two variants of a coupling device 40 with attached finger receptacles 30. One of the two coupling elements 44 is L-shaped, while the other coupling element 42 is a straight connecting rod that crosses one of the legs of the other coupling element 44. The upward-facing leg 440 has a slot or recess, making it flexible and elastic and able to provide an elastic restoring force. The finger receptacle 30 moves downward when the finger, together with the L-shaped coupling element 44, is moved via an actuator (not shown) to grasp an object. As the leg 440 is moved further forward in the direction of the arrow, the gap within it widens.The leg 440 acts like a bending spring, limiting the clamping force on the object and maintaining it even over a return range during a reversal of movement. This results in an increasing clamping force when the coupling device 40 is actuated by an actuator, while simultaneously providing force limitation and storage. The spring action of the leg 440 protects the actuator (not shown) as well as the other components of the coupling device 40 and the finger receptacle 30.

[0057] A variant of a spring-loaded design is shown in the right-hand illustration of Figure 15. Here, too, one coupling element 44 is designed as an L-shaped component, while the other coupling element 42 is designed as a spring arranged in a cross shape with the horizontal leg of the coupling element 44. Both coupling elements 42 and 44 are coupled to the finger receptacle 30. The second coupling element 44, designed as a tension spring, is straight and relatively rigid, so that without a counterforce, for example from a clamped object, it acts like a rigid rod. When an object is grasped or wrapped by the finger and the upward-pointing leg of the first coupling element 42 is moved further forward, as shown in the bottom right-hand illustration of Figure 15, the second coupling element 44, or rather the spring, is stretched and tensioned because the distal finger joint tilts.This results in a force limitation and simultaneously exerts a flexion force on the gripped object. Upon reverse movement of the L-shaped coupling element 42, the spring is first released and the second coupling element 44 is moved back to its original starting length, as shown in the upper right figure.

[0058] Figure 16 shows a variant of the locking device 60 that acts on the power transmission element 70. The locking element 60 can be moved into two different locking positions, as shown in the two upper illustrations. In the upper left illustration, the locking element 60 is in a position that allows movement of the power transmission element 70 to the right, but prevents movement in the opposite direction, to the left. If the locking element 60 is pivoted into the other position, shown in the upper right illustration, the opposite locking effect is present. The power transmission element 70 cannot be moved to the right, but movement to the left is always possible. The positioning of the locking device 60 is shown in the lower illustration of Figure 16.The basic structure, comprising the carrier 20, the coupling device 40 with coupling elements 44 and 42, and the finger receptacle 30, essentially corresponds to that shown in Figures 3, 5, 10, or 12. The locking device 60 is located in the proximal region of the carrier 20 and blocks the force transmission element 70, which, in the area of ​​the locking device 60, can be designed, for example, as a rod or tube. The locking element 60 is designed as a bidirectionally switchable lock, with a through-opening in a disk for the force transmission element 70. Different positioning of the locking element 60 results in a blocking action in one direction or the other. To reinforce the locking effect, a series of recesses, similar to toothing, can be arranged in the force transmission element 60 to achieve not only clamping but also positive locking.With a smooth surface, the force transmission element 60 can be continuously adjusted and fixed in the desired position. If the locking element 60 is in a vertical position between the two extreme positions shown, the force transmission element 70 can move freely in both directions.

[0059] Figure 17 shows another variant of the coupling device 40, in which the coupling elements 42, 44 are guided essentially parallel to each other with axes of rotation spaced apart from each other, without the coupling elements 44, 42 crossing each other. The palmar coupling element 44 has two palmar coupling element bearings, the first 444 on the carrier, the second on the finger receptacle 30. Similarly, the dorsal coupling element 42 has two coupling element bearings dorsally on the carrier and the finger element 30. The coupling element bearings of the individual coupling elements 42, 44 are spaced apart from each other in the dorsal-palmar direction. In the illustrated embodiment, the palmar, proximal coupling element bearing 444 is slidably mounted on the carrier (not shown) and can be moved by an actuator (not shown). The direction of movement is indicated by the arrow.In the upper left of Figure 17, the finger receptacle 30, or the middle finger segment, is in contact with an object. When the actuator is moved in the direction of the arrow, the palmar, proximal coupling element bearing 444 shifts proximally, causing the finger receptacle 30 to pivot about its distal, dorsal bearing point. Simultaneously, the entire coupling assembly 40, including the finger receptacle 30, pivots about its dorsal, proximal coupling element bearing, resulting in a closing hand movement corresponding to the natural closing motion of a hand. The grasped object is displaced.

[0060] In the right-hand illustration of Figure 17, the two different positions are shown without a grasped object. Due to the displacement of the proximal, palmar coupling element bearing 444 without a significant resistance force, no moment arises about the dorsal proximal coupling element bearing. Therefore, the middle finger segment or finger receptacle 30 pivots primarily about the distal, dorsal bearing point, while the dorsal coupling element 42 remains essentially unchanged. Depending on the direction of the force and the displacement of the proximal, palmar bearing point, a correspondingly altered movement pattern results, with different preferred movement sequences.Both proximal bearing points of the coupling elements 42, 44 can also be designed to be displaceable, resulting in different rotation angles depending on the various pivoting movements and allowing correspondingly different degrees of flexion of the finger receptacle 30 to be set in relation to the pivoting of the coupling device 40 relative to the carrier.

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 joint, 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 two coupling elements (42, 44) which are each pivotably mounted on the carrier (20) and the finger receptacle (30).

2. Hand orthosis according to claim 1, characterized in that the coupling elements (42, 44) are attached to bearing blocks (24, 34) of the carrier (20) and / or the finger receptacle (30).

3. Hand orthosis according to claim 2, characterized in that two finger receptacles (30) are arranged on opposite sides of the bearing block (34).

4. Hand orthosis according to one of claims 2 or 3, characterized in that the coupling elements (42, 44) are arranged between two projections (342, 344) of the bearing block (24, 34).

5. Hand orthosis according to one of the preceding claims, characterized in that the finger receptacle (30) is designed as a ring, cup, support surface or brace.

6. Hand orthosis according to one of the preceding claims, characterized in that the coupling elements (42, 44) are arranged side by side. are or a coupling element (42) is passed through the other coupling element (44).

7. 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 force transmission element (70).

8. Hand orthosis according to one of the preceding claims, characterized in that a locking device (60) is arranged on the base body (10) and / or support (20), which is coupled to a force transmission element (70) with the finger receptacle (30), the coupling element (42, 44) or a bearing block (24, 34).

9. Hand orthosis according to claim 8, characterized in that the locking device (60) allows pivoting movement in one direction and automatically locks in the opposite direction.

10. Hand orthosis according to claim 8 or 9, characterized in that a changeover switch (66) is associated with the locking device (60) which changes the locking direction.

11. Hand orthosis according to one of claims 8 to 10, characterized in that the locking device (60) is designed as a locking wedge, locking roller, locking slide, ratchet or locking coupling.

12. Hand orthosis according to one of claims 7 to 11, characterized in that the force transmission element (70) is designed to be flexible and is coupled to a clamping device (80).

13. 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 metacarpal bone when applied.

14. 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.

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

16. Hand orthosis according to one of the preceding claims, characterized in that the coupling elements (42, 44) are guided in a crossing manner and / or at least one coupling element bearing (444) is displaceably mounted (42, 44).

17. Hand orthosis according to one of the preceding claims, characterized in that at least one of the coupling elements (42, 44) is resiliently mounted or designed.

18. 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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