DE4229330A1 - Limb function restoration using somatronic device - has microchip which responds to detected movement of sound limb to provide signals for stimulating impaired limb - Google Patents
Limb function restoration using somatronic device - has microchip which responds to detected movement of sound limb to provide signals for stimulating impaired limbInfo
- Publication number
- DE4229330A1 DE4229330A1 DE19924229330 DE4229330A DE4229330A1 DE 4229330 A1 DE4229330 A1 DE 4229330A1 DE 19924229330 DE19924229330 DE 19924229330 DE 4229330 A DE4229330 A DE 4229330A DE 4229330 A1 DE4229330 A1 DE 4229330A1
- Authority
- DE
- Germany
- Prior art keywords
- limb
- muscles
- microchip
- somatronics
- somatronic
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Ceased
Links
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/36003—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation of motor muscles, e.g. for walking assistance
Abstract
Description
Die Anmeldung betrifft die Wiederherstellung der Funktion eines gelähmten Körpers mit Hilfe einer Elektronik (Mikrochip) nach dem Oberbegriff des Anspruches 1.The application concerns the restoration of the function of a paralyzed body Using electronics (microchip) according to the preamble of claim 1.
Wird eine erregbare Zelle, also eine Nerven- oder Muskelzelle, gereizt, ändern sich an ihrer Membran die Ionenleitfähigkeit und das Potential. Ist der Reiz stark genug, kommt es zu einem sog. Aktionspotential (AF), das im Nerv das weitergeleitete Signal darstellt und am Muskel zur Kontraktion führt. Beim AP spielen sich folgende Vorgänge ab: Durch den Reiz wird das (negative) Ruhemembranpotential (-90 mV) in Richtung 0 mV verringert (Depolari sation), wobei bald ein kritischer Wert, das sog. Schwellerpotential, erreicht wird. Wird diese Schwelle überschritten, werden Natrium-Kanäle aktiviert, d. h. es kommt zu einem kurzzeitigen Anstieg der Natrium-Leitfähigkeit. Dadurch bricht das Membranpotential sehr rasch zusammen (Depolarisationsphase des AP) und erreicht vorübergehend sogar positive Werte (engl.: Overshoot). Die Natrium-Leitfähigkeit sinkt schon vor Erreichen des Over shoots wieder (Inaktivation beginnt nach <0,1 ms), und gleichzeitig steigt die Kalium-Leitfähig keit relativ langsam an, was zum Wiederaufbau des Ruhemembranpotentials (Repolarisations phase) beiträgt. Wegen der noch anhaltenden Erhöhung der Kalium-Leitfähigkeit kann es anschließend zu einer Hyperpolarisation kommen.If an excitable cell, i.e. a nerve or muscle cell, is stimulated, it changes on it Membrane the ionic conductivity and the potential. If the stimulus is strong enough, it happens a so-called action potential (AF), which represents the transmitted signal in the nerve and on Muscle leads to contraction. The following processes take place in AP: Through the stimulus the (negative) resting membrane potential (-90 mV) is reduced towards 0 mV (Depolari sation), whereby a critical value, the so-called sill potential, will soon be reached. Becomes exceeding this threshold, sodium channels are activated, i. H. it comes to one short-term increase in sodium conductivity. This breaks the membrane potential very much quickly together (depolarization phase of the AP) and temporarily even positive Values (overshoot). The sodium conductivity drops before reaching the over shoots again (inactivation starts after <0.1 ms), and at the same time the potassium conductivity increases relatively slowly, which leads to the reconstruction of the resting membrane potential (repolarizations phase). Because of the ongoing increase in potassium conductivity, it may hyperpolarization then occurs.
(Silbernagl/Despopoulos, Taschenatlas der Physiologie, 3. überarbeitete und erweiterte Auflage, S.26).(Silbernagl / Despopoulos, pocket atlas of physiology, 3rd revised and expanded Edition, p.26).
Bei einem Schlaganfall (Apoplexia cerebri, apoplektischer Insult) wird die Steuerung motori scher und sensibler Funktionen beeinträchtigt, was sich in verschieden starken Symptomen äußern kann: von einer sehr geringen Symptomatik bis hin zu einem Totalausfall. Ursachen eines Schlaganfalls können erstens Hirninfarkte infolge arterieller Durchblutungsstörungen des Gehirns durch Arteriosklerose, Thrombose oder Thromboembolie sein (vor allem betroffen: Arteria cerebri media). Eine zweite Ursache liegt in Massenblutungen innerhalb des Gehirns nach Riß eines Blutgefäßes im Gehirn aufgrund von Bluthochdruck oder Arteriosklerose. Der Altersgipfel des Schlaganfalls liegt im 50. bis 60. Lebensjahr, Frauen und Männer sind gleich häufig betroffen.In the event of a stroke (apoplexia cerebri, apoplectic insult), the control becomes motori shear and sensitive functions impaired, which manifests itself in symptoms of different strength can express: from a very low level of symptoms to a total failure. causes First of all, a stroke can result from a stroke due to arterial circulatory disorders of the Brain atherosclerosis, thrombosis or thromboembolism (especially affected: Cerebral artery). A second cause is mass bleeding within the brain after a ruptured blood vessel in the brain due to high blood pressure or arteriosclerosis. Of the The peak age of the stroke is in the 50th to 60th year of life, women and men are the same often affected.
Die Therapie des Schlaganfalls umfaßt heute eine nur symptomatische Behandlung: vor allem Überwachung von Atmung und Kreislauf, gegebenenfalls Behandlung eines Hirnödems, frühzeitig Krankengymnastik und evtl. neurochirurgische Therapie. (Pschyrembel, de Gruyter-Verlag, 256. Auflage, S.105)Stroke therapy today includes symptomatic treatment only: above all Monitoring of breathing and circulation, treatment of cerebral edema if necessary, early physiotherapy and possibly neurosurgical therapy. (Pschyrembel, de Gruyter-Verlag, 256th edition, p.105)
Bei leichten Schlaganfällen kann durch die o. g. Therapien der ursprüngliche, gesunde Zustand wieder hergestellt werden, in schweren Fällen ist eine 100%ige Wiederherstellung dieses Zustandes jedoch nicht möglich, so daß der Patient für den Rest seines Lebens an einen Krückstock oder sogar Rollstuhl gebunden ist.In the case of mild strokes, the above-mentioned. Therapies the original, healthy state to be restored, in severe cases this is a 100% recovery However, the condition is not possible, so that the patient is in one for the rest of his life Crutch stick or even wheelchair is bound.
Bekannt ist die Verwendung des sogenannten "Reizstroms", der z. B. nach Operationen eingesetzt wird, um lange nicht bewegte Muskeln wieder zu aktivieren. Solche Reizstromge räte sind in verschiedenen Variationen beim Deutschen Patentamt angemeldet, so z. B. die folgenden:It is known to use the so-called "stimulation current" which, for. B. after operations is used to reactivate muscles that have not been moved for a long time. Such stimulus current Councils are registered in various variations with the German Patent Office. B. the following:
DE 19 47 10 C3 Implantiertes Reizstromgerät für elektromedizinische Zwecke mit
mindestens zwei Batterien
(DE) 22 36 434.7-33 Implantiertes elektromedizinisches Reizstromgerät
DT 23 46 223 Implantiertes Nervenreizgerät
(Offenlegungsschrift)
DE 38 12 478 A1 Reizstromgenerator mit mehreren Reizkanälen zur Erzeugung von
Reizpulsen für elektrische Stimulation der Nerven und Muskeln
DE 40 00 893 A1 Mehrkanaliges Gerät zur Elektrostimulation
AZ 29 03 392.9-33 Reizstromgerät
(Offenlegungsschrift)
AZ 29 14 546.8 Verfahren und Gerät zum Stimulieren von Nervenbahnen im
menschlichen Körper
DE 36 37 800 A1 Reizstromgerät
DE 33 44 831 C2 Mehrkanaliges Reizstromgerät
DE 27 03 628 C2 Wiederaufladbares, implantiertes Reizimpulsgerät.DE 19 47 10 C3 Implanted electrical stimulation device for electromedical purposes with at least two batteries
(DE) 22 36 434.7-33 Implanted electromedical stimulation current device
DT 23 46 223 Implanted nerve stimulator (laid-open specification)
DE 38 12 478 A1 stimulation current generator with several stimulation channels for generating stimulation pulses for electrical stimulation of the nerves and muscles
DE 40 00 893 A1 Multi-channel device for electrical stimulation
AZ 29 03 392.9-33 stimulation current device (laid-open specification)
AZ 29 14 546.8 Method and device for stimulating nerve pathways in the human body
DE 36 37 800 A1 stimulation current device
DE 33 44 831 C2 Multi-channel stimulation current device
DE 27 03 628 C2 Rechargeable, implanted stimulation pulse device.
Desweiteren sind auch schon Mikrochip-gesteuerte Geräte bekannt, die am Körper des
Patienten verschiedene Aufgaben mit verschiedenen Zielsetzungen wahrnehmen:
EPA 0 001 156 A1 Programmable, implantable body function controller and method for
reprogramming said apparatus
DE 28 03 366 C2 Programmierbarer elektrischer Stimulator für menschliches Gewebe.Furthermore, microchip-controlled devices are already known which perform various tasks on the patient's body with different objectives: EPA 0 001 156 A1 Programmable, implantable body function controller and method for reprogramming said apparatus
DE 28 03 366 C2 Programmable electrical stimulator for human tissue.
Das letztgenannte Gerät kommt der hier angeführten Erfindung noch am nächsten, doch liegt der entscheidende Unterschied darin, daß die Elektronik in diesen Fällen nicht dazu da ist, die Aktivität der Muskulatur der gesunden Seite des Körpers zu erfassen und dann entsprechende Impulse an die Muskulatur der gelähmten Seite abzugeben, damit diese wieder so voll funktionsfähig wird wie vor dem Schlaganfall.The latter device comes closest to the invention mentioned here, however The key difference is that the electronics do not do this in these cases there is to grasp the activity of the muscles of the healthy side of the body and then to give appropriate impulses to the muscles of the paralyzed side, so that these becomes as fully functional again as before the stroke.
Die folgenden Erfindungen sind eventuell benötigte "Zusatzgeräte":
DE 35 14 210 C1 Paßteil zur elektrischen Behandlung von Körperteilen ("Fußsack"!)
GM 77 03 530 (U1) Ummantelung für einen implantablen Impulsgenerator
(Gebrauchsmuster)
GM 69 109 970.6 Tragbare Vorrichtung zu EMG-getriggerter Muskelstimulation von
zentral gelähmten Muskeln:
EPA 84 901 434.5 Therapeutic method and therapeutic means using sheetlike battery
(Background: The present invention relates to therapeutic methode
and therapeutic means for curing an affected part by applying a vol
tage to the human body).
The following inventions are "additional devices" that may be required:
DE 35 14 210 C1 fitting part for electrical treatment of body parts ("footmuff"!)
GM 77 03 530 (U1) sheathing for an implantable pulse generator (utility model)
GM 69 109 970.6 Portable device for EMG-triggered muscle stimulation of centrally paralyzed muscles:
EPA 84 901 434.5 Therapeutic method and therapeutic means using sheetlike battery (Background: The present invention relates to therapeutic method and therapeutic means for curing an affected part by applying a vol day to the human body).
Die Erfindung bezieht sich zunächst auf den Einsatz der Somatronik beim Schlaganfall.The invention first relates to the use of somatronics in stroke.
Der Begriff der "Somatronik" beinhaltet die Kombination von Körper (griechisch: σωµα=soma) und Elektronik. Dabei kann die Elektronik zur Unterstützung oder zur voll ständigen Wiederherstellung ausgefallener körperlicher Funktionsabläufe eingesetzt werden. Einsatzmöglichkeiten der Somatronik ergeben sich vorzugsweise auf dem Gebiet des Schlag anfalls und der (Arm-oder Bein-) Amputation.The term "somatronics" includes the combination of body (Greek: σωµα = soma) and electronics. The electronics can support or to full constant restoration of failed physical functions. Somatronics are preferably used in the field of field seizure and (arm or leg) amputation.
Die erfindungsgemäße Lösung wird an Hand der Abbildungen A, B und C (s. Anlage) be schrieben.The solution according to the invention is shown in Figures A, B and C (see Appendix) wrote.
- A) Die Erfindung besteht aus dem Einsatz einer Elektronik (=Somatronik) 1, die aufgrund der Messung der Aktivität einzelner Muskelgruppen der nicht gelähmten, gesunden Seite 2 des Körpers die Muskulatur der gelähmten Seite 3 wieder aktiviert. Da beim Schlaganfall die zentrale Steuerung ausfällt, die Nerven und die Muskeln selbst aber nicht funktionsunfähig sind, kann eine "abhängige" Elektronik die Aufgabe der Steuerung übernehmen. "Abhängig", insofern, als daß Sensoren 4 auf der Musku latur der gesunden Seite 2 Impulse über eine elektrische Leitung an die Elektronik übermitteln 5, die daraufhin die Bewegung selbst (z. B. "Gehen", "Laufen", usw.) und die Intensität sowie die Geschwindigkeit dieser Bewegung erkennt und dementspre chend Impulse auf die Nerven einzelner Muskeln und deren Anteile der gelähmten Seite 3 wiederum über Leitungen weitergibt 6. Es ergibt sich daraus eine koordinierte, von der Bewegung der gesunden Seite 2 abhängige Bewegung der gelähmten Seite 3, so daß z. B. bei elektronischer Erfassung des Befehls "Gehen" durch entsprechende Bewegung des gesunden Beins 2 die Elektronik exakt gesteuerte Impulse an die korre spondierenden Muskeln 7 des kranken Beins 3 überträgt, so daß auch diese die entsprechende Bewegung "Gehen" ausführen. Ebenso wird der Befehl "Setzen" von der Elektronik erfaßt, so daß die gelähmte Seite durch die Elektronik veranlaßt wird, die Bewegung "Setzen" auszuführen. Dies sind nur zwei Beispiele, doch kann aufgrund der geschickten Programmierung der Elektronik jegliche Bewegung ausgeführt werden.A) The invention consists of the use of electronics (= somatronics) 1 , which reactivates the muscles of the paralyzed side 3 again on the basis of the measurement of the activity of individual muscle groups on the non-paralyzed, healthy side 2 of the body. Since the central control fails in the case of a stroke, but the nerves and muscles themselves are not unable to function, "dependent" electronics can take over the control function. "Dependent" insofar as sensors 4 on the muscles of the healthy side transmit 2 impulses via an electrical line to the electronics 5 , which then trigger the movement itself (eg "walking", "running", etc.) and recognizes the intensity and the speed of this movement and accordingly transmits impulses to the nerves of individual muscles and their portions of the paralyzed side 3 via cables 6 . This results in a coordinated, dependent on the movement of the healthy side 2 movement of the paralyzed side 3 , so that, for. B. with electronic detection of the command "walking" by appropriate movement of the healthy leg 2, the electronics transmits precisely controlled pulses to the correct sponding muscles 7 of the sick leg 3 , so that they also perform the corresponding movement "walking". Likewise, the command "set" is detected by the electronics, so that the paralyzed side is caused by the electronics to carry out the "set" movement. These are just two examples, but due to the skillful programming of the electronics, any movement can be carried out.
Operativ werden dem Patienten das gelähmte sowie das gesunde Bein geöffnet, so daß die Muskelanteile gut zugänglich sind. Die Sensoren, die die Bewegungen des gesunden Beins erfassen, werden auf die einzelnen Muskeln aufgebracht. Die Lei tungen, die die Informationen übermitteln, werden durch das Becken zur gelähmten Seite verlegt. Dort sitzt, wie ein Herzschrittmacher, im Unterhautfettgewebe die Somatronik, zu der die Leitungen gelangen. Von der Somatronik führen Leitungen weg, die an den Nerven der einzelnen Muskelanteile enden und dort über Kontaktflä chen Strom(stöße) abgeben und damit die Nerven erregen, was nach dem oben be schriebenen physiologischen Prinzip der Signalübertragung erfolgt. Entsprechend werden auch weitere Körperfunktionen erfindungsgemäß ausgeführt.The paralyzed and healthy leg are opened to the patient surgically, so that the muscle parts are easily accessible. The sensors that track the movements of the healthy legs are applied to the individual muscles. The lei The information transmitted through the pool becomes paralyzed Page misplaced. There, like a pacemaker, sits in the subcutaneous fat Somatronics to which the lines arrive. Cables lead from the Somatronik away, which end at the nerves of the individual muscle parts and there via contact surface emit current (shocks) and thus excite the nerves, which is after the above written physiological principle of signal transmission takes place. Accordingly, other bodily functions are also carried out according to the invention.
- B) Ein einfacherer Lösungsweg - eventuell als Entwicklungsvorstufe für den gerade beschriebenen - ist die direkte Steuerung durch den Patienten. Der Unterschied zu der o.g. Lösung besteht darin, daß die Leitimpulse nicht durch Erfassen der Bewegung durch Sensoren über der Muskulatur der gesunden Seite 1 des Körpers, sondern durch Eingabe eines direkten Befehls 2 (z. B. "Bein heben") seitens des Patienten in die Elektronik 3 durch Drücken des entsprechenden Knopfes 4 der Schaltung der Elektronik umgesetzt werden und dadurch die Handlung ("Bein heben") von dem ge lähmten Bein ausgeführt wird.B) A simpler solution - possibly as a preliminary development for the one just described - is direct control by the patient. The difference to the above-mentioned solution is that the guiding impulses are not given by the movement of sensors by sensing the movement over the muscles of the healthy side 1 of the body, but by entering a direct command 2 (e.g. "lift leg") the electronics 3 are implemented by pressing the corresponding button 4 of the circuit of the electronics and thereby the action ("leg lifting") is carried out by the paralyzed leg.
- C) Ein weiterer Einsatz der Somatronik ergibt sich bei dem Ersatz eines amputierten Beins durch eine mit Motoren ausgestattete Prothese.C) Another use of Somatronik results from the replacement of an amputee Legs through a prosthesis equipped with motors.
Das Prinzip entspricht genau dem der Somatronik beim Schlaganfall, wobei sowohl die Lösungsmöglichkeit nach dem Prinzip von A, als auch nach dem von B möglich ist. Der Unterschied besteht darin, daß die von der Elektronik 1 erfaßten Bewegungen des vorhandenen Beins 2 auf eine mit Motoren ausgestattete Prothese 3 übertragen werden, so daß diese die entsprechende Bewegung ausführt.The principle corresponds exactly to that of somatronics in the case of a stroke, with the possibility of solving both the principle of A and that of B being possible. The difference is that the movements of the existing leg 2 detected by the electronics 1 are transmitted to a prosthesis 3 equipped with motors, so that this carries out the corresponding movement.
Operativ wird dem Patienten das gesunde Bein geöffnet, so daß die Muskelanteile gut zugänglich sind. Die Sensoren, die die Bewegungen des gesunden Beins erfassen, werden auf die einzelnen Muskeln aufgebracht. Die Leitungen, die die Informationen übermitteln, werden durch das Becken zur gelähmten Seite verlegt. Eventuell braucht man gar nicht das Bein zu öffnen, falls es möglich ist, die Aktivität der Muskeln auch über der Haut abzuleiten und dann die Leitungen sowie den Mikrochip entsprechend auf der Haut zu verlegen. Von der Somatronik führen andere elektrische Leitungen weg, die an den Motoren der Prothese enden, die dann die entsprechende Bewegung derselben ausführen. The patient's healthy leg is surgically opened so that the muscle components are good are accessible. The sensors that detect the movements of the healthy leg are applied to the individual muscles. The lines that carry the information transmit, are moved through the pelvis to the paralyzed side. Possibly needs one does not open the leg at all, if it is possible, the activity of the muscles too above the skin and then the lines and the microchip accordingly laying on the skin. Other electrical cables lead from Somatronik away, which end on the motors of the prosthesis, which then the corresponding movement execute the same.
Durch den Einsatz der Somatronik wird es vielen Patienten ermöglicht, nach einem Schlaganfall bzw. einer Amputation mit Ersatz durch eine Prothese wieder ein weitge hend normales Leben zu führen, was sicherlich eine große Erleichterung sein wird.The use of Somatronik makes it possible for many patients to have one Stroke or amputation with replacement by a prosthesis living normal life, which will surely be a great relief.
Claims (6)
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DE19924229330 DE4229330A1 (en) | 1992-09-02 | 1992-09-02 | Limb function restoration using somatronic device - has microchip which responds to detected movement of sound limb to provide signals for stimulating impaired limb |
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DE19924229330 DE4229330A1 (en) | 1992-09-02 | 1992-09-02 | Limb function restoration using somatronic device - has microchip which responds to detected movement of sound limb to provide signals for stimulating impaired limb |
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