HK1239503B - Orthosis for range of motion - Google Patents

Description

Range of motion orthotics

public domain

The present disclosure relates generally to orthoses for treating a subject's joints, and particularly to orthoses for increasing the range of motion of a subject's joints.

Public background

In human joints, the range of motion of a joint depends on the anatomy and pathology of the joint, and on the specific genetics of each individual. Many joints move primarily in flexion or extension, although some joints are also capable of varying degrees of rotational movement. Flexion is the bending of a joint and extension is the straightening of a joint; however, in orthopedic practice, some joints only flex. Some joints (such as the knee) may exhibit slight internal or external rotation during flexion or extension. Other joints (such as the elbow or shoulder) not only flex and extend, but also exhibit more rotational ranges of motion, which allow them to move in multiple planes. The elbow joint, for example, is capable of supination and pronation, which is the rotation of the hand around the longitudinal axis of the forearm, with the palm facing up or the palm facing down. Similarly, the shoulder is capable of a combination of movements such as abduction, internal rotation, external rotation, flexion, and extension.

When a joint is injured due to trauma or surgery, scar tissue may form or the tissue may contract and therefore limit the range of motion of the joint. For example, adhesions may form between tissues, and the muscle itself may contract in the case of persistent muscle contracture or tissue hypertrophy (such as capsular tissue or skin tissue). Loss of range of motion may also be caused by trauma such as excessive temperature (e.g., thermal burns or chemical burns) or surgical trauma, so that tissue planes that normally slide past each other may adhere together, thereby significantly limiting motion. Adhered tissue may be caused by chemical bonding, tissue hypertrophy, proteins such as actin or myosin in the tissue, or simply by bleeding and fixation. This condition can often be alleviated and even corrected by the use of a range of motion (ROM) brace.

ROM braces are used during physical rehabilitation to increase the range of motion of human joints. They can also be used for tissue transport, bone elongation, traction of skin or other tissues, tissue fascia, etc. When used to treat a joint, the device is usually attached to the body part on the opposite side of the joint so that it can apply force to oppose contraction and thus move the joint.

A variety of different configurations and approaches can be used to increase the range of motion of a joint. For example, stress relaxation technology can be used to apply a variable force to a joint or tissue while in a constant position. "Stress relaxation" is the reduction in force over time in a material that is pulled and held at a constant length. When a tissue is held in a fixed position over time, relaxation occurs due to fiber realignment and material elongation. Treatments that use stress relaxation are casts and static splinting. An example of a device that utilizes stress relaxation is the JAS EZ brace from Joint Active Systems, Inc. of Effingham, IL.

The sequential application of the stress relaxation technique known as static progressive traction ("SPS") uses the biomechanical principles of stress relaxation to restore the range of motion (ROM) in joint contractures. SPS is an incremental application of stress relaxation—traction to a position to allow tissue force to decrease as the tissue is pulled, and then further traction of the tissue by moving the device to a new position—constant displacement is repeatedly applied using variable force. In the SPS protocol, an orthosis is fitted around the patient's joint. The orthosis is operated to pull the joint until there is tissue/muscle resistance. The orthosis maintains the joint in this position within a set time period (e.g., five minutes), thereby allowing stress relaxation. Subsequently, the orthosis is operated to incrementally increase the traction in the tissue and again remains in place within a set time period. The process of incrementally increasing the traction in the tissue continues, with the pattern repeating for a maximum total task time, e.g., 30 minutes. The protocol can be performed by increasing the time period, the total treatment time, or by increasing the task daily. In addition, the applied force can also be increased.

Another treatment approach uses the principle of creep to continuously apply force within a variable displacement. In other words, techniques and devices that utilize the principle of creep involve continuous deformation under the application of a fixed load. For tissue, the deformation and elongation are continuous but slow (taking hours to days to achieve plastic deformation), and the material is maintained in a constant state of stress. Treatment methods such as traction therapy and dynamic splinting therapy are based on the properties of creep.

In one aspect, an orthosis for increasing the range of motion of a human joint generally includes a first body part securing member configured to be secured to a first body part associated with the human joint, and a second body part securing member configured to be secured to a second body part associated with the human joint. First and second dynamic force mechanisms are operatively connected to the respective first and second body part securing members and configured to simultaneously apply dynamic forces to the respective first and second body parts.

In another aspect, an orthosis for increasing the range of motion of a human joint generally includes a first body part securing member configured to be secured to a first body part associated with the human joint; a second body part securing member configured to be secured to a second body part associated with the human joint; and an actuator mechanism. First and second linkage mechanisms operably connect the respective first and second body part securing members to the actuator mechanism and are configured to transmit force from the actuator mechanism to the respective first and second body part securing members to impart movement of the first and second body part securing members relative to each other. The first and second linkage mechanisms include respective first and second crank connecting rods.

Other features will be in part apparent and in part pointed out hereinafter.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG1 is a perspective view of one embodiment of an orthosis for use in treating a stretched human joint;

FIG2 is a front view of an orthosis including a first cuff and a second cuff driven in a flexion direction;

FIG3 is a partially exploded view of a portion of the actuator mechanism and linkage mechanism of the orthosis;

FIG4 is an exploded view of the transmission assembly of the actuator mechanism and the portion of the linkage mechanism;

FIG5 is a top view of the transmission assembly of the actuator mechanism and the portion of the linkage mechanism;

FIG6 is an exploded view of the orthosis showing the linkage and dynamic force mechanisms exploded from the actuator mechanism;

FIG7 is an exploded view of the brace showing the crank connecting rod exploded from the remainder of the linkage;

FIG8 is an exploded view of the drive assembly of the actuator mechanism;

FIG9 is an enlarged top view, partially in section, of the clutch mechanism of the drive assembly;

FIG10 is an exploded view of the orthosis showing the dynamic force mechanism broken out from the corresponding linkage mechanism;

FIG11 is a front view of an orthosis comprising a first cuff and a second cuff driven in an extension direction;

FIG12 is similar to FIG11 , wherein the spring of the dynamic force mechanism is loaded by pivoting the crank connecting rod;

FIG13 is another embodiment of an orthosis for use in treating a flexed human joint;

FIG14 is a front view of an orthosis comprising a first cuff and a second cuff driven in an extension direction;

FIG15 is a front view of an orthosis comprising a first cuff and a second cuff driven in a flexion direction;

FIG16 is similar to FIG15 , wherein the spring of the dynamic force mechanism is loaded by pivoting the crank connecting rod;

FIG17 is an enlarged top view, partially in section, of the clutch mechanism of the orthosis;

FIG18 is a perspective view of another embodiment of an orthosis for use in treating a human joint in extension;

FIG19 is a front view of an orthosis comprising a first cuff and a second cuff driven in a flexion direction;

FIG20 is an exploded view of the orthosis showing the linkage and dynamic force mechanisms exploded from the actuator mechanism;

FIG21 is an exploded view of the brace showing the crank connecting rod exploded from the remainder of the linkage;

FIG22 is a perspective view of a second dynamic force mechanism;

FIG23 is a right elevational view of the second dynamic force mechanism;

FIG24 is an exploded view of a second dynamic force mechanism;

FIG25 is a front view of an orthosis comprising a first cuff and a second cuff driven in an extension direction;

FIG26 is similar to FIG11 , wherein the spring of the dynamic force mechanism is loaded by pivoting the crank connecting rod;

FIG27 is a perspective view of another embodiment of an orthosis for use in treating a flexed human joint;

FIG28 is a front view of an orthosis including a first cuff and a second cuff driven in an extension direction;

FIG29 is a perspective view of a second dynamic force mechanism;

FIG30 is a right elevational view of the second dynamic force mechanism;

FIG31 is an exploded view of a second dynamic force mechanism;

FIG32 is a front view of an orthosis including a first cuff and a second cuff driven in a flexion direction;

FIG33 is similar to FIG11 , wherein the spring of the dynamic force mechanism is loaded by pivoting of the crank connecting rod; and

34 is an enlarged top view, partially in section, of another embodiment of a clutch mechanism of a drive assembly.

Corresponding reference characters indicate corresponding parts throughout the drawings.

Public details

With reference to Figures 1 and 2, an orthosis for treating a joint of a patient is generally indicated by reference numeral 10. The general structure of the orthosis shown in Figures 1 and 2 is suitable for treating a hinge joint (e.g., knee joint, elbow joint, and ankle joint) or an elliptical joint (e.g., wrist joint, finger joint, and toe joint) of the body. Specifically, the configuration of the orthosis 10 shown in Figures 1 and 2 is suitable for increasing the range of motion of the human joint of extension, although as shown in Figures 13-16 and explained in more detail below, in other configurations, the orthosis is suitable for increasing the range of motion of the human joint of flexion. In addition, Figures 18-26 illustrate another embodiment that is suitable for increasing the range of motion of the human joint of extension, and Figures 26-33 illustrate another embodiment that is suitable for increasing the range of motion of the human joint of flexion. These other embodiments are explained in more detail below. The various teachings of the orthosis set forth herein are also suitable for treating orthoses for other joints, including but not limited to shoulder joint and radius-ulnar joint. Thus, in other embodiments, the teachings of the illustrated orthosis can be adapted to increase the range of motion of human joints in adduction and/or abduction (e.g., the shoulder joint) or pronation and/or supination (e.g., the radioulnar joint), among other joints. The illustrated embodiment is adapted to apply dynamic traction or load to the joint. It should be understood that the embodiment can be modified to apply static traction or load to the joint, such as by omitting the dynamic force mechanism described below.

Referring to Figures 1 and 2, brace 10 is a dynamic traction brace that includes first and second dynamic force mechanisms, generally designated 12 and 14, respectively, for applying dynamic traction to respective first and second body parts on opposite sides of a human joint. An actuator mechanism, generally designated 16, is operably connected to first and second linkage mechanisms, generally designated 20 and 22, respectively, for transmitting force to the respective first and second dynamic mechanisms 12 and 14 and loading the dynamic force mechanisms during use, as explained in greater detail below. As shown in Figure 2, first and second cuffs (broadly, body part securing members), generally designated 24 and 26, respectively, are secured to the respective first and second dynamic mechanisms for coupling the body part thereto. Each cuff 24, 26 may include a plastic shell 30, an inner liner 32 comprising a soft, pliable material, at least one strap 34 secured to the plastic shell for securing the body part to the cuff, and an associated loop 36. The straps may include hook and loop fasteners as are commonly known in the art.Other ways of attaching the cuffs 24, 26 to the desired body part on the opposite side of the joint do not depart from the scope of the present invention.

In one non-limiting example, the first cuff 24 may be configured to couple to a thigh portion of a subject, and the second cuff 26 may be configured to couple to a lower leg portion of the subject to treat the subject's knee joint. In another non-limiting example, the first cuff 24 may be configured to couple to an upper arm portion of a subject, and the second cuff 26 may be configured to couple to a lower arm portion of the subject to treat the subject's elbow joint. In yet another non-limiting example, the first cuff 24 may be configured to couple to a lower arm portion of a subject, and the second cuff 26 may be configured to couple to a hand portion of a subject to treat the subject's wrist joint. In another non-limiting example, the first cuff 24 may be configured to couple to a lower leg portion of a subject, and the second cuff 26 may be configured to couple to a foot portion of a subject to treat the subject's ankle joint. It should be understood that the first cuff 24 and the second cuff 26 may be configured to couple to other body parts to treat other joints of the subject without departing from the scope of the present invention.

In one or more embodiments, one or more of the cuffs 24, 26 can be further configured to apply a compressive force to the corresponding body part to increase blood flow and/or inhibit thrombosis in the body part. In one example, the one or more cuffs 24, 26 can be configured to apply sequential compression therapy to the corresponding body part. The one or more cuffs 24, 26 can include a sleeve that includes one or more inflatable balloons. The one or more inflatable balloons can be configured to be in fluid communication with a source of pressurized fluid (e.g., air) for delivering the pressurized fluid to inflate the one or more balloons. The one or more cuffs can be configured to apply compression to the corresponding body part in other ways.

As will be understood from the following disclosure, the orthosis 10 (as well as other orthosis embodiments disclosed herein) can be used as a combined dynamic and static progressive traction orthosis. It should be understood that in other embodiments, the dynamic force mechanism can be omitted without departing from the scope of the present invention, thereby making the orthosis 10 suitable as a static traction or static progressive traction orthosis by utilizing the actuator mechanism 16 and/or linkage mechanism of the orthosis shown. Furthermore, it should be understood that in other embodiments, the orthosis 10 can include the dynamic force mechanism shown while omitting the actuator mechanism and/or linkage mechanism shown.

3-5 , the actuator mechanism 16 includes a drive assembly, generally indicated at 38, and a transmission assembly (e.g., a gearbox), generally indicated at 40, which is operably connected to the drive assembly. The transmission assembly 40 is contained within a transmission housing 42, and a portion of the drive assembly 38 extends outside the transmission housing. The drive assembly 38 includes a rotatable input shaft 46, a knob 48 accessible from outside the transmission housing 42, and a clutch mechanism, generally indicated at 54, which operably connects the knob to the input shaft to transmit torque from the knob to the input shaft. (More details of the clutch mechanism 54 are shown in FIG8 and FIG9 and disclosed below.) The knob 48 and the input shaft 46 are rotatable about a common input axis A1 ( FIG1 ). The knob 48 is configured to be grasped by a user (e.g., a subject) and rotated about the input axis to impart rotation to the input shaft 46 about the input axis. It should be understood that the input shaft 46 may be operably connected to a prime mover, such as an electric motor or engine, for rotating the input shaft, rather than the knob 48 or other component for manual operation of the brace 10. The drive assembly 38 may have other configurations without departing from the scope of the present invention.

Still referring to Figures 3-5, the transmission assembly 40 includes an input gear 56 connected to the input shaft 46, a reduction gear 58, an output shaft 60, and an output gear 62. The input gear 56 is rotatable about the input shaft, while the reduction gear 58, the output shaft 60, and the output gear 62 are each rotatable about a common output axis A2 (Figure 4). In the illustrated embodiment, the output axis is generally parallel to the input axis, although the axes may be arranged in other orientations relative to each other. The input gear 56 is connected to the end of the input shaft 46 and rotates with the input shaft about the input axis. In turn, the input gear 56 is operatively connected to (i.e., meshes with) the reduction gear 58 to drive the reduction gear to rotate about the output axis. One end of the output shaft 60 is fixed to the reduction gear 58 and the other end is fixed to the output gear 62, so that rotation of the reduction gear 58 about the output axis imparts axial rotation to the output shaft, which in turn imparts axial rotation to the output gear. The reduction gear 58 is configured to reduce the rotational speed transmitted from the input gear 56 to the output gear 62 while increasing the torque transmitted from the input gear to the output gear. In the illustrated embodiment, the reduction gear 58 has a larger diameter (and more teeth) than the input gear 56, thus forming a simple single-stage gear reduction system. It should be understood that the transmission mechanism may have other configurations or may be omitted from the orthosis 10 without departing from the scope of the present invention.

6 and 7 , each of the first and second linkages 20 and 22 includes a sliding link 72, a yoke link 74, a crank link generally designated 76, and a fixed link 78. The first and second linkages 20 and 22 can have similar configurations, although the sizes of the components of the respective linkages can vary slightly depending on the human joint being treated. As shown in FIGS. 3-5 , in the illustrated embodiment, the sliding link of each of the first and second linkages 20 and 22 is operably connected to the output gear 62 of the transmission assembly 40. Specifically, each of the first and second sliding links 72 meshes with the output gear 62 to form a double rack and pinion mechanism, whereby the sliding link is configured as a rack and the output gear is configured as a pinion. The sliding links 72 are slidably received in the transmission housing 42 such that the linear tooth sets 82 extending along the respective sliding links are in opposing relation, with the output gear 62 (i.e., the pinion) disposed between the linear tooth sets. When driven by rotation of the knob 48, rotation of the output gear 62 (i.e., the pinion) about the output axis imparts linear movement in opposite directions to the first and second sliding links 72. Specifically, as shown in FIG2 , rotation of the knob 48 in a first direction (e.g., clockwise) about the input axis (as indicated by arrow R1) moves the sliding links along a linear path in an opposite first direction (e.g., indicated by arrow D1), and as shown in FIG11 , rotation of the knob in a second direction (e.g., counterclockwise) about the input axis (as indicated by arrow R2) moves the sliding links along a linear path in an opposite second direction (e.g., indicated by arrow D2). Thus, the illustrated actuator mechanism 16 is configured as a linear actuator mechanism that converts rotational movement (e.g., rotation of the knob 48) into linear movement of the first and second sliding links 72. The sliding links 72 extend out of opposite ends of the transmission housing 42 through respective first and second openings 86, 88.

The first and second yoke links 74, 74 are fixed to the ends of the respective first and second sliding links 72, 72 outside the transmission housing 42. In the illustrated embodiment, the yoke links 74 are fastened (e.g., bolted) to the respective first and second sliding links 72, 72, although it should be understood that the yoke links can be formed integrally with the first and second sliding links. By separating the yoke links 74 from the sliding links 72, yoke links 74 of different sizes/configurations can be interchanged on the orthosis 10 to accommodate different human joint sizes and/or different human joints. Each of the yoke links 74 defines a slotted opening 90 having a length that extends generally transversely (e.g., orthogonally) to the length and linear path of the respective first and second sliding links.

Still referring to Figures 6 and 7, the first and second crank links 76 of the respective first and second linkages 20 and 22 are generally L-shaped, each having a first crank arm 94 (or first pair of arms) operatively (i.e., slidingly) connected to the respective yoke link, and a second crank arm 96 (or second pair of arms) extending outwardly from the first crank arm in a direction generally transverse to the length of the first crank arm. A yoke pin 97 is slidably received in a slotted opening 90 of the respective yoke link 74 to secure the terminal end of the first crank arm 94 to the yoke link, thereby allowing the first crank arm to slide relative to the respective yoke link. The first and second crank links 76 are rotatably (e.g., pivotally) attached to the terminal ends of the respective first and second fixed links 78, generally adjacent to the junction of the first and second crank arms 94 and 96. Specifically, the fixed link pin 98 pivotally connects the first crank 76 and the second crank 76 to the corresponding first fixed link 78 and the second fixed link 78 so that the crank links 76 can rotate about the pivot axis PA1 (Figures 2 and 11). The other ends of the fixed links 78 are fixedly fixed to the underside of the transmission housing 42, such as by fasteners 100 (e.g., screws). In the illustrated embodiment, the position of the fixed links 78 on the transmission housing 42 is adjustable to change the distance d (Figure 2) between the pivot axes of the first crank links 76 and the second crank links 76 to accommodate different sizes of joints and body parts and/or different joints.

In operation, rotation of the knob 48 imparts rotation to the input shaft 46 and the input gear 56 about the input axis. Rotation of the input gear 56 imparts rotation to the reduction gear 58, thereby imparting rotation to the output gear 62 (i.e., the pinion gear). The rotation of the pinion gear, in turn, imparts linear movement to the first and second sliding links 72, 72. Referring to FIG2 , rotation of the knob 48 in a first direction (e.g., clockwise as viewed in FIG2 ) imparts linear movement to the first and second sliding links 72, 72, thereby causing the yoke links 74 to move away from each other to increase the distance between the yoke links. Moving the yoke links 74 away from each other imparts rotation to the first and second cranks 76, 76 about the pivot axis in a flexion direction (broadly, a first direction) as indicated by arrow R4, thereby causing the second crank arm 96 to pivot toward each other and the first crank arm 94 to slide along the slotted opening 90 as indicated by arrow D4. As the second crank arm 96 pivots toward each other in the flexion direction, the angle α between the cuff 24 and the axis of the cuff 26 (and the second crank arm) decreases. Referring to FIG. 11 , in the illustrated embodiment, rotation of the knob 48 in the second direction (e.g., counterclockwise as viewed in FIG. 11 ) imparts linear movement to the first and second sliding links 72, 72, thereby moving the yoke links 74 toward each other to reduce the distance between the yoke links. As shown in FIG. 11 , moving the yoke links 74 toward each other imparts rotation of the first and second cranks 76, 76 about the pivot axis in the extension direction (broadly, the second direction), as indicated by arrow R3, thereby pivoting the second crank arms 96 away from each other and causing the first crank arms 94 to slide along the slotted opening 90, as indicated by arrow D3. As the second crank arms 96 pivot away from each other in the extension direction, the angle α between the cuff 24 and the axis of the cuff 26 (and the second crank arm) increases. Thus, the actuator mechanism 16 and the linkage mechanism are used to adjust the angular position of the first and second cuffs 24, 26 relative to each other to facilitate extension and flexion of a human joint. As can also be seen in Figures 2 and 11, the intersection of the axes of the cuffs 24, 26 (i.e., the effective pivot point of the cuffs) moves as the cuffs pivot about the pivot axis PA1.

10 and 11 , the first and second dynamic force mechanisms 12 and 14 are operably connected to the respective first and second cranks 76, 76. In the illustrated embodiment, the dynamic force mechanisms are generally configured as levers, each including a lever arm 104 pivotally connected to a respective one of the cranks 76 via a lever pivot pin 106 serving as a fulcrum. A force element 108 applies a force to the respective lever arm 104 to cause the lever arm to pivot about a pivot axis PA2 and relative to the respective crank 76 (more specifically, the second crank arm 96 of the crank). In the illustrated embodiment, the force element 108 is a spring (e.g., a compression spring) mounted on a respective spring mount 110 secured to the respective lever arm 104. The illustrated spring mount 110 includes a shaft 112 having a first end secured to the respective lever arm, and a head 114 spaced apart from the lever arm 104 at a second end of the shaft. The shaft 112 of the spring mount 110 extends through a slotted opening 116 in the second crank arms 96 of the first and second cranks 76. In the illustrated embodiment, the spring 108 is received on the mount shaft 112 and captured between the respective heads 114 of the spring mount 110 and the respective second crank arms of the cranks 76. In one embodiment, the spring mount 110 may comprise a bolt. As shown in FIG11 , with this configuration, the lever arms 104 are biased away from each other and toward the respective second crank arms 96 in a biasing direction indicated by arrow R5, such that the lever arms are in a collapsed position relative to the respective second crank arms. In the illustrated embodiment, the lever arms 104 nest with the respective second crank arms 96 to allow the lever arms to be generally parallel to the second crank arms in the collapsed position. As shown in FIG12 , from the collapsed position, the lever arms 104 can pivot toward each other about a pivot axis, as indicated by arrow R6, against the force of the spring 108 in the loading direction, and away from the respective second crank arms 96 toward an extended position. The pivoting of the lever arm 104 about the pivot axis adjusts the angle between the cuffs 24, 26 (and the lever arm 104) independently of the movement of the linkage and actuator mechanisms 16, and loads the spring 108 to apply a dynamic force to the human joint as indicated by the spring force F1 in Figure 12. Thus, the pivoting of the lever arm 104 also adjusts the angular position of the first and second cuffs 24, 26 relative to each other independently of the movement of the linkage and actuator mechanisms 16, so as to facilitate extension and flexion of the human joint.

The brace 10 also includes an anti-backup mechanism for inhibiting movement of the crank 76 in at least one of the extension and flexion directions independently of the drive assembly 38. In other words, the anti-backup mechanism inhibits rotation of the crank 76 about its corresponding pivot axis PA1 in at least one of the extension and flexion directions without operating the drive assembly 38. As described above, the embodiment shown in Figures 1-12 is configured to increase the range of motion of a human joint in extension. For reasons explained in more detail below when discussing the use of the brace 10, the anti-backup mechanism of this embodiment is configured to inhibit rotation of the crank 76 in at least the flexion direction independently of the drive, so that when the body part is secured to the cuffs 24, 26, the position of the crank in extension is maintained against forces exerted by the human joint that bias the crank in flexion. Furthermore, the anti-backup mechanism is configured to allow rotation of the crank 76 in the extension direction independently of the drive. As explained in more detail below, this allows the position of the extended crank 76 (and the ferrules 24, 26) to be quickly set without operating the actuator. In one or more embodiments disclosed herein, the anti-backup mechanism can be configured to inhibit rotation of the crank 76 in both directions (i.e., both flexion and extension). An example of such a configuration is shown in FIG34 and explained below, and it should be understood that such a configuration can be incorporated into the devices of FIG1-12 and other embodiments disclosed herein.

In the illustrated embodiment, the anti-backup mechanism is integrated with the drive assembly 38, although in other embodiments, the anti-backup mechanism may be integrated or associated with other components of the brace 10, including but not limited to the transmission mechanism and/or the linkage mechanism. The illustrated anti-backup mechanism includes a clutch mechanism 54. Referring to Figures 8 and 9, the clutch mechanism 54 is a one-way clutch mechanism (broadly speaking, a one-way anti-rotation device) that interconnects the knob 48 to the input shaft 46 via the knob shaft 122. The one-way clutch mechanism 54 is contained within a clutch housing 123 that is connected to the transmission housing 42. The clutch mechanism 54 includes a hub 124 fixed to the knob shaft 122, an outer ring 126 fixedly fixed to the transmission housing 42, an inner ring 128 (e.g., two inner ring members) disposed within the outer ring and fixedly connected to the input shaft 46, and a roller 130 (e.g., a cylinder) located between the inner and outer rings. The inner ring 128 is rotatable within the outer ring 126 about the input axis. The hub 124 includes fingers 132 (e.g., three fingers) spaced about the input axis for connecting the hub to the inner ring 128. The inner ring 128 includes radially extending stops 136 (e.g., three stops) spaced about the input axis. Disposed between adjacent stops 136 are first and second roller recesses 138 adjacent to the respective stops, and a finger recess 140 intermediate and adjacent the roller recesses 138. A rib on each of the hub fingers 132 is slidably received in a corresponding one of the finger recesses 140 to connect the hub to the inner ring 128. The roller 130 is received in one of the first and second roller recesses 138, 138.

In operation, the one-way clutch allows torque to be transferred from the knob 48 to the input shaft 46 when the knob is rotated in either direction. When torque is applied to the hub 124 by rotating the knob 48, the hub fingers 132 transfer the torque to the inner ring 128. In the illustrated embodiment, with the rollers 130 received in the first roller recesses 138, torque applied to the hub 124 in a first direction (e.g., counterclockwise) imparts rotation to the inner ring 128, whereby the stops 136 move toward and engage the rollers 130, moving the rollers along the inner wall of the outer ring 126 and rotating the inner ring and input shaft 46 about the axis of rotation. Torque applied to the hub 124 in a second direction (e.g., clockwise) causes the hub fingers 132 to move toward the rollers 130, moving the rollers along the inner wall of the outer ring 126 and rotating the inner ring 128 and input shaft 46 about the axis of rotation. Thus, rotation of the knob 48 in either direction imparts rotation of the input shaft 46 about the axis of rotation via the one-way clutch.

The one-way clutch also allows torque to be transmitted from the input shaft 46 to the knob 48 in one direction, thereby allowing the crank arm to pivot in one direction about the pivot axis without operating the knob, and inhibits torque from being transmitted from the input shaft to the knob in the opposite direction, thereby inhibiting the crank arm from pivoting in the opposite direction about the pivot axis without operating the knob. When torque is applied to the input shaft 46 from the linkage (e.g., torque is applied to the input shaft without operating the knob 48), the input shaft transmits the torque to the inner ring 128. In the illustrated embodiment, with the roller 130 received in the first roller recess 138, as shown, torque applied to the input shaft 46 in a first direction (e.g., counterclockwise) imparts rotation to the inner ring 128, whereby the stop 136 moves toward the roller and engages the roller to move the roller along the inner wall of the outer ring 126 and rotate the inner ring and the knob 48 about the rotation axis. Torque applied to input shaft 46 in a second direction (e.g., clockwise) causes inner ring 128 to move relative to outer ring 126 and independently of roller 130. As inner ring 128 moves independently of roller 130, the notched portion of the inner ring engages roller 130 and pushes the roller against the inner wall of outer ring 126, thereby creating interference between the roller and the outer ring, thereby inhibiting relative movement between inner ring 128 and outer ring 126. Thus, torque applied to input shaft 46 in one direction through the linkage mechanism imparts rotation of inner ring 128 relative to outer ring 126, thereby allowing ferrules 24, 26 to move in one direction without operating knob 48, while torque applied to the input shaft in the opposite direction through the linkage mechanism does not impart rotation of inner ring 128 relative to outer ring, thereby inhibiting movement of crank 76 (and therefore ferrule) in the opposite direction without operating the knob.

As disclosed above, the configuration of the brace 10 shown in Figures 1-12 is suitable for increasing the range of motion of an extended human joint. In an exemplary method of use, a first body part is secured to a first cuff 24, and a second body part, for example, on the opposite side of the joint, is secured to a second cuff. As a non-limiting example, in the embodiment shown in Figure 1, a thigh or upper arm portion can be secured to the first cuff 24 and a calf or lower arm portion can be secured to the second cuff for treating an extended knee or elbow joint. In the illustrated embodiment, straps and hook-and-loop fasteners on the straps are used to secure the body parts to the cuffs 24, 26. With the body parts secured to the respective cuffs 24, 26, the subject extends the human joint to a desired initial position of extension, such as a position recommended by a healthcare professional, and/or to the maximum initial position of extension to which the subject can move the human joint. As described above, the one-way clutch allows the crank 76 to rotate in the extension direction without operating the knob 48, so that extension of the human joint causes the crank to rotate to the initial angular position in the extension direction R3. Furthermore, the one-way clutch prevents the crank 76 from rotating in the flexion direction R4 without operating the knob 48 (i.e., the one-way clutch prevents the crank from "backing off" in the flexion position). In another example, the desired initial rotational position of the crank 76 can be set, for example, by applying force to the crank using a person's hand prior to donning the brace 10. With the crank 76 in the desired initial angular position, the cuffs 24, 26 can be secured to the corresponding body part to position the human joint in the desired initial position of extension.

With the body part secured to the brace 10 and the human joint in the desired initial position of extension, the knob 48 is rotated to impart rotation to the crank 76 in the extension direction. At a certain point in the human joint's range of motion in extension (e.g., in the human joint's initial extended position), rotation of the crank 76 in the extension direction does not impart further extension to the human joint because the stiffness of the human joint overcomes the biasing force of the spring 108. Thus, when the lever arm and the cuff are with the body part, further rotation of the crank 76 in the extension direction causes the crank's second crank arm 96 to move away from the lever arm 104 and the cuffs 24, 26 secured thereto (e.g., relative pivoting of the lever arm and the cuff in the direction R6). As the crank's second crank arm 96 pivots away from the lever arm 104 about the pivot axis PA2 in the direction R6, the spring 108 elastically deforms (e.g., compresses) on the spring mount 110, as shown in FIG. The elastic deformation of the spring 108 generates a dynamic force (as indicated by force F1) on the lever arm 104 that biases the lever arm toward the corresponding second crank arm 96 of the crank 76, which in turn generates a biasing force of the spring 108 on the body part in the extension direction R5. Further pivoting of the crank 76 by turning the knob 48 increases the angular distance between the second crank arm and the corresponding lever arm 104, thereby increasing the dynamic force imparted by the spring 108 on the body part in the extension direction. The crank 76 is pivoted to a suitable treatment position, wherein the biasing force of the spring 108 is continuously applied to both sides of the human joint in the extension direction. The application of this biasing force utilizes the principle of creep to continuously pull the joint tissue over a set time period (e.g., 4-8 hours), thereby maintaining, reducing, or preventing tissue relaxation.

As described above, in other embodiments, an orthosis can be configured to increase the range of motion of a flexed human joint. Referring to Figures 13-17, such an orthosis embodiment for increasing the range of motion of a flexed human joint is generally indicated by reference numeral 210. Except as disclosed below, the orthosis 210 is substantially identical to the orthosis 10 and includes the same components indicated by corresponding reference numerals.

Because the brace 210 is configured to increase the range of motion of a human joint in flexion, the crank connecting rod 276 differs from the crank connecting rod 76 of the first embodiment in that the angle between the first crank arm 294 and the second crank arm 296 is greater than the angle between the first crank arm 94 and the second crank arm 96 of the first brace 10. This allows for a greater range of motion in flexion.

Because the orthosis 210 is configured to increase the range of motion of a flexed human joint, the one-way clutch mechanism 254 is also configured differently than the clutch mechanism 54 of the first orthosis 10, such that the present clutch mechanism is configured to inhibit rotation of the crank 76 in at least the extension direction independently of the drive, so that when the body part is secured to the cuffs 224, 226, the flexed crank position is maintained against the force exerted by the human joint that biases the crank in the extension direction. As shown in FIG17 , the clutch mechanism 254 is substantially similar to the clutch mechanism 54 of the first orthosis 10, except for the position of the roller 130. In this embodiment, the roller 130 is received in the second recessed portion of the inner ring 128, such that torque applied to the input shaft 46 in a first direction (e.g., clockwise) imparts rotation to the inner ring, whereby the stop 136 moves toward the roller and engages the roller, thereby moving the roller along the inner wall of the outer ring 126 and rotating the inner ring and the knob 48 about the rotation axis. Torque applied to input shaft 46 in a second direction (e.g., counterclockwise) causes inner ring 128 to move relative to outer ring 126 and independently of roller 130. As inner ring 128 moves independently of roller 130, the notched portion of inner ring 128 engages roller 130 and pushes the roller against the inner wall of outer ring 126, thereby creating interference between the roller and the outer ring, thereby inhibiting relative movement between inner ring 128 and outer ring 126. Thus, torque applied to input shaft 46 in one direction through the linkage mechanism imparts rotation of inner ring 128 relative to outer ring 126, thereby allowing crank connecting rod 276 to move in one direction (e.g., extension direction R3) without operating knob 48, while torque applied to the input shaft in the opposite direction (e.g., flexion direction R4) through the linkage mechanism does not impart rotation of inner ring 128 relative to outer ring, thereby inhibiting movement of crank 76 in the opposite direction without operating the knob. As described above, in one or more embodiments disclosed herein, the anti-backup mechanism can be configured to inhibit rotation of the crank 76 in both directions (i.e., both flexion and extension). An example of such an embodiment of the anti-backup mechanism is generally indicated by reference numeral 354 in FIG. 34 . The anti-backup mechanism is similar to the anti-backup mechanisms 54 and 254 , with corresponding reference numerals indicating like components. The primary difference is that the roller 130 is received in both the first and second recessed portions of the inner ring 128 so that torque applied to the input shaft 46 in either a first direction (e.g., clockwise) or a second direction (e.g., counterclockwise) causes the inner ring to move relative to the outer ring 126 and independently of the roller 130. When the inner ring 128 moves independently of the roller 130, the recessed portion of the inner ring engages the roller and pushes the roller against the inner wall of the outer ring 126, thereby creating interference between the roller and the outer ring, thereby inhibiting relative movement between the inner and outer rings. Therefore, the knob 48 must be operated to rotate the crank link 276 in either direction. This embodiment may be combined with the apparatus of Figures 1-12 and the apparatus of Figures 13-17 as well as other embodiments disclosed herein.

Because the orthosis 210 is configured to increase the range of motion of a flexed human joint, the first and second dynamic force mechanisms 212 and 214 are configured such that the force element 108 (e.g., a compression spring) applies a force to the corresponding lever arm 104 to cause the lever arm to pivot in a biasing direction R6 about the pivot axis PA2 and relative to the corresponding crank 276 (more specifically, the second crank arm of the crank), unlike the first and second dynamic force mechanisms 12 and 14 of the first orthosis 10. The spring is received on the shaft 112 of the mounting member and captured between the corresponding lever arm 104 and the corresponding second crank arm of the crank 276. As shown in FIG. 16 , from the extended position, the lever arms 104 can be pivoted about the pivot axis away from each other and toward the corresponding second crank arm to a collapsed position, as indicated by arrow R5, against the force of the spring in the loading direction. The pivoting of the lever arm 104 about the pivot axis adjusts the angle between the cuffs 224, 226 (and the lever arm) independently of the movement of the linkage and actuator mechanisms, and loads the spring to apply a dynamic force to the human joint as indicated by the spring force F2 in Figure 16. Thus, the pivoting of the lever arm 104 also adjusts the angular position of the first cuff 224 and the second cuff 226 relative to each other independently of the movement of the linkage and actuator mechanisms 216 to facilitate extension and flexion of the human joint.

The orthosis 210 for increasing the range of motion in flexion is used in a manner similar to the orthosis 10, except that the springs of the first dynamic force mechanism 212 and the second dynamic force mechanism 214 are loaded when the crank link 276 is pivoted in the flexion direction. The crank link 276 is pivoted to a suitable treatment position, wherein the biasing force of the springs is continuously applied to both sides of the human joint in the flexion direction. The application of this biasing force utilizes the principle of creep to continuously pull the joint tissue over a set period of time (e.g., 4-8 hours), thereby maintaining, reducing, or preventing tissue laxity.

Referring to Figures 18 and 19, another embodiment of an orthosis for increasing the range of motion of a human joint in extension is generally indicated by reference numeral 310. Unless otherwise noted below, this embodiment has the same or substantially similar components as the first embodiment disclosed in Figures 1-12. For example, components of the orthosis 310 that are identical or substantially identical to corresponding components of the first orthosis 10 include, but are not limited to: an actuator mechanism, generally indicated at 316, including its drive assembly 338, generally indicated at 338, and its transmission assembly 340 (not visible); and first and second cuffs, generally indicated at 324 and 326, respectively. As explained in more detail below, the primary difference between the present orthosis 310 and the first orthosis 10 is that the force elements 408 of the first and second dynamic force mechanisms 312, 314, respectively, of the present orthosis are different from the force elements 108 of the first orthosis. Specifically, and as explained below, the force elements 408 of the current orthosis 310 are configured to apply torque, rather than the linear force applied by the force elements 108 of the first orthosis. In the illustrated embodiment, each force element 408 comprises a torsion spring, although the force elements 408 may be of other types for applying torque. Because the current orthosis 310 utilizes torsion elements 408—rather than the linear force elements 108 of the first orthosis 10—the first and second linkage mechanisms 320, 322, respectively, differ from their counterparts in the first orthosis, and the first and second dynamic force mechanisms 312, 314, respectively, differ from their counterparts in the first orthosis. These differences are described below.

20 , each of the first and second linkage mechanisms 320, 322 includes a sliding link 372, which may be identical to or substantially similar to sliding link 72; a yoke link 374, which may be identical to or substantially similar to yoke link 74; a crank link, generally indicated at 376, which is different from crank link 76; and a fixed link 378, which may be identical to or substantially similar to fixed link 78. The first and second crank links 376, 376 of the respective first and second linkage mechanisms 320, 322 are generally L-shaped, each having a first crank arm 394 (or a first pair of arms) operatively (i.e., slidingly) connected to the corresponding yoke link, and a second crank arm 396 (or a second pair of arms) extending outwardly from the first crank arm in a direction generally transverse to the length of the first crank arm. 20 , a yoke pin 397 is received in a slotted opening 390 of a corresponding yoke link 374 to slidably secure the terminal end of the first crank arm 394 to the yoke link, thereby allowing the crank link 376 to slide relative to the corresponding yoke link. As with the first orthosis 10 , the first and second crank links 376 are rotatably (e.g., pivotally) attached to the terminal ends of the corresponding first and second fixed links 378 , 378 , generally adjacent to the junction of the first and second crank arms 394 , 396 . Specifically, the fixed link pin 398 pivotally connects the first and second cranks 376 , 376 to the corresponding first and second fixed links 378 , 378 , such that the crank links can rotate about a pivot axis PA1 ( FIG. 19 ). Rotation of the knob 348 (e.g., operation of the actuator assembly 316) imparts rotation of the first crank link 376 and the second crank link 376 about the pivot axis PA1 to adjust the angular position of the first and second ferrules 324, 326 relative to each other to facilitate extension and flexion of the human joint in substantially the same manner as described above with respect to the brace 10.

21 and 22 , the first and second dynamic force mechanisms 312 and 314 are operably connected to respective first and second cranks 376 and 376. In the illustrated embodiment, the dynamic force mechanisms 312 and 314 include levers, generally designated 400, each including a first lever arm 404a to which the corresponding collar 324 and 326 are secured, and a second lever arm 404b extending transversely (e.g., orthogonally) relative to the first arm portion. Each lever 400 is pivotally connected to a corresponding one of the crank links 376 via a lever pivot pin 406 (serving as a fulcrum) generally located at the junction of the first and second arm portions 404a and 404b. The levers 400 may also be considered cranks.

The force element 408 applies a force to the corresponding lever 400 to pivot the lever about the pivot axis PA2 and relative to the corresponding crank link 376 (more specifically, the second crank arm 396 of the crank). In the illustrated embodiment, the force element 408 is a spring (e.g., a torsion spring) mounted on the corresponding crank link 376. Specifically, each force element 408 is received on a spring drum or mounting member 325, and the spring drum is secured to the corresponding crank link 376 by passing the lever pivot pin 406 through the drum. The first spring arm 408a (Figures 22-24) of each spring 408 engages the base plate 327 of the corresponding crank link 376, and the second spring arm 408b of each spring engages the second lever arm 404b. More specifically, the second spring arm 408b engages the rod 331 or other structure of the second lever arm 404b to transmit torque to the second lever arm when the torsion spring 408 elastically deforms (e.g., when the spring twists or buckles). As shown in FIG25 , with this configuration, the first lever arms 404a are biased away from each other and toward the respective second crank arm links 376 in a biasing direction, as indicated by arrow R5, such that the first lever arms are in a collapsed position relative to the respective second crank arms 396. In the illustrated embodiment, the first lever arms 404a are nested with the respective second crank arms 396 to allow the first lever arms to be generally parallel to the second crank arms in the collapsed position. As shown in FIG26 , from the collapsed position, the first lever arms 404a can pivot toward each other about pivot axis PA2 and away from the respective second crank arms toward the extended position, as indicated by arrow R6, against the second spring arms 408a and against the biasing force or torque of the springs 408 in the loading direction. The pivoting of the first lever arm 404a about the pivot axis PA2 adjusts the angle between the cuffs 324, 326 (and the first lever arm) independently of the movement of the linkage mechanisms 320, 322 and the actuator mechanism 316, and loads the torsion spring 408 to apply a dynamic force to the human joint in the direction R5 as shown in Figure 25. Therefore, the pivoting of the lever 404 also adjusts the angular position of the first cuff 324 and the second cuff 326 relative to each other independently of the movement of the linkage mechanism and the actuator mechanism 316, so as to facilitate extension and flexion of the human joint.

As disclosed above, the configuration of the brace 310 is suitable for increasing the range of motion of a human joint in extension. The method of operation is substantially similar to that described above with respect to the brace 10, and further details are referred to above. With the body part secured to the brace 310 and the human joint in a desired initial position of extension (such as described above with respect to the operation of the first brace 10), the knob 348 is rotated to impart rotation to the crank link 376 in the extension direction. At a certain point in the human joint's range of motion in extension (e.g., in the human joint's initial extended position), rotation of the crank link 376 in the extension direction does not impart further extension to the human joint because the stiffness of the human joint overcomes the biasing force of the spring 408. Therefore, when the lever arm and cuff are in contact with the body part, further rotation of the crank link 376 in the extension direction causes the second crank arm 396 of the crank link to move away from the first lever arm and the cuffs 324, 326 secured to the first lever arm 404a (e.g., relative pivoting of the lever arm and cuff in direction R6). When the second crank arm 396 of the crank link 376 pivots in the direction R6 about the pivot axis PA2 away from the first lever arm 404a, the rod 331 of the second lever arm 404b pushes against the second spring arm 408b, and the spring elastically deforms (e.g., twists or distorts) on the spring drum 325, as shown in FIG26. The elastic deformation of the spring 408 generates a dynamic force, more specifically, a dynamic torque, on the second lever arm 404b that biases the first lever arm 404a toward the corresponding second crank arm 396 of the crank link 376. This, in turn, generates a biasing torque of the spring on the body part in the extension direction R5. Further pivoting of the crank link 376 by rotating the knob 348 increases the angular distance between the second crank arm 396 and the corresponding first lever arm portion 404a, thereby increasing the dynamic torque imparted by the spring 408 on the body part in the extension direction. The crank link 376 is pivoted to a suitable treatment position, wherein the biasing torque of the spring 408 is continuously applied to both sides of the human joint in the extension direction. The application of this biasing torque utilizes the principle of creep to continuously pull the joint tissue over a set period of time (e.g., 4-8 hours), thereby maintaining, reducing or preventing tissue relaxation.

27-33, another embodiment of an orthosis for increasing the range of motion of a flexed human joint is generally indicated by reference numeral 410. Except as disclosed below, the orthosis 410 is identical or substantially identical to the orthosis 310, except that the orthosis is configured to increase the range of motion of a flexed human joint and, therefore, some components are slightly different, as described below. In addition, the actuator mechanism 416 is substantially identical to the actuator mechanism 216 of the second embodiment 210.

Because the brace 410 is configured to increase the range of motion of a human joint in flexion, the crank connecting rod 476 differs from the crank connecting rod 76 of the first embodiment in that the angle between the first crank arm 494 and the second crank arm 496 is greater than the angle between the first crank arm 394 and the second crank arm 396 of the similar brace 310. This allows for a greater range of motion in flexion.

Because the orthosis 210 is configured to increase the range of motion of a flexed human joint, the first and second dynamic force mechanisms 412 and 414 are configured such that a force element 508 (e.g., a torsion spring) applies a torque to the corresponding lever arm 504 to cause the lever arm to pivot in the biasing direction R6 about the pivot axis PA2 and relative to the corresponding crank link 476 (more specifically, the second crank arm of the crank link) to an extended position, unlike the first and second dynamic force mechanisms 312 and 314 of the first orthosis 310. To this end, each spring 508 is mounted on the corresponding crank link 476 using a spring drum 425 and a lever pivot pin 506, similar to the other orthosis 310. The first spring arm 508a engages the base plate 429 of the corresponding lever arm 504, and the second spring arm 508b engages the second crank arm 496 of the corresponding crank link 476. Specifically, first spring arm 508a extends through an opening in bottom plate 427 of second crank arm 496 and engages bottom plate 429 of lever arm 504 to apply a spring force to the lever arm. Second spring arm 508b engages rod 431 of second crank arm 496.

As shown in FIG33 , from the extended position, the lever arms 504 can be pivoted in the load direction about pivot axis PA2 away from each other and toward the corresponding second crank arm against the force of spring 508, as indicated by arrow R5. The pivoting of the lever arms 504 about pivot axis PA2 adjusts the angle between the ferrules 424, 426 (and the lever arms) independently of the movement of the linkage and actuator mechanisms 416, and loads the springs to apply dynamic torque to the human joint in direction R6. Thus, the pivoting of the lever arms 504 also adjusts the angular position of the first and second ferrules 424, 426 relative to each other independently of the movement of the linkage and actuator mechanisms 416, so as to facilitate extension and flexion of the human joint.

The orthosis 410 for increasing the range of motion in flexion is used in a manner similar to the orthosis 310, except that the springs of the first dynamic force mechanism 412 and the second dynamic force mechanism 414 are loaded when the crank link 476 is pivoted in the flexion direction. The crank link 476 is pivoted to a suitable treatment position, wherein the biasing force of the springs is continuously applied to both sides of the human joint in the flexion direction. The application of this biasing force utilizes the principle of creep to continuously pull the joint tissue over a set period of time (e.g., 4-8 hours), thereby maintaining, reducing, or preventing tissue laxity.

When introducing elements of the present invention or the preferred embodiments thereof, the articles "a", "an", "said" are intended to mean that there are one or more of the elements. The terms "comprising", "including" and "having" are intended to be inclusive and mean that there may be additional elements other than the listed elements.

In view of the above, it will be seen that the several objects of the invention are achieved and other advantageous results attained.

As various changes could be made in the above constructions, products and methods without departing from the scope of the invention, it is intended that all matter contained in the above description and shown in the accompanying drawings shall be interpreted as illustrative and not in a limiting sense.

Claims (17)

1. An orthosis for increasing the range of motion of human joints, the orthosis comprising: A first body part fixing member is configured to be fixed to a first body part associated with a human joint; A second body part fixing member is configured to be fixed to a second body part associated with the human joint; A first dynamic force mechanism and a second dynamic force mechanism are operably connected to the respective first body part fixing member and the second body part fixing member, and are configured to simultaneously apply dynamic forces to the respective first body part and the second body part. The first dynamic force mechanism and the second dynamic force mechanism include corresponding first springs and second springs that offset the corresponding first body part fixing member and the corresponding second body part fixing member toward or away from each other about the corresponding first pivot axis and the corresponding second pivot axis. 2. The orthotics of claim 1, further comprising an actuator mechanism operatively connected to the first dynamic force mechanism and the second dynamic force mechanism, and configured to selectively transmit applied forces to the first dynamic force mechanism and the second dynamic force mechanism. 3. The orthotics of claim 2, wherein the actuator mechanism includes a drive assembly and a transmission assembly operatively connected to the drive assembly. 4. The orthotics of claim 3, wherein the drive assembly includes an input shaft, and the transmission assembly includes a gearbox, wherein the input shaft is operatively connected to the gearbox. 5. The orthotics of claim 4, wherein the gearbox includes an input gear operably connected to the input shaft, a reduction gear meshing with the input gear, and an output gear operably connected to the reduction gear. 6. The orthotics of claim 2, further comprising a first linkage mechanism and a second linkage mechanism, the first linkage mechanism and the second linkage mechanism being operatively connected to the first dynamic force mechanism and the second dynamic force mechanism to transmit the applied force from the actuator mechanism to the first dynamic force mechanism and the second dynamic force mechanism. 7. The orthotics of claim 6, wherein the first linkage mechanism and the second linkage mechanism include respective first sliding links and second sliding links operably connected to the actuator mechanism, wherein operation of the actuator mechanism imparts linear movement of the first sliding link and the second sliding link in opposite directions. 8. The orthosis of claim 7, wherein the first linkage mechanism and the second linkage mechanism include a corresponding first crank-connecting rod and a second crank-connecting rod operably connected to the corresponding first dynamic force mechanism and the second dynamic force mechanism. 9. The orthosis of claim 8, wherein the first dynamic force mechanism and the second dynamic force mechanism include respective first lever arms and second lever arms pivotally connected to the respective first crank connecting rod and second crank connecting rod for rotation about the respective first pivot axis and second pivot axis. 10. The orthotics of claim 9, wherein the first spring and the second spring bias the first lever arm and the second lever arm toward or away from the corresponding first crank connecting rod and the second crank connecting rod about the respective first pivot axis and the second pivot axis. 11. The orthotics of claim 10, wherein the first lever arm and the second lever arm comprise a corresponding first crank and a second crank. 12. The orthotics of claim 9, wherein the first linkage mechanism and the second linkage mechanism include corresponding first yoke links and second yoke links fixedly connected to the corresponding first sliding link and second sliding link, wherein the first crank link and the second crank link are connected to the corresponding first yoke links and second yoke links. 13. The orthotics of claim 12, wherein the first linkage mechanism and the second linkage mechanism include corresponding first fixed link and second fixed link fixedly connected to the actuator mechanism, wherein the first crank link and the second crank link are pivotally fixed to the corresponding first fixed link and the second fixed link. 14. The orthotics of claim 6, wherein the first linkage mechanism and the second linkage mechanism include a corresponding first crank link and a second crank link operably connected to the respective first dynamic force mechanism and the second dynamic force mechanism of the actuator mechanism. 15. The orthosis of claim 14, wherein the first dynamic force mechanism and the second dynamic force mechanism include respective first lever arms and second lever arms pivotally connected to the respective first crank connecting rod and second crank connecting rod for rotation about the respective first pivot axis and second pivot axis. 16. The orthosis of claim 15, wherein the first spring and the second spring bias the first lever arm and the second lever arm toward or away from the corresponding first crank connecting rod and the second crank connecting rod about the respective first pivot axis and the second pivot axis. 17. The orthotics of claim 16, wherein the first lever arm and the second lever arm comprise respective first cranks and second cranks.