DE102016121201B4 - Orthosis - Google Patents

Abstract

Orthosis (1) with
- a contact element (2) which, when the orthosis (1) is in the applied state, rests against a torso (8) of the wearer (4) of the orthosis (1),
- a guide element (12) with an extension direction,
- an arm support element (10) which, when worn, supports an arm of the wearer (4), and
- a joint (14) by means of which the guide element (12) is movable relative to the contact element (2), wherein in the applied state
- the joint (14) is arranged above, i.e. cranially to, a shoulder of the wearer (4) and is designed to enable raising and lowering of an upper arm (16) of the wearer (4) in a sagittal plane, i.e. forwards and backwards, and
- the arm support element (10) is displaced relative to the guide element (12) along the direction of extension or a length of the guide element (12) is changed in the direction of extension when the guide element (12) is moved by the joint (14) relative to the contact element (2), characterized in that the guide element (12) has at least two tubular extension elements (36) which are arranged one inside the other so as to be displaceable relative to one another, wherein at least one inner stop element (38) is arranged within the extension elements (36), by means of which a displacement of an extension element (36) relative to the extension element (36) with the next smaller diameter or relative to the extension element (36) with the next larger diameter is limited to a maximum displacement in at least one direction.

Description

The invention relates to an orthosis with an abutment element which, when the orthosis is in use, rests against a torso of a wearer of the orthosis, a guide element with a direction of extension, an arm support element which, when the orthosis is in use, supports an arm of the wearer, and a joint by means of which the guide element is movable relative to the abutment element, wherein, when the orthosis is in use, the joint is arranged above, i.e. cranially, a shoulder of the wearer and is designed to enable an upper arm of the wearer to be raised and lowered forwards or backwards, wherein the arm support element is displaced relative to the guide element along the direction of extension or a length of the guide element is changed in the direction of extension when the guide element is moved relative to the abutment element.

Such an orthosis is, for example, in the form of an arm support orthosis from the US 2011 / 0 164 949 A1 known. In the document mentioned, the orthosis supports the wearer's forearm, for example, to compensate for the influence of gravity and the force required to overcome it. Different joints can be moved using various actuators, allowing the movement of the arm to be followed.

From the WO 2012 / 099 995 A2 Another arm support orthosis is known in which a force is permanently exerted on the wearer's upper arm in order to compensate for the influence of gravity and thus, for example, to make working overhead easier.

An orthosis for a similar task is available from JP 2014 - 113 317 A Here, too, a force is applied to the wearer's upper arm to counteract the influence of gravity.

From the US 2014 / 0 158 839 A1 Another arm support orthosis with multiple joints is known, which is also intended to compensate for the influence of gravity on the wearer's arm and at the same time allow the wearer as much freedom of movement as possible.

Another arm support orthosis for balancing the force of gravity on the arm of a wearer while allowing the wearer as free a movement as possible is known from the US 2012 / 0 184 880 A1 known

In the unpublished WO 2016 / 065 350 A1 An arm support device is described, for example for use in an arm support orthosis, which should allow the wearer as much freedom of movement as possible.

The US 2014 / 0 212 243 A1 describes a robotic device for assisting a wearer in lifting heavy objects, while simultaneously allowing the wearer to walk.

From the DE 20 2013 009 698 U1 Parallel kinematics is known for an exoskeleton or orthosis, which is intended to enable, for example, the full movement of an arm, including the upper arm and forearm. It is important that the rotational axes of the joints of the orthosis or exoskeleton are not coaxial with the joint axes of the natural human joint.

For this purpose, the aforementioned orthoses have at least one joint through which movements of the shoulder can be simulated. A disadvantage, however, is that these joints and/or the at least one guide element are arranged laterally next to the shoulder joint when the orthosis is in place. This has the advantage that a joint axis can be positioned so that it coincides as closely as possible with the natural joint axis of the shoulder joint, around which the upper arm can be pivoted relative to the shoulder in the sagittal plane, i.e. forwards and backwards. A disadvantage, however, is that this can restrict freedom of movement in other directions and, in addition, the orthosis rests laterally on the wearer's body. The overall width of the wearer with the orthosis is therefore greater than the width of the wearer without the orthosis.

The wearer of the orthosis must therefore get used to the increased width of the brace when the brace is in place, meaning they cannot fit through narrow doors or gaps, or can only fit through them in certain orientations and directions. This can be particularly disadvantageous if the orthosis is used as a work support, for example, to facilitate overhead work, as this work often has to be performed in confined spaces, such as under a motor vehicle.

The invention is therefore based on the object of further developing an orthosis according to the preamble of claim 1 in such a way that the freedom of movement of the shoulder joint is not or only slightly restricted and the orthosis can experience greater acceptance, in particular as work support.

The invention solves the stated problem by an orthosis according to the preamble of claim 1, which is characterized in that the guide element has at least two tubular extension elements which are arranged displaceably within one another relative to one another, wherein at least one inner stop element is arranged within the extension elements, by means of which a displacement of an extension element relative to the extension element with the next smaller diameter or relative to the extension element with the next larger diameter is limited to a maximum displacement in at least one direction.

According to the present invention, the at least one joint is therefore not arranged next to, i.e. lateral to, the shoulder joint of the wearer, but above, i.e. in a cranial direction. This reduces the required width of the orthosis and the wearer of the orthosis fits through the same gaps with the orthosis on as without the orthosis on. This significantly reduces the adjustment phase and the risk of accidents. This significantly increases the acceptance of the orthosis. In addition, the guide element is advantageously arranged above the arm, in particular above the upper arm, of a wearer of the orthosis. This also means that the orthosis does not add any bulk to the side of the arm, so that the width of the wearer without the orthosis is the same as the width of the wearer with the orthosis.

However, due to this arrangement of the joint above the wearer's shoulder, incongruities can occur during certain movements of the upper arm relative to the shoulder. This particularly applies to raising and lowering the upper arm in a sagittal plane, i.e., forwards or backwards. During this type of movement, the axis of rotation of at least one joint no longer coincides with the axis of rotation of the shoulder joint. To compensate for this, the distance of the arm support element from the rest of the orthosis, i.e., in particular from the joint, can be changed by moving the support element relative to the guide element along the direction of extension or by changing the length of the guide element in this direction. This is preferably done without additional actuators by raising or lowering the wearer's arm. Detection of a corresponding movement, for example via sensors, and active actuation of the arm support element or the guide element is possible, but not necessary.

In an orthosis according to the invention, the contact element is therefore designed to be applied to the torso of the wearer of the orthosis. This advantageously takes place in an area of the back or shoulder, so that secure yet comfortable application and support is possible. The arm support element is designed to support the wearer's arm. The special positioning of the joint prevents tilting of the device when loaded, which could lead to incorrect loading and possibly uncomfortable positioning. In contrast to the prior art, the joint is advantageously located in the same sagittal plane in which the upper arm is located when unloaded, hanging from the shoulder. The upward and downward movement described above also occurs in this sagittal plane.

The application element, the guide element, the arm support element and the joint are therefore arranged relative to each other in such a way that the joint is positioned cranial to the shoulder when applied and, in addition, the desired movements of the arm support element or the guide element are achieved.

Advantageously, the arm support element is designed to support the wearer's upper arm. This way, the orthosis does not have to take into account movements of the forearm relative to the wearer's upper arm, and a complicated joint design, as is sometimes known from the prior art, is not required.

It has proven advantageous if the guide element is a rail on which the arm support element is slidably arranged. In a preferred embodiment of this rail, the rail has a recess in which a correspondingly shaped projection of the arm support element or a carriage on which the arm support element is arranged can be moved. The recess can, for example, be dovetail-shaped or have a different shape. The carriage can also be equipped with a corresponding projection that engages in the recess. Alternatively or additionally, the carriage can also have a fastening element that partially or completely surrounds the rail and is slidably arranged along the rail. The bearing is preferably provided by bearing devices known in principle from the prior art, such as plain or ball bearings.

Alternatively or additionally, the guide element can also consist of or comprise several rods or bars connected to one another via at least one joint. These are connected in an articulated manner to the joint and the arm support element, so that a movement of the arm support element relative to the joint via a Deformation of the guide element, which is designed in this way, can take place, whereby the distance of the arm support element from the joint and thus the length of the guide element can change.

In a preferred embodiment, the arm support element or slide has more than one contact element with which the slide or arm support element rests against the rail. For example, the arm support element can have two slides, both of which engage in the same recess in the rail or encompass the same rail. The same naturally also applies to a projection that the arm support element has. Here, too, two projections arranged one behind the other in the direction of extension can be provided, as is also the case with the slides. Of course, there can also be a projection or slide that extends in the direction of extension. In this way, it is prevented that when the upper arm moves relative to the shoulder, which leads to a movement of the joint and thus to a change in the position of the arm support element relative to the joint, the arm support element tilts on or in the rail and thus blocks further movement and possibly makes it impossible. This also further increases the manageability, comfort, and acceptance of the device.

Alternatively or additionally, the guide element and the arm support element can each have at least one slide element, which are arranged so that they can slide along each other. Air cushion or gel bearings can preferably be used here.

Alternatively or additionally, the guide element is designed as a telescopic rod. A movement of the joint, i.e., a displacement of the upper arm of the orthosis wearer relative to the shoulder, causes the telescopic rod to be extended or retracted, changing the effective length of the telescopic rod up to the point where the arm support element is positioned on the guide element. This can also compensate for the incongruity between the pivot points of the joint and the wearer's shoulder joint.

The joint is preferably a ball-and-socket joint. This allows for other shoulder movements that do not exclusively result in movement of the upper arm in the aforementioned sagittal plane. Of course, several separate joints can also be used for this purpose, each of which is used to enable movement of the arm support element in the respective pivoting direction. The advantage of a ball-and-socket joint, however, is that movement in all directions is possible with one joint whose rotation axes for the respective movement all pass through the same point, namely the center of the ball-and-socket joint.

In a preferred embodiment, a resistance that opposes movement of the joint is adjustable and the joint can in particular be locked. Of course, the resistance can also be designed differently for different directions of movement of the joint. Variable adaptation, for example to a state of movement of the joint, such as a joint angle enclosed between the legs of the joint, is also advantageous for certain applications. For example, it can be useful to prevent a movement of the joint that leads to the upper arm being lowered relative to the shoulder as long as the wearer of the orthosis is performing work overhead. However, a movement in the opposite direction, which corresponds to a further raising of the upper arm relative to the shoulder, should be freely possible.

Alternatively or additionally, a resistance that prevents the arm support element from moving relative to the guide element and/or a resistance that prevents the length of the guide element from changing can also be adjustable. The arm support element can, in particular, be designed to be lockable relative to the guide element and/or the length of the guide element can be fixed. Here, too, different directions of movement or changes in length can, of course, be subjected to different resistances. A change in the respective resistance depending on the position of the two components relative to each other or the currently set length of the guide element is also conceivable.

In a preferred embodiment, the orthosis has an electrical or electronic control system that is configured to adjust this resistance depending on the position of the wearer's head. If the wearer of the orthosis tilts their head back, for example, to look upwards, this can be detected by a sensor or a positioning element that rests against the head. The signal achieved in this way, which can also be transmitted mechanically, is then preferably used to prevent or at least impede a movement of the joint in the direction corresponding to a lowering of the upper arm. This also makes it possible to to compensate for the influence of gravity on the respective arm of the wearer of the orthosis.

Particularly when using the orthosis as work support for otherwise healthy wearers, it is advantageous if the orthosis can be put on as quickly and easily as possible. For this purpose, the arm support element advantageously has a shell device that can be brought into a closed position by inserting the arm of the orthosis wearer into the shell device. Using an actuating element, for example a strap running within the shell device, the shell device can be closed simply by inserting the arm, so that the orthosis can be put on without using another hand. The easier it is to put on an orthosis used as a work aid, in particular, the greater the wearer's acceptance of it.

Additional locking elements for the shell device are of course possible.

The orthosis is advantageously designed to support both arms of the wearer. It features two arm support elements, two guide elements, and two joints. Of course, the respective elements can be designed differently for the different arms, allowing, for example, the resistance of the individual joints to be controlled independently.

If the guide element is designed as a telescopic rod, it advantageously has at least two tubular extension elements that are arranged within one another so that they can be displaced relative to one another. This is the case with conventional telescopic rods from the prior art. Preferably, at least one internal stop element is arranged within the extension elements, by means of which the displacement of an extension element relative to the extension element with the next smaller diameter or relative to the extension element with the next larger diameter is limited to a maximum displacement in at least one direction.

Traditionally, telescopic rods or telescopic supports comprise several tubular extension elements arranged one inside the other, with the outermost of two nested extension elements projecting inwards and the innermost of the two extension elements projecting outwards, for example, featuring a projection or thickening. This creates stop elements and stops that ensure that the two nested extension elements can be moved relative to one another but cannot be detached from one another. However, this design has the disadvantage that additional bearing devices, such as ball, roller, or plain bearings, are required to support the various extension elements. Consequently, there are only a few selected locations where the two extension elements are in contact with one another via these bearing devices. This can lead to disadvantages with the present orthoses, as they require a change in length of the telescopic guide element under load, with the load generally acting perpendicular to the longitudinal extent of the guide element.

This disadvantage is remedied by arranging an internal stop element within the extension element, which limits the possible displacement to a maximum. An internal stop element, which limits the movement of two adjacent extension elements relative to each other, is therefore not arranged between these two extension elements, but also within the extension element with the smaller diameter. "Inside" means that it is arranged radially inward relative to the center axis of the telescopic guide element. Depending on the design, the stop element may well be located outside in the axial direction, for example, in front of the smaller extension element.

Advantageously, for each of the pull-out elements present, with the exception of the pull-out element with the smallest diameter or the pull-out element with the largest diameter, at least one, preferably exactly one, internal stop element is provided, by means of which a displacement of the respective pull-out element relative to the pull-out element with the next smaller diameter or relative to the pull-out element with the next larger diameter is limited to a maximum displacement in at least one direction. This is not necessary for the pull-out element with the smallest diameter or the pull-out element with the largest diameter, since a movement to an even smaller or even larger pull-out element is not possible and therefore does not need to be limited. The maximum displacement is preferably, but not necessarily, identical for all pull-out elements. It is certainly possible to combine different maximum displacements for different pull-out elements.

Preferably, the inner stop elements form a telescopic device. This is therefore a "telescope" within a "telescope." It is important that the "inner telescope," i.e. the distance formed by the inner stop elements, dete telescopic device not only limits the maximum length of the guide element, which is designed as a telescopic support, but also and in particular limits the displacement of each of the extension elements relative to the extension element with the next smaller diameter or relative to the extension element with the next larger diameter.

Advantageously, the telescopic guide element has a stop for each of the inner stop elements, against which the respective inner stop element strikes when the maximum displacement of the respective extension element relative to the extension element with the next smaller diameter or relative to the extension element with the next larger diameter is reached.

Preferably, at least one of these stops is arranged on one of the inner stop elements. This results in a particularly simple design. Alternatively or additionally, at least one of the stops is advantageously arranged on the inside of one of the extension elements.

Advantageously, the extension elements lie flat against one another. Particularly preferably, the extension elements are made at least partially, but advantageously entirely, of steel or carbon. The full-surface contact of the various extension elements reliably prevents tilting and jamming of the individual extension elements, even if the length of the telescopic guide element needs to be changed under load. When manufacturing the extension elements from carbon, it is advantageous if the sliding surfaces with which the various extension elements lie against one another are made of carbon or have a corresponding coating. This material has the advantage of exhibiting particularly good sliding properties in this arrangement.

In a preferred embodiment, the telescopic guide element is arranged on the joint with the extension element having the smallest diameter. This design makes it structurally simple to design a fastening element, for example, a slide element on which the arm support element is arranged, to slide on the outer side of the telescopic guide element. In this way, the effective length, i.e., for example, the distance between the joint and the fastening element or slide element, can be significantly reduced and is not limited by the length of the individual extension elements.

If the telescopic guide element is arranged on the joint with the extension element having the largest diameter, the slide element is preferably arranged displaceably on the extension element with the smallest diameter. In this case, all other extension elements preferably have a groove or slot through which at least a portion of the slide element protrudes and in which it can be displaced.

• 1 - die schematische Darstellung einer Orthese im angelegten Zustand,
• 2 - einen Ausschnitt aus der in 1 gezeigten Orthese,
• 3a und 3b - die schematische Darstellung einer angelegten Orthese in zwei unterschiedlichen Positionen,
• 4 und 5 - einen schematischen Ausschnitt einer Orthese gemäß einem weiteren Ausführungsbeispiel der vorliegenden Erfindung und
• 6 und 7 - die schematische Darstellung einer angelegten Orthese gemäß einem weiteren Ausführungsbeispiel der vorliegenden Erfindung in unterschiedlichen Positionen,
• 8 bis 10 - schematische Schnittdarstellungen durch ein teleskopierbares Führungselement in unterschiedlichen Positionen und
• 11 und 12 - schematische Ansichten eines teleskopierbaren Führungselementes.

An embodiment of the present invention is explained in more detail below with the aid of the accompanying drawings. It shows:

• 1 - the schematic representation of an orthosis in the applied state,
• 2 - an excerpt from the 1 shown orthosis,
• 3a and 3b - the schematic representation of an orthosis in two different positions,
• 4 and 5 - a schematic section of an orthosis according to a further embodiment of the present invention and
• 6 and 7 - the schematic representation of an applied orthosis according to a further embodiment of the present invention in different positions,
• 8 to 10 - schematic sectional views through a telescopic guide element in different positions and
• 11 and 12 - schematic views of a telescopic guide element.

1 shows an orthosis 1 according to a first embodiment of the present invention in the applied state. It has several contact elements 2, which in the illustrated embodiment rest in the shoulder area and in the hip area of a wearer 4 of the orthosis 1. The various contact elements 2 are connected to one another via an adjustable rod 6. In this way, the orthosis 1 can be adapted to the respective physique of the wearer 4. The distribution of the contact elements 2 in the form shown, in particular at different heights on a torso 8 of the wearer 4, allows, in particular, stable support under load.

The 1 The orthosis 1 shown also has an arm support element 10, which in the illustrated embodiment is attached to a guide element 12. The guide element 12 is coupled to the rest of the orthosis via a joint 14. An upper arm 16 of the wearer 4 of the orthosis 1 can be inserted into the arm support element 10 and attached thereto. The joint 14 enables movement of the upper arm 16 relative to the shoulder of the wearer 4, which extends in the sagittal plane, i.e., forwards or backwards. However, the pivot points of the joint 14 and the shoulder joint of the wearer 4 of the orthosis 1 are not aligned, resulting in an incongruity. If the guide element 12 is pivoted relative to the rest of the orthosis by the joint 14, for example, by the wearer 4 inserting their upper arm 16 into the arm support element 10 and raising it, the arm support element 10 moves along the guide element 12 to compensate for this incongruity.

A further joint 18 also allows movement of the arm support element 10 relative to the support elements 2 in a pivoting direction in the transverse plane, which is perpendicular to the described sagittal plane. It has proven advantageous to arrange the joint 14 and the further joint 18 as close to each other as possible in order to minimize the incongruities between the different movements.

2 shows an enlarged section of the 1 The orthosis 1 shown in Figure 1. One can see part of the rod 6 as well as the further joint 18 and the joint 14. On these is the guide element 12, which in the embodiment shown includes a rail 20 to which a slide element 22 is movably attached. The arm support element 10 is arranged on this slide element 22. In order to allow movement of the upper arm, which in 2 not shown, which do not occur exclusively in the sagittal plane, an additional joint 24 is provided between the slide element 22 and the arm support element 10.

In the advantageous embodiments shown in the figures, the joint 14 is designed to be lockable. It has a locking mechanism 26 by which movement in at least one direction of the joint can be restricted, made more difficult, or completely prevented. For example, it is possible to enable an upward movement of the guide element 12 in the illustrated embodiment, i.e., a clockwise pivoting, while pivoting in the opposite direction is not possible or is made more difficult. This is particularly useful when the orthosis 1 is worn by a wearer 4 who must perform work overhead. This relieves strain on the arms.

3a shows the wearer 4 of the orthosis 1 with the upper arm 16 lowered. The rod 6 connects the support elements 2, which are located in the shoulder and waist or hip area. This ensures secure support of the orthosis 1 on the torso 8 of the wearer 4. The arm support element 10 is attached to the guide element 12 via a rod 27 and can be moved in the longitudinal direction of the guide element 12, i.e., along the longitudinal direction of the upper arm 16.

In the 3a In the situation shown, the upper arm 16 is lowered and therefore the rod 27 is moved further in the distal direction, i.e. in the direction of the elbow 30. 3b shows the same orthosis 1, with the difference that the wearer 4 has raised the upper arm 16. The arm support element 10 is still in the same position on the upper arm 16, but is now mounted on the guide element 12 via the rod 27, significantly more proximally, i.e., toward the shoulder. There is no displacement of the arm support element 10 relative to the upper arm 16. This displacement of the arm support element 10 relative to the guide element 12 is caused solely by the wearer 4 moving his upper arm 16.

4 shows a part of the orthosis 1. One can see the joint 14 as well as the further joint 18 and the guide element 12 arranged on the joint 14. This is in comparison for example to 2 It is designed differently and comprises several sliding elements 28 that are movable relative to one another. At the front end there is a fastening element 30 on which an arm support element can be arranged.

5 shows that in 4 split component, whereby the individual displacement elements 28 are now displaced relative to each other, so that the distance between the fastening element 30 and the joint 14 has increased significantly. Consequently, in this way, an arm support element 10, which is fastened to the fastening element 30, can be displaced relative to the joint 14 and thus also relative to the contact elements 2, which are in 4 and 5 are not shown.

The representation in 6 shows the orthosis 1 applied by a wearer 4, whereby the representation of the 6 from the 3b shown embodiment only by the guide element 12. In 6 the guide element 12 has two rods 32 which are connected to each other and to the rod 27 and the joint 14 by connecting joints 34.

7 shows the 6 The orthosis shown in a situation in which the wearer 4 lowers the upper arm 16. It can be seen that the angles assumed by the respective connecting joints 34 change and thus the length of the guide element 12, which is guided by the 6 and 7 formed by two bars 32 shown. The direction of extension of this guide element 12 always extends from the joint 14 to the rod 27. The distance between these two components changes depending on the arm position of the carrier 4, so that this length, as shown in the 6 and 7 shown, changed.

8 shows a guide element 12 that is designed to be telescopic. It has three extension elements 36 that are arranged so that they can slide into one another.

Inside there are two inner stop elements 38, which are also arranged inside each other. 8 At the left end, these inner stop elements 38 each have an annular projection 40, with which they strike against stops 42 provided for this purpose when a maximum displacement of two adjacent pull-out elements 36 occurs. This is shown in 9 and 10 presented more clearly.

External stops 44 are provided radially on the outside of the pull-out elements 36, which come into effect when the various pull-out elements 36 are pushed together, i.e. when the guide element 12 is shortened, or, as in the 8 The outer stop 44 shown on the far right is used to limit the freedom of movement of a slide element 22, not shown, which can be arranged displaceably on the outside of the largest extension element 36.

Links in 8 There is a mounting element 46 with which the guide element 12 can be fastened to the joint 14 (not shown).

9 shows the guide element 12 from 8 in the partially extended state. It can be seen that the extension elements 36 are displaced relative to one another, and the projections 40 on the inner stop elements 38 are also closer to the respective stops 42.

In the present embodiment, the smallest inner stop element 38 is arranged on the outermost, i.e., largest, extension element 36 with a first fastening plug 48. The inner stop element 38 with the larger diameter is fastened to the second-largest extension element 36 with a second fastening plug 50. The stop 42 is also located on the second fastening plug 50.

10 shows the guide element 12 in its fully extended state. The extension elements 36 are each in the maximum displaced state, and the inner stop elements 38 each rest with their projection 40 against the stop 42.

11 shows a side view of the guide element 12. The outer extension element 36 with two outer stops 44 can be seen. The mounting element 46 for fastening the guide element 12 to the joint 14 is shown bottom right. A slide element 22 is slidably arranged on an outer side of the outermost extension element 36. This is shown in 12 shown in a schematic 3D view. A cap 52, which forms the outer stop 44, contains a ventilation opening 54 through which air can flow into or out of the guide element 12 when the guide element 12 is extended and retracted. Preferably, various armrests can be mounted on the slide element 22. Therefore, the armrest is preferably detachably attached to the slide element 22.

List of reference symbols

1

Orthosis

2

Investment element

4

carrier

6

rods

8

hull

10

Armrest element

12

Guide element

14

joint

16

upper arm

18

another joint

20

rail

22

Slide element

24

Additional joint

26

locking mechanism

27

rod

28

Sliding element

30

Fastening element

32

rod

34

connecting joint

36

pull-out element

38

Internal stop element

40

projection

42

stop

44

Outside stop

46

Mounting element

48

first fastening plug

50

second fastening plug

52

cap

54

ventilation opening

Claims (18)

Orthosis (1) with - a support element (2) which, when the orthosis (1) is in place, rests against a torso (8) of the wearer (4) of the orthosis (1), - a guide element (12) with a direction of extension, - an arm support element (10) which, when in place, supports an arm of the wearer (4), and - a joint (14) by means of which the guide element (12) is movable relative to the support element (2), wherein, when in place, - the joint (14) is arranged above, i.e. cranial to, a shoulder of the wearer (4) and is configured to enable raising and lowering of an upper arm (16) of the wearer (4) in a sagittal plane, i.e. forwards and backwards, and - the arm support element (10) is displaced relative to the guide element (12) along the direction of extension or a length of the guide element (12) is changed in the direction of extension when the guide element (12) is moved by the joint (14) is moved relative to the contact element (2), characterized in that the guide element (12) has at least two tubular pull-out elements (36) which are arranged one inside the other so as to be displaceable relative to one another, wherein at least one inner stop element (38) is arranged within the pull-out elements (36), by means of which a displacement of a pull-out element (36) relative to the pull-out element (36) with the next smaller diameter or relative to the pull-out element (36) with the next larger diameter is limited to a maximum displacement in at least one direction. Orthosis (1) after Claim 1 , characterized in that the arm support element (10) is arranged to support the upper arm (16) of the wearer (4). Orthosis (1) after Claim 1 or 2 , characterized in that the guide element (12) has a rail (20). Orthosis (1) after Claim 3 , characterized in that the rail (20) has a recess in which a correspondingly designed projection (40) of the arm support element (10) or a slide (22) on which the arm support element (10) is arranged can be displaced. Orthosis (1) according to one of the preceding claims, characterized in that the guide element (12) and the arm support element (10) each have at least one slide element (22) which are arranged on one another in such a way that they can slide along one another. Orthosis (1) according to one of the preceding claims, characterized in that the guide element (12) has a telescopic rod. Orthosis (1) according to one of the preceding claims, characterized in that the joint (14) is a ball joint. Orthosis (1) according to one of the preceding claims, characterized in that a resistance which opposes a movement of the joint (14) and/or a displacement of the arm support element (10) relative to the guide element (12) and/or a change in the length of the guide element (12) is adjustable and the joint (14) and/or the arm support element (10) relative to the guide element (12) is in particular blockable and/or the length of the guide element (12) is fixable. Orthosis (1) after Claim 8 , characterized in that the orthosis (1) has an electrical control which is designed to adjust the resistance as a function of a head position of the wearer (4). Orthosis (1) according to one of the preceding claims, characterized in that the arm support element (10) has a shell device which can be brought into a closed position by inserting the arm into the shell device. Orthosis (1) according to one of the preceding claims, characterized in that the guide element (12) has at least one, preferably exactly one, inner stop element (38) for each extension element (36) except for the extension element (36) with the smallest diameter or the extension element (36) with the largest diameter, by means of which a displacement of the respective extension element (36) relative to the extension element (36) with the next smaller diameter or relative to the extension element (36) with the next larger diameter is limited to a maximum displacement in at least one direction. Orthosis (1) after Claim 11 , characterized in that the inner stop elements (38) form a telescopic device. Orthosis (1) according to one of the preceding claims, characterized in that the Guide element (12) has a stop (42) for each inner stop element (38) against which the inner stop element (38) strikes when the maximum displacement of the respective pull-out element (36) relative to the pull-out element (36) with the next smaller diameter or relative to the pull-out element (36) with the next larger diameter is reached. Orthosis (1) after Claim 13 , characterized in that at least one of the stops (42) is arranged on an inner stop element (38). Orthosis (1) after Claim 13 or 14 , characterized in that at least one of the stops (42) is arranged on an inner side of a pull-out element (36). Orthosis (1) according to one of the preceding claims, characterized in that the pull-out elements (36) lie flat against one another. Orthosis (1) according to one of the preceding claims, characterized in that a slide element (22) on which the arm support element (10) is arranged is displaceably arranged on an outer side of the extension element (36) with the largest diameter. Orthosis (1) according to one of the preceding claims, characterized in that a slide element (22) on which the arm support element (10) is arranged is displaceably arranged on one of the extension elements (36) with the smallest diameter and all other extension elements (36) have a groove or a slot through which the slide element (22) projects and in which it is displaceable.