DE19930103C1 - Dynamic orthopaedic seat shell for wheelchair user has chest restraints pivoted relative to backrest via pivot levers with tension bands limiting their movement - Google Patents

Abstract

The dynamic orthopaedic seat shell is attached to a wheelchair via a base plate (1), with its backrest (5) divided transverse to its longitudinal axis in the lumbar region, a flexible coupling provided between the backrest parts, the lower part of the backrest formed the back surface of the seat surface. The chest restraints are pivoted relative to the backrest via pivot levers (9.1,9.2) supported by a common pivot mounting (10) in the lumbar region of the pivoted part of the backrest, with their movement limited via tension bands (15.1,15.2).

Description

The object of the invention is a dynamic seat shell with pads for stable fixation physically disabled people, which can be mounted on wheelchairs and a limited Upper body movement forward on both sides as well as a body extension in the stage of a seizure (stretching spasm).

To improve the quality of life of victims with infantile cerebral palsy, systemic myopathies, myelodysplasia or various clinical pictures scoliotic spinal deformities, especially those of spastic handicaps modular seat shells offered for transport on wheelchairs. By functional assemblies are intended to provide individual care, d. H. an individual adjustment can be achieved on the patient.

With DE-OS 36 43 540 an orthopedic seat shell was proposed, which consists of a There is inner and outer shell, which are movably connected in the back part. Through the Tiltable storage of the seat and backrest leave them to a limited extent a body-related adjustment too. However, they cannot be set individually.

In order to achieve an individual adaptation for the physically handicapped, modular Orthopedic seat shells (seat orthoses) proposed (DE-GM 88 15 292, DE-OS 195 20 585 A1 and OS 197 31 066 A1), which in principle comprise a central support (column) on the Independently changeable pads for fixing the torax, pelvis and thigh are attached. In detail, the pads are in the longitudinal direction of the frame slidable and adjustable in length (width) across the beam. Preferably, the Pads for the upper body can be folded to the side to accommodate the disabled. The The handicap is secured in the seat shell using adjustable straps.

Despite the physical adaptation that can be achieved, these systems are statically rigid. they seem in principle against a decline in posture. On the other hand, the handicapped becomes rigid in fixes his sitting position and thus significantly in his natural range of motion limited. The Torax in particular is firmly fixed and the freedom of movement except for the Arms greatly reduced. Spastic people in particular feel this Restriction of posture additionally hampered in the seizure-free periods. Under Everyday conditions cause claustrophobia, the trigger for spontaneous Liberation attacks are. Lead with subconscious acceptance of physical injuries often such attacks to destroy the pads. In addition to the material damage the quality of life of the disabled is further reduced.

Due to the rigid attachment of the pads in the torax area and fixed, unchangeable Sitting position, it is not possible for the handicapped relative spastic seizure to live harmlessly. The rigid arrangement of the pads in the torax area prevents this lateral freedom of movement. Due to the rigid backrest and seat, there is also an after legitimized tilting movement not possible.

The u. a. proposed with DE-GM 29 50 4555, openable on the outside Create the backrest of the fuselage or reclining pads no remedy in this regard. They only allow, as under / 1 / an easier occupation of the Seat shell and a flexible mutual attachment not explained a Adaptation to the respective upper body circumference, such as B. by the clothing of the Disabled. However, this pad closure does not allow any influence on one Change of location. The disabled person is still rigidly fixed in his sitting position.  

As can be seen, the aforementioned seat shells are available on the market especially about no possibility to adjust the seating position at a Body stretching as occurs during a stretching spasm. Spastic seizures therefore occur for the patient always under physical stress.

Belt mounts, as suggested with the device according to DE-GM 87 13 279 from today's perspective are therefore only taking into account the aforementioned shortcomings axeptable in the case of a very severe decline in the posture of the disabled.

With EP 0 911 008 A2, a movable seat arrangement, in particular a Wheelchair for the physically challenged proposed by one on a chassis attached seat shell, which comprises a backrest and a seat, which are articulated together.

In the stage of a body movement (spasm) caused by convulsions, the Backrest and seat, which are freely pivotable, this Body movement follow, with a tensioning device on the seat and the Backrest in the bent seating position creates tension. This resilience is supposed to dampen the sequence of movements when the body is stretched and the physically disabled Guide the person back to the sitting position in a controlled manner.

From an orthopedic point of view, this device is not yet optimal. especially the pivoting connection of the backrest and seat is problematic because of the Swivel axis in the physiological fulcrum, namely the hip joint, the disabled Person lies. When the body is stretched, the hip angle is opened. With that the Adduction tendency and at the same time the tendency to dislocation (dislocation of the hip) intensified. With increasing body stretch, the progressive effect of the increases Tensioning device, which in the event of a spasm by the person concerned additional, uncontrollable Muscle tension causes, which intensify the stress situation and to muscle injuries being able to lead.

The aim of the invention is to develop a dynamic seat shell for patients that it Allows those affected to sit in limited conditions, i.e. H. under Ensuring their physical integrity to actively influence themselves as well as passively to adapt to body movements.

In particular, a limited should be achieved in the phase of an attack Allow freedom of movement for the disabled by physical restrictions in the Torax area and the sitting posture are canceled so that the Torax both lateral and forward tilting movements and a body extension (Stretching spasm) is possible without the retention and safety system to maintain the physical integrity is canceled. The device is said to cause stress Reduce self-liberation and the associated risk of injury Create the prerequisite that the disabled person can live out an attack as stress-free as possible.

The object of the invention is to provide a non-rigid (dynamic) seat shell develop with which the individual seating position of a disabled person is definitely entered can and which is consequently a limited longitudinal seat tilt movement and with respect to the center axis of the seat shell sideways and forward torax movement including an adjustable upright function (return). Independent of The body of the handicapped is to ensure this freedom of movement in every posture phase supported and counteract the conditional decline in posture.  

The seat shell should be designed so that a stepless seat and back tilt adjustment is possible and that with a body extension, such as during a spastic seizure, self-regulating lumbar support comes into effect.

The features of the invention are summarized in claims 1 to 10.

The solution according to the invention comprises a multi-part anatomical to the patient adapted seat shell. It consists of a base plate that can be clamped onto the wheelchair, one on the sides and in the buttocks up to the lumbar area (lumbar) raised seat shell and a swiveling backrest with a side opposite the central axis displaceable Torax pads.

The seat is articulated on the front edge of the base plate. At the back of the There is a vertically adjustable stop on the base plate, on which the Seat supported on a buffer. The backrest is at the level of the lumbar area attached to the backrest raised buttocks or rump support surface like a joint.

To perform a controlled lateral tilting movement of the Torax, they are forward directed and retracted to the middle of the body, fastened individually height adjustable Torax pads attached to elastically tensioned swivel levers. The storage of the Swivel lever takes place on the back of the backrest in one together Lumbar region arranged lever bearings. Both are in the closed state To each other in a form-fitting manner. In this position include the padded Pad the upper body of the disabled. For better erection and stabilization of the Torax in the BWS area, the pads are preferably pulled up to the clavicle at the front. The storage of the swivel levers in the lumbar area allows regardless of the position the backrest a parallel circular arc-shaped pendulum movement of the Torax pads relative to the central axis of the seat shell without the distance between the pads changed to each other. In this way, the upper body of the disabled person is in every inclination phase securely supported and the given decline in posture compensated.

For maintaining the Torax fixation during the swiveling movement of the pad and their common parallel resetting after a lateral torax inclination in the erect position are elastic at the free end points of the swivel lever adjustable straps clamped to the backrest. To the The tensioning and retraction force are continuously adjusted to at least the tensioning straps one attachment point on the backrest or the swivel levers of one Clasp held. This clamp is for quick release of the strap equipped with a bayonet lock. The bayonet lock can also directly free Hold the end of the strap.

To support the mutual tensioning of the swivel levers, but especially for Keep the Torax pads open to seat or lift the disabled person into the or from the seat shell is just above the lever bearing between the swivel levers Spring element, preferably an elastic strap. With diametrical The Torax pads swivel back due to the effective tension held in their open position.

To allow lateral freedom of movement for the Torax, especially the Torax The backrest is constricted to the middle. For circular arc guidance the pad can also have a guide window with the for each pad in the backrest the same radius of curvature as the swivel lever.

The radius of curvature r is determined individually from the height of the disabled person. An additional individual adjustment of the pad height can be done in a known manner  a perforated strip can be reached. To reduce the installation height, the swivel levers are as designed flat plate. Preferably, the pivot levers are from the backrest supported. In order to reduce the frictional resistance between these sliding pairs, the Swivel levers preferably covered with a PE plate or with PE sliding blocks.

For the limited release of the backrest inclination towards and towards her automatic return is a circular elastic at the top of the backrest Strap attached. This belt is placed over the guide handles of the wheelchair in question, which thus form the abutment for the swiveling backrest.

To adjust the seating position of the disabled, the seat inclination is opposite the seat shell the base plate adjustable by a height adjustable stop. To dampen the Return movement of the seat carries an elastic buffer. The The seat pan is limited by an adjustable safety belt that is held by at least one clamp closure.

With the proposed dynamic seat shell, the previous rigid is immobile Disabled safety bracket. Ensuring an effective against the decline in posture directed fixing of a disabled person, such as. B. a spastic, This has the option of active as well as passive posture in a controlled manner to change. Possible stressful situations and liberation attacks are considerably reduced and thus the risk of self-harm. This also makes the possibility of Damage to the seat shell contained. The key advantage is that the Disabled in seizure situations, this much less stressful and in diminished Can live out the risk of injury.

The proposed dynamic seat shell is based on an exemplary embodiment clarified again. For a better overview, the representation of the upholstery renounces, which is executed anyway according to the anatomical body dimensions of the disabled becomes.

The drawings show:

Fig. 1 is a front perspective view of a seat pan;

Fig. 2: the rear view of the seat shell;

Fig. 3: a seat shell in the extended position.

The perspective view of Fig. 1 shows as a supporting element, the base plate 1 , which is placed and attached to the respective chassis of the wheelchair. On the rear edge of the base plate 1, which is angled downwards, a vertically adjustable stop bracket 2, which is occupied by a buffer 11, is attached. To adjust the seat inclination by means of the stop bracket 2 , the seat 3 is connected in the front area to the base plate 1 by joints 7 . This articulated connection can also be arranged in the side guide 4 of the seat.

The backrest 5 is fastened at the level of the lumbar region on the buttock support surface 3.1 of the seat 3 in a flexible or articulated manner. The backrest 5 can thus be pivoted both forwards and backwards. The backrest 5 carries Torax pads 6 which are adjustable with respect to the longitudinal axis of the seat to hold and fix the position. As can be seen from FIG. 2, these are fastened individually or by means of a perforated strip as pelotte fastening 6.1 adjustable in height to swivel levers 9.1 and 9.2 . The swivel levers are located on the back of the backrest 5 . They are stored at the level of the lumbar region in a common lever bearing 10 . In the interaction of the flexible Torax mounting and the pivotable attachment of the backrest 5 in the joint 8 , a gimbal support is achieved for the disabled without the holding and support function being lost. The swivel radius r of the pads 6 is determined from the overall length of the swivel levers 9 . The swivel angle α with respect to the longitudinal axis of the seat shells is limited by constriction 5.1 of the backrest 5 or by window slots. The height of the pads 6 can be adjusted by means of a perforated strip on the pad holder 6.1 or by exchanging the swivel levers 9 or by means of a telescopic setting option. For an arrangement of the headrest 6.1 plug sleeves can be provided on the pad holders, which accommodate a height-adjustable bracket with headrest. This means that the head of the disabled person can be carried safely during a lateral torax movement. Such a bracket can also be designed as a single bracket. In this case, the receptacle would be designed as a profile sleeve to guide the bracket.

To limit the possible tilting movement of the backrest 5 to the front, there are at the upper end of the same tether slots 12 which accommodate a circular elastic belt which is placed over the handles of the respective wheelchair.

As with all known ortho seats, the seat 3 is equipped with an attached abduction wedge 20 that can be adjusted on the seat surface. This is held elastically by the spring clip 20.1 and is determined by means of the clamping screw 20.2 . On the side guides 4 , slots 21 are provided for a lap belt. There are also slots 22 in the buttock support surface, in which a pair of trousers can be attached.

The rear view of the seat shell according to FIG. 2 specifically shows the arrangement of the pivot levers 9.1 and 9.2 and their storage in the common lever bearing 10 . The pivot levers 9.1 and 9.2 bear against each other in the closed state. Due to the elastic tension band 18 arranged directly above the lever bearing 10 and the elastic tension bands 15.1 and 15.2 fastened to the free ends of the pivot levers 9 , the pivot levers 9.1 and 9.2 are braced against one another. The straps 15.1 and 15.2 are held by the clamp closures 16.1 and 16.2 . The free end of the tightening straps 15.1 and 15.2, as illustrated with the respective clamping closure 16.1 / 16.2 at the bayonet locks 17 in detail X attached.

The clamp locks 16 and bayonet locks 17 can also be combined to form a functional element for simplification, which is then hooked onto the relevant pivot lever 9 . In order to achieve sufficient elasticity of the straps 15.1 and 15.2 over their length, they are clamped crosswise and fastened to the backrest 5 in the slots 14 by toggles 14.1 .

To limit the seat inclination of the seat 3 to the front and to reset between the stop angle 2 of the base plate 1 and the seat 3 , the webbing 13 is attached. It is fastened under the seat 3 with the retaining screw 13.1 and is guided through the slot 13.3 in the stop bracket 2 to the backrest 5 and held by the clamp lock 13.2 . The seat inclination is preset by the stop 2 , which is adjustable in the vertical direction after loosening the clamping screw 2.2 . The infinitely adjustable travel is limited by the adjustment slot 2.1 . The buffer 11 provides cushioned support for the seat 3 .

In Fig. 3 the dynamic bucket seat is shown in the side view in the extended position. This position enables the disabled person to live a stretching spasm without being hampered by rigid pads and the belt holder.

In such an attack, the seat 3 clearly stands out from the stop angle 2 of the base plate 1 and tilts forward via the joint 7 of the base plate 1 . Due to the rigid connection between the seat surface of the seat 3 and the raised buttock support surface 3.1 to the joint 8 in the lumbar region, an effective lumbar support is achieved by the displacement of this joint in cooperation with the buttock support surface 3.1 which is shifted forward. In the end position, the backrest 5 forms approximately a straight line with the seat, as shown in the illustration. The belt 13 limits the forward inclination of the seat 3 and at the same time generates a restoring torque.

After the seat 3 has fallen back into the starting position on the buffer 11 , the backrest 5 returns to its normal position.

To use the dynamic seat shell, the Torax pads 6 are first pivoted outwards independently of one another. By means of the elastic tension band 18 , which is displaced over the center of the lever bearing 10 or below, the pivot levers 9.1 and 9.2 are held in the open position against the tension of the tension bands 15.1 and 15.2 . The disabled person can now be seated in the seat. Then the pelottes 6 adjusted to the body dimensions of the disabled person are pivoted back (this process takes place in reverse order when the disabled person gets out). The direction of action of the strap 18 is reversed. The padded pads 6 encompass the disabled person's chest. By pulling the pads 6 upwards from their front end to the clavicle, the support surface for the torax of the disabled is increased in such a way that the ESPE is supported in a safe, less stressful manner.

In this position, the pivot levers 9.1 and 9.2 bear against one another in a form-fitting manner. Through the pre-tensioned straps 15.1 and 15.2 as well as through the elastic straps 18 , they are simultaneously non-positively clamped together.

In individual cases, the pads 6 can additionally be connected to one another by means of a holding strap or latch and thus secured against bending open.

After the pads 6 have been closed, the headband can be inserted into the receptacles with a headrest and the lap belt 21 and all other headbands can be put on in the leg area. Likewise, the abduction wedge 20 is adjusted and the clamping screw 20.2 is locked . The disabled person is thus adequately secured against falling out and a physical decline in posture.

As far as the physical requirements of the handicapped allow, he can move his upper body in spite of body fixation at his own request and without stress forward and to both sides. The shift to the front enables the backrest 5 , which is flexibly mounted in the lumbar area. The trunk flexion is limited by a circular elastic belt, which is fastened in the tether slot 12 and is placed over the handles of the respective wheelchair in order to fulfill this function. As the angle of diffraction increases, the return force increases, which counteracts a decline in posture. At the same time, the pads 6 prevent the seat pan from tipping out.

The lateral displacement is made possible in that the pads 6 are guided in parallel on an arc of a radius r. The center of the radius is on the longitudinal axis of the seat shell in the lumbar area. In the center of the radius is the lever bearing 10 for the pivot levers 9.1 and 9.2 . arranged.

The pivotal movement to one side is due to the lateral load on the relevant Pad by the disabled against the resilience of the diametrically opposed Tensioning strap, which is operatively connected to the leading swivel lever. With increasing Tilting moment increases and with it the return force.

The unloaded pad is tracked by the relaxing tension band and by the tension band 18 .

Is z. B. the right pad 6 is loaded, so increases the restoring force of the tensioning strap 15.1 acting on the pivot lever 9.1 . The left pad 6 with the swivel lever 9.2 is reliably tracked by the pretensioning of the tensioning strap 15.2 and by the tensioning strap 18 in contact with the upper body of the disabled person. The increase in the restoring force also compensates for the decline in posture affecting the handicapped and brings his upper body back to the normal position after the urge to move has ceased. This presupposes that all of the restoring moments triggered are as large as the mass force generated by the body of the disabled person. This course of action is reversed when the left pad is loaded.

An additional headrest, which is attached to the pads, makes this for the disabled executed movements with.

In the case of a stretching spasm, the flexible connection between the backrest in the lumbar region and the mounting of the seat 3 on its front edge enables these two surfaces to be stretched to form a common support surface which merges into the straight line. The seat 3 , which is set in its forward inclination, stands out from the buffer 11 and from the stop angle 2 of the base plate 1 . Due to the rigid seat 3 (buttock support surface 3.1 ), which is drawn up into the lumbar region, the joint 8 with the articulated backrest 5 is raised upwards and forwards to an approximately extended support surface. The joint 8 becomes an active lumbar support. This enables a disabled person to experience an attack with less stress and less risk of injury without overloading or switching off the restraining device. In particular, the luxation tendency of the hip joints is considerably restricted by the lumbar support. At the same time, this support triggers the body's own neurophysiological reactions in the event of a spastic attack. This causes an extension of the abdominal muscles, which has an afferent effect on the overexcited extensor muscles through triggered afferents. When a hypertonic phase subsides, the body of the disabled person is gently returned to the normal sitting position due to its own gravity due to the decrease in tension in the abdominal muscles.

The webbing 13 , which is attached to the seat 3 and is guided over the stop bracket 2 through the slot 13.3 (see FIG. 2), limits the seat adjustment of the seat 3 to the front and leads it back to the set starting position.

List of the reference symbols used

1

Base plate

2nd

Stop angle

2.1

Slot

2.2

Clamping screw

3rd

Seat

3.1

Buttock support surface

4th

Side guide

5

backrest

5.1

Constriction

6

Pad

6.1

Pad mounting

7

joint

8th

Lumbar joint

9.1

Swivel lever

9.2

Swivel lever

10th

Lever bearing

11

buffer

12th

Tether slot

13

Webbing

13.1

Webbing attachment

13.2

Clamp closure

13.3

slot

14

slot

14.1

Gag

15.1

Strap (elastic)

15.2

Strap (elastic)

16

Clamp closure

16.1

Clamp closure

16.2

Clamp closure

17th

Bayonet lock

18th

Strap (elastic)

19th

Clamp closure

20th

Abduction wedge

20.1

Spring clip

20.2

Clamping screw

21

slot

22

Slit (for trousers)

Claims (10)

1.Dynamic seat shell with pads for the stable fixation of physically handicapped persons, which can be mounted on wheelchairs and allows limited upper body movement to the front, on both sides, as well as a body extension in the stage of an attack (stretching spasm), with the seat shell in the area of the front edge of its seat is tiltable at the front, characterized in that the backrest ( 5 ) of the seat shell is flexibly separated in the lumbar region transversely to its longitudinal axis, the lower part of the backrest being firmly connected to the seat surface ( 3 ) in the form of a seat support surface ( 3.1 ) and in that the Torax pads ( 6 ) are supported laterally by means of swivel levers ( 9 ) relative to the longitudinal axis of the seat shell in a common lever bearing ( 10 ) at the level of the lumbar region of the pivotable part of the backrest ( 5 ) and that their adjustment path by means of elastic tensioning means ( 15 ) compared to that Backrest ( 5 ) be is bordered. 2. Dynamic seat shell with pads according to claim 1, characterized in that the pivot levers ( 9.1 , 9.2 ) are mounted on the back of the backrest ( 5 ). 3. Dynamic seat shell with pads according to claim 1, characterized in that between the free ends of the pivot levers ( 9.1 , 9.2 ) and the backrest ( 5 ) adjustable elastic straps ( 15.1 , 15.2 ) are attached and that the pivot levers ( 9.1 , 9.2 ) support each other in the tensioned state of the pads ( 6 ) in a positive and non-positive manner. 4. Dynamic seat shell with pads according to claim 1, characterized in that the pivot levers ( 9.1 , 9.2 ) above the lever bearing ( 10 ) are clamped together directly by an elastic element, preferably by a tensioning strap ( 18 ), which is open when the pads ( 6 ) is located below the lever bearing ( 10 ). 5. Dynamic seat shell with pads according to claim 1, characterized in that the pads ( 6 ) are individually height-adjustable on pivoting levers ( 9.1 , 9.2 ). 6. Dynamic seat shell with pads according to claim 1, characterized in that the base plate ( 1 ) on the side facing away from the joint ( 7 ) carries a height-adjustable stop ( 2 ) with elastic buffer ( 11 ) for the seat surface ( 3 ). 7. Dynamic seat shell with pads according to claim 1, characterized in that the base plate ( 1 ) and the seat surface ( 3 ) are braced by at least one adjustable elastic belt ( 13 ). 8. Dynamic seat shell with pads according to claim 1, characterized in that the backrest ( 5 ) for the pads ( 6 ) is constricted according to their pivoting range to the center. 9. Dynamic seat shell with pads according to claim 1, characterized in that the backrest ( 5 ) for the pads ( 6 ) according to their pivoting range with respect to the lever bearing ( 10 ) has circular window slots. 10. Dynamic seat shell with pads according to claim 1, characterized in that the pivot levers ( 9 ) for support on the backrest ( 5 ) carry PE sliding elements.