METHODS AND GYROSCOPIC APPARATUS FOR REHABILITATION

TRAINING RELATED APPLICATIONS

This application is related to U.S. Provisional Application No. 60/542,022 filed on February 5, 2004, U.S. Provisional Application No. 60/566,078 filed on April 29, 2004, U.S.

Provisional Application No. 60/566,079 filed on April 29, 2004, U.S. Provisional Application

No. 60/604,615 filed on August 25, 2004, U.S. Provisional Application No. 60/633,428 filed on December 7, 2004, U.S. Provisional Application No. 60/633,429 filed on December 7,

2004 and U.S. Provisional Application No. 60/633,442 filed on December 7, 2004. This application is also related PCT Application PCT/IL2005/000138 filed on February 4, 2005,

PCT Application PCT/IL2005/000137 filed on February 4, 2005, PCT Application

PCTAL2005/000135 filed on February 4, 2005, PCT Application PCT/IL2005/000139 filed on

February 4, 2005, PCT Application PCT/IL2005/000136 filed on February 4, 2005, PCT

Application PCT/IL2005/000140 filed on February 4, 2005, and PCT Application PCT/IL2005/000141 filed on February 4, 2005, the disclosures of these applications incorporated herein by reference.

FIELD OF THE INVENTION

The present invention relates to manipulation of a body, for example for physical rehabilitation and/or training. BACKGROUND OF THE INVENTION

After accidents or strokes, people often need a prolonged rehabilitation process in an attempt to recapture some or all of the body function damaged in the accident or stroke. Such rehabilitation may include one or both of physical rehabilitation, in which damaged or unused muscles, nerves and/or joints are brought back to full functioning (to the extent possible) and cognitive rehabilitation, in which the cognitive ability to control the body is restored. In some cases, the damage to the body and/or brain is such that a patient needs to be trained in modified functionality (e.g., when one limb is made short) or even new functionality, for example, in the use of an artificial limb.

Physical therapy is currently provided mainly by personal attention of a physical therapist who monitors and instructs a patient in the performance of certain exercises. Thus, costs for rehabilitation are high and compliance after a patient leaves a treatment center is relatively low.

Some home physical therapy devices are known, for example US patent 5,466,213, the

disclosure of which is incorporated herein by reference, describes a rehabilitation system using a robotic arm.

Another physical therapy device is known from US patent 6,007,500, the disclosure of which is incorporated herein by reference. This patent discloses a shoulder, rotator cuff and elbow stretching machine. The apparatus adjusts to allow internal and external rotation stretching of the shoulder at levels of abduction from 45 degrees to 100 degrees and allows that stretch to be accomplished at various levels of horizontal adduction and abduction.

US patent 7,204,814 and US application 2004/0243025, the disclosures of which are incorporated herein by reference, describe a portable orthotic system that performs predefined or user-controlled limb movements, collects and displays data regarding limb movement and data analysis results in real time.

An article in Journal of Rehabilitation Research and Development, Vol. 37 No. 6,

November/December 2000, titled "Development of robots for rehabilitation therapy: The Palo

Alto VA/Stanford experience", by Charles G. Burgar, MD; Peter S. Lum, PhD; Peggy C. Shor, OTR; H.F. Machiel Van der Loos, PhD, the disclosure of which is incorporated herein by reference, describes usage of robots for rehabilitation.

SUMMARY OF THE INVENTION

An aspect of some embodiments of the invention relates to a rehabilitation device which guides a hand or arm of a patient through a series of movements. Conventionally such movements cause bending, rotating torsional and/or flexing forces applied to the hand and/or arm. Such forces can be painful or even counterproductive in establishing a desired motion pattern. The movements are generally established by attaching an arm of a patient to an attachment platform and/or by the hand holding or being attached to a hand attachment device.

This aspect is related to an arm attachment which provides and/or permits movement of the hand and/or arm in one, two, three or more degrees of freedom to provide a stable and/or comfortable position and/or orientation to the hand and/or arm to counter bending, rotating, torsional (i.e. torque) and/or flexing forces applied to the hand and/or arm during exercise.

Optionally, movement is provided and/or permitted simultaneously in the one, two, three or more degrees of freedom, hi an embodiment of the invention, the movement of the arm attachment is adapted to counter the bending, rotating, torsional (i.e. torque) and/or flexing forces applied to the hand and/or arm during exercise such that the hand and/or arm can remain in a "neutral" condition during exercise (this movement is similar to that of a gyroscope), for example "neutral" being the position and/or orientation of the hand and/or arm prior to the

commencement of exercise movement. In some embodiments of the invention, the arm attachment is adapted to counter exercise movement but to provide and/or permit arm and/or hand movement while in a non-neutral position. hi an embodiment of the invention, a first degree of freedom corresponds to rotation of the arm and/or hand about the longitudinal axis of an arm attachment platform located on the arm attachment, hi some embodiments of the invention, a second degree of freedom corresponds to rotation of the arm attachment about a longitudinal axis of the patient's arm. hi some embodiments of the invention, a third degree of freedom corresponds to rotation about a vertical axis (i.e. longitudinal axis of a rehabilitation device arm). Optionally, an additional degree of freedom is provided comprising rotation about a pitch axis, hi some embodiments of the invention, these degrees of freedom are alternative to or in addition to degrees of freedom provided by the rehabilitation device itself, for example x, y and/or z axis movement. Movement of the patient's arm and/or hand is performed freely by the patient or automatically and fully by the rehabilitation device or anything along the spectrum of controlled/guided movement in between. In some embodiments of the invention, the arm attachment is adapted to counter exercise movement but to permit arm and/or hand movement while in a non-neutral position, for example if a non-neutral position of the hand and/or arm would be desirable for patient rehabilitation, hi some embodiments of the invention, the rehabilitation device guides the patient to perform a motion with a desired spatial trajectory and/or with an appropriate orientation of the patient's hand and/or arm, by the device applying one or more pushing, assisting, reminding, responding and/or resisting forces during a motion (or intent to move) by the patient. Optionally, a desired spatial trajectory and/or orientation includes rotation and/or torsion of at least portion of the patient in at least one of the degrees of freedom. In an exemplary embodiment of the invention, the forces are applied by motor. In some embodiments of the invention, the portions of the arm attachment that are automatically controlled by the motor are the same as those which allow the patient to freely move, with a difference being that the motor is not used when the patient is moving freely (i.e. without assistance from the rehabilitation device).

There is thus provided in accordance with an exemplary embodiment of the invention, an apparatus for exercise, comprising: an arm attachment base, comprising at least an arm attachment platform provided with movement in at least one degree of freedom; and, at least one of an arm attachment and an arm attachment component connected to the arm attachment platform and adapted for use in conjunction with at least a portion of a patient, wherein during

apparatus motion during exercise, at least one of the arm attachment and the arm attachment component move with the portion of the patient in the at least one degree of freedom to provide a neutral condition to the portion of the patient. Optionally, the at least one degree of freedom is rotation about a longitudinal axis of the arm attachment platform. Optionally, the at least one degree of freedom is rotation about an axis coinciding with a longitudinal axis of the portion of the patient. Optionally, the at least one degree of freedom is rotation about a vertical axis. Optionally, the at least one degree of freedom is rotation about a pitch axis.

In an embodiment of the invention, at least one of the arm attachment and the arm attachment component are provided with a motor to provide at least assisted movement to the patient. hi some embodiments of the invention, at least one the arm attachment and the arm attachment component are moved by the patient.

Optionally, the arm attachment component is a hand plate.

Optionally, the arm attachment component is a hand grip. Optionally, the arm attachment component is a forearm support.

Optionally, the arm attachment component is an expandable hand grip. hi some embodiments of the invention, the arm attachment includes an attachment link and at least one of the hand plate, the hand grip, the expandable hand grip and the forearm support. Optionally, at least one of the arm attachment and the arm attachment component are interchangeably connected to the arm attachment platform.

In an embodiment of the invention, the apparatus further comprises a controller programmed to provide the exercise to the patient via the apparatus. hi an embodiment of the invention, the apparatus further comprises at least one sensor for monitoring at least one of the arm attachment, at least a portion of the patient and the arm attachment component in communication with the controller. Optionally, the controller is configured to provide feedback to the patient via the apparatus. Optionally, the controller is configured to analyze data from the at least one sensor. Optionally, the at least one sensor is a force sensor. Optionally, the at least one sensor is a position sensor. Optionally, the at least one sensor is a velocity sensor. Optionally, the at least one sensor is an acceleration sensor.

Optionally, the at least one sensor is used to determine information regarding at least one of: the arm attachment; at least a portion of the patient; and, the arm attachment component; with respect to the apparatus.

In an embodiment of the invention, the arm attachment platform is provided with movement by a motor in communication with a controller.

There is further provided in accordance with an embodiment of the invention, a method for providing exercise to a patient, comprising: positioning patient within an exercise apparatus comprising an arm attachment platform connected to at least one of an arm attachment and an arm attachment component such that the at least one of an arm attachment and an arm attachment component are provided with movement in at least one degree of freedom; and, commencing exercise of the patient, wherein a movement of the exercise apparatus of at least a portion of the patient in the at least one degree of freedom is accompanied by simultaneous movement of the at least one arm attachment and arm attachment component in the at least one degree of freedom to provide a neutral condition to the portion of the patient. Optionally, movement of at least the portion of the patient is around a longitudinal axis of the arm attachment platform. Optionally, the movement of the at least portion of the patient is around a longitudinal axis of that portion. Optionally, the movement of the at least portion of the patient is around a vertical axis. Optionally, the movement of the at least portion of the patient is rotation about a pitch axis.

In an embodiment of the invention, commencing exercise of the patient is controlled at least partially by a controller. Optionally, commencing exercise of the patient is controlled entirely by a controller. In an embodiment of the invention, the method further comprises monitoring the exercise performed by the patient. Optionally, the method further comprises providing feedback to the patient based on the monitoring.

In an embodiment of the invention, the arm attachment platform which is in rotating joint within the arched rack, is supplied with a removable and turning connector means for the arm attachment and arm attachment component. The arched rack is supplied with angle scales on the both sides of the arch and with the angle scales on external surfaces on the both ends of the arch near the longitudinal axis of the arm attachment platform.

In an embodiment of the invention, the arched rack is supplied by first manual turning and fixing means for turning and fixing the arm attachment platform near its longitudinal axis. In an embodiment of the invention, the arched rack is rotary mounted in a support means which is supplied with an angle scale on its top near the vertical axis of turning of the arched rack.

In an embodiment of the invention, the arched rack is manually moved and is supplied

by the manually fixed means. This support means may be supplied by the second manual turning and fixing means for turning and fixing the arched rack near the vertical axis. The support means also may be supplied with the bayonet elements on its external cylindrical surface for connection with an attachment interface and with means for fixing on the attachment interface.

BRIEF DESCRIPTION OF THE FIGURES

Non-limiting embodiments of the invention will be described with reference to the following description of exemplary embodiments, in conjunction with the figures. The figures are generally not shown to scale and any sizes are only meant to be exemplary and not necessarily limiting. In the figures, identical structures, elements or parts that appear in more than one figure are preferably labeled with a same or similar number in all the figures in which they appear, in which:

Fig. 1 shows an arm attachment base which provides sensing, control and/or feedback for one or more degrees of motion of a hand and/or arm of a patient, in accordance with an exemplary embodiment of the invention;

Fig. 2 shows an arm attachment including a forearm support and a hand plate, in accordance with an exemplary embodiment of the invention;

Fig. 3 shows an arm attachment including a forearm support and a hand grip, in accordance with an exemplary embodiment of the invention; Fig. 4 shows an arm attachment including a hand plate, in accordance with an exemplary embodiment of the invention;

Fig. 5 shows an arm attachment including a hand grip, in accordance with an exemplary embodiment of the invention;

Fig. 6A shows an arm attachment including a closed, expandable hand grip, in accordance with an exemplary embodiment of the invention;

Fig. 6B shows an arm attachment including an open, expandable hand grip, in accordance with an exemplary embodiment of the invention;

Fig. 7 shows an arm attachment being used in combination with a ball-based rehabilitation device, in accordance with an exemplary embodiment of the invention; Fig. 8A is a flowchart of a method of using a rehabilitation device, in accordance with an exemplary embodiment of the invention; and,

Fig. 8B is a flowchart of a long term use of a rehabilitation device, in accordance with an exemplary embodiment of the invention;

Figs. 9-10 show a manually controllable arm attachment base and support means for one or more degrees of motion of a hand and/or arm of a crew or a patient, showing visual graduations and/or scales, in accordance with an exemplary embodiment of the invention.

DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS General

Currently, exercise apparatuses provide arm attachments that have a fixed orientation, during motion regardless of rotation, position change or torsion of a patient's hand and/or arm caused by the motion. Such an arrangement can cause unnecessary and/or undesired stress to the hand and/or arm during exercise. In an embodiment of the invention, exercise of the patient is facilitated by providing an arm attachment which simultaneously moves (e.g. rotates, tracks) in one, two, three or more degrees of freedom to provide a stable and/or comfortable position and/or orientation to the patient's hand and/or arm to counter to the bending, rotating, torsional (i.e. torque) and/or flexing forces typically applied to the patient's hand and/or arm during exercise. For example, motion of the handle of the rehabilitation device depicted in Fig. 7, below, could potentially cause patient's hand to be subjected to torsional and/or other forces which are undesirable for patient exercise, however by providing an arm attachment, such as described herein, desired movement of the hand and/or arm is achieved despite the angular movement of the rehabilitation device relative to the patient by permitting and/or providing movement to the hand and/or arm in one, two, three or more degrees of freedom. In an embodiment of the invention, permitting and/or providing movement to the hand and/or arm in one, two, three or more degrees of freedom allows the hand and/or arm to remain in a "neutral" position during exercise, for example "neutral" being the position and/or orientation of the hand and/or arm prior to the commencement of device exercise movement. In some embodiments of the invention, the arm attachment is adapted to counter exercise movement but to permit arm and/or hand movement while in a non-neutral position, for example if a non- neutral position of the hand and/or arm would be desirable for patient rehabilitation.

The methods and apparatus of some embodiments of the invention provide for controlled, partially controlled, directed motion, assisted motion and/or free motion of portions of the body, particularly the hand and/or arm. The following sections describe this equipment by first describing the design of an exemplary general device (an attachment and/or handle for a patient's arm and/or hand), followed by additional rehabilitation device designs and/or features and then various rehabilitation methods. The invention should not be considered as being limited to particular devices used to illustrate particular methods. Rather, many of the

δ methods can be practiced with a variety of devices and many of the devices can be used to practice a variety of methods.

An Exemplary Arm Attachment Base

Referring to Fig. 1, an arm attachment base 100 which provides sensing, control and/or feedback for one or more degrees of motion of a hand and/or arm of a patient is shown, in accordance with an exemplary embodiment of the invention. Arm attachment base 100 is comprised of a plurality of components which are adapted to provide an arm attachment platform 102 with motion in one, two, three or more degrees of freedom, in some embodiments of the invention. It should be understood that motion of arm attachment base 100 and/or arm attachment platform 102 is wholly controlled by a patient (i.e. free motion), partially controlled by the patient (i.e. assisted motion) or is not controlled by the patient (i.e. the rehabilitation device controls the patient's movements). In an embodiment of the invention, arm attachment platform 102 is adapted to removably and/or interchangeably connect to arm attachments such as those described with respect to Figs. 2-6B, below. Optionally, arm attachment platform 102 is provided with at least one connector 110 at least adapted for removably and/or interchangeably connecting an arm attachment to arm attachment platform 102.

In an embodiment of the invention, arm attachment platform 102 is situated on an arched rack 104 between two sides of the arch created by arched rack 104 such that arm attachment platform 102 rotates (or is rotatable) about the longitudinal axis 106 of arm attachment platform 102 (i.e. the first degree of freedom described in the Summary section). Optionally, arched rack 104 forms half of a circle, wherein arm attachment platform 102 is mounted on arched rack 104 at the diameter of the circle. In some embodiments of the invention, a motor 108 is used to provide motion to arm attachment platform 102 about longitudinal axis 106. Optionally, motor 108 is a DC motor. In an embodiment of the invention, at least one sensor, such as a position encoder and/or a potentiometer, is provided to detect degree and/or speed of rotation of arm attachment platform 102 about longitudinal axis 106. The at least one sensor is in operative communication with a controller in some embodiments of the invention. In an embodiment of the invention, arched rack 104 is positioned within an arch mount

112. Arch mount 112 is used in some embodiments of the invention to provide a controllably slidable connection between arch mount 112 and arched rack 104. In an embodiment of the invention, arch mount 112 and arched rack 104 move 114 in relation to each other around an

axis 128 which coincides with a central axis of the patient's arm (i.e. the second degree of freedom described in the Summary section). Optionally, the slidable connection keeps arm attachment platform 102 horizontal in relation to the floor. Movement 114 of arch mount 112 in relation to arched rack 104 is optionally provided by a motor 116 which drives a toothed wheel (not shown) which engages notches or holes 118 in arched rack 104 to impart movement to arched rack 104. It should be understood that the toothed wheel embodiment is merely an example, for instance a screw mechanism could be used to impart movement to arched rack 104. Optionally, motor 116 is a DC motor. In some embodiments of the invention, at least one sensor is provided to monitor direction and/or amount of movement and/or speed of arched rack 104 in relation to arch mount 112. The at least one sensor is in operative communication with the controller in some embodiments of the invention.

In some embodiments of the invention, arch mount 112 is provided with a yaw pivot mechanism (not shown) which provides rotation to arch mount 112 around a vertical axis 120 (i.e. the third degree of freedom described in the Summary section). Optionally, the yaw rotation is controlled by a motor, for example a DC motor. In an embodiment of the invention, at least one sensor is provided to monitor the degree and/or speed of rotation of arch mount 112 about vertical axis 120. The at least one sensor is in operative communication with a controller in some embodiments of the invention.

Arm attachment base 100 includes a pitch base 122, in some embodiments of the invention. Pitch base 122 is provided with a pivot mechanism which enables rotation of pitch base 122 about a pitch axis 124 (i.e. an optional fourth degree of freedom described in the Summary section). In an embodiment of the invention, rotation of pitch base 122 also causes arch mount 112, arch rack 104 and arm attachment platform 102 to rotate around axis 124 since they are all connected to one another. However, it should be noted that as a result of the various forms of motion provided to each of the components of arm attachment base 100, as described above, a wide range of motion is optionally afforded to the patient's hand/or arm being used with arm attachment base 100 regardless of the motion of pitch base 122. In some embodiments of the invention, the connection between arch mount 112 and pitch base 122 is the yaw pivot mechanism described above. As with other components, a motor 126 is optionally provided to pitch base 122 in order to enable motorized control of the rotation around axis 124. Optionally, at least one sensor is provided to monitor the amount and/or speed of rotation of pitch base 122 around axis 124. The at least one sensor is in operative communication with a controller in some embodiments of the invention.

Virtually any type of sensor, such as force, velocity, acceleration, and/or position, is capable of use with the components described herein, in various embodiments of the invention. In some embodiments of the invention, a plurality of sensors are used to determine information regarding position or motion of at least a portion of the patient, such as the hand or arm, with respect to attachment platform 102, arm attachment base 100, and/or a rehabilitation device generally, such as shown in Fig. 7 below.

In some embodiments of the invention, an assistant handle or grip 128 is provided to arm attachment base 100 to allow the patient and/or an attending medical professional to impart positioning or movement to arm attachment base 100 additionally or alternatively to the patient's hand and/or arm being used with the base 100. In an embodiment of the invention, an attachment interface 130 is provided to arm attachment base 100 in order to allow base 100 to be interchangeably and/or removably affixed to an exercise system, such as those described in WO 2005/074373, the contents of which are incorporated herein by reference, and/or below with respect to Fig. 7. In an embodiment of the invention, arm attachment base 100 is interchangeable with the attachments described with respect to Figs. 15A-F of WO 2005/074373.

Alternatively or additionally, each pivot mechanism and/or sliding connection is selectively lockable. In an exemplary embodiment of the invention, arm attachment base 100 (e.g., its locking and/or force application and/or movement) is controlled by a controller, for example a personal computer or a dedicated embedded computer. Optionally, a display and/or a user input device are used for interaction with the patient. Optionally, the display comprises (or is limited to) an audio display, for example for providing audible and/or speech instruction and/or feedback.

It should be noted that some implementations of arm attachment base 100 include no computer and/or controller. Some implementations require no electrical power. In one example, a mechanical computer is used to control the device parameters. In some embodiments of the invention, resistance to motion (optionally variable) is provided using a brake or hydraulic system. Exemplary Arm Attachment Embodiments Fig. 2, shows an arm attachment 200 including an attachment link 202, a forearm support 204 and a hand plate 206, in accordance with an exemplary embodiment of the invention. Attachment link 202 is optionally used when more than one arm attachment component (e.g. forearm support 204, hand plate 204, hand grip (described below)) is used in

combination with arm attachment base 100. In an embodiment of the invention, attachment link 202 is adapted to accommodate a plurality of components. Attachment link 202 is interchangeably and/or removably connected to arm attachment base 100 using the at least one connector 110 provided on base 100. hi some embodiments of the invention, universal connections are provided to the various arm attachment components, component link 202 and the arm attachment base 100 wherein the connections between the various arm attachment components and attachment link 202 mirror those between attachment link 202 and arm attachment base 100 or between the various arm attachment components and arm attachment base 100 (in embodiments where the arm attachment components are connected directly to the base 100, for example in Figs. 4, 5 and 6A-B). hi an exemplary embodiment of the invention, the at least one connector 110 provides one or more of mechanical fixation, power (e.g., electrical power) and data transfer, for example the at least one connector 110 includes a USB port for data transfer and/or a power coupling. Optionally, the at least one connection also provides identifying information about the arm attachment component and/or arm attachment being used. hi an embodiment of the invention, a patient's arm below the elbow is placed on forearm support 204 such that the patient's hand can be placed on hand plate 206. For example, the patient's wrist would approximately be located at the region between forearm support 204 and hand plate 206. Optionally, the patient's hand is placed palm-side down on hand plate 206, depending on the exercise being performed. Optionally, the patient's hand is placed palm-side up on hand plate 206, depending on the exercise being performed, hi some embodiments of the invention, the patient's hand and/or arm are removably fastened to the arm attachment, for example using Velcro straps. hi an embodiment of the invention, the various motions provided to arm attachment base 100 are extended to any arm attachments and/or arm attachment components located on base 100 via arm attachment platform 102 and/or pitch base 122 and/or arch mount 112 and/or arch rack 104. For example, a patient's arm positioned on forearm support 204 can rotate around the longitudinal axis 128 of the patient's arm and/or can pitch up or down around axis 124 and/or can rotate around vertical axis 120 and/or can rotate around longitudinal axis 106 of arm attachment platform 102. In an embodiment of the invention, at least one of these motions is performed during exercise. Optionally, all three of these motions are performed simultaneously during exercise to counter forces applied to the arm and/or hand by the rehabilitation device. Optionally, one or more of the motions described is supported by one or

more motors and/or controllable brakes.

In some embodiments of the invention (this and as well as others described herein), the arm attachment and/or the arm attachment components are used provide a sensation to the patient, for example, vibration, pricking, pinching or a surface texture. Electrical power may be provided to the arm attachment and/or the arm attachment components, as well as data, to generate and control such sensation. Surface texture may be varied, for example, by providing a smooth layer with an underlay that is bumpy and then extending the bumps or the bumpy layer, which will vary the surface texture.

Optionally, straps (not shown) are provided to the arm attachment and/or the arm attachment components in order to at least loosely secure the patient thereto during exercise.

Fig. 3 shows an arm attachment 300 which includes forearm support 204 and a hand grip 302 connected to attachment link 202, in accordance with an exemplary embodiment of the invention. Hand grip 302 is positioned by attachment link 202 such that a patient whose forearm is located in forearm support 204 can grip a handle 304 of hand grip 302. Optionally, the patient grips handle 304 in an over-hand position, whereby the patient's fingers extend in a counter-clockwise fashion around handle 304. Optionally, the patient grips handle 304 in an . under-hand position, depending on the exercise being performed, hi some embodiments of the, invention, such as that shown in Fig. 3, handle 304 may be maintained substantially parallel to . the floor, even during exercise, by using arm attachment base's 100 ability to provide movement to arm attachment 300, as described above. Optionally, handle 304 is maintained at any orientation determined to be effective for patient exercise, even if off a horizontal plane parallel to the floor.

In an embodiment of the invention, hand grip 302 is vertically oriented, like assistant handle 128 or the grip shown in Figs. 6 A and 6B described below, rather than horizontally oriented. Optionally, hand grip 302 assumes any orientation suitable for patient exercise. For example, hand grip 302 is optionally provided with adjustable orientation such as 0 (vertical),

45 and 90 degrees (horizontal), or any angle in between.

In some embodiments of the invention finger indentations are provided in handle 304.

An optional button for input from the patient is provided to handle 304, in some embodiments of the invention. Additional buttons may be provided and buttons may be provided in other embodiments as well. Optionally, handle 304 is squeezable (as it may be in other embodiments as well). One type of squeezable handle 304 includes a gas-filled bladder. Optionally, the

compression of the gas can be varied to change the resistive force. In an alternative embodiment, handle 304 is formed of two panels separated by one or more springs. hi an embodiment of the invention, forearm support 204 is used depending on the exercise needs and/or capabilities of the patient. For example, some patients may require forearm support because of an inability to control and/or hold up the forearm without assistance. Often this is the case after a severe stroke. In other cases, an attending therapist may decide that using a forearm support will provide the best rehabilitation or exercise result for the patient, hi some embodiments, as described below, forearm support 204 is not used.

Fig. 4 shows an arm attachment 400 which includes hand plate 206 connected directly to arm attachment platform 102, in accordance with an embodiment of the invention. The various forms of movement described with respect to Figs. 2-3 are also optionally used with arm attachment 400. Fig. 5 similarly shows an arm attachment component, hand grip 302, connected directly to arm attachment platform 102 without the need for attachment link 202, in accordance with an exemplary embodiment of the invention. In an embodiment of the invention, handle 304 and hand plate 206 are chosen for attachment to attachment base depending on the patient's ability to hold a handle or grip. For example, as a result of a stroke . a patient may not be ably to hold something like a handle or grip, so hand plate 206 is used.. Optionally, as the patient's rehabilitation progresses a handle or grip are substituted for hand plate 206. hi some embodiments of the invention, various arm attachments are used to manipulate hand movement such as by stimulating or enabling pinching, gripping, opening and/or closing of the hand. Fig. 6A shows an arm attachment component 600 with an expandable hand grip which is used to exercise a patient's grip, in accordance with an exemplary embodiment of the invention. Arm attachment component 600 is shown in a "closed" configuration, wherein a patient's hand gripping arm attachment component 600 would be substantially similar to a closed fist. In an embodiment of the invention, arm attachment component 600 is comprised of a grip base 602 and a grip expander 604. Grip base 602 does not move during the transition from a closed configuration to an open configuration, in some embodiments of the invention. Grip expander 604, however, transitions from a closed configuration to an open configuration by projecting outwardly in a direction 606 away from grip base 602, as shown in Fig. 6B. A patient's hand grasping arm attachment component 600 is forced towards an open condition by movement of grip expander 604, in accordance with an embodiment of the invention. A patient can return to a closed hand condition when grip expander 604 returns to the closed

configuration depicted in Fig. 6A. In an embodiment of the invention, a patient's hand is removably secured to arm attachment component 600 such that the patient's hand follows the opening and closing movement of arm attachment component 600. Optionally, the patient's hand is removably secured to arm attachment component 600 using a strap. While not shown in Figs. 6A and 6B, arm attachment component 600 is used with arm attachment base 100 and/or forearm support 204, in some embodiments of the invention. It should be understood that while arm attachment component 600 is shown without arm attachment base 100 or arm attachment platform 102, arm attachment component 600 is adapted for use with base 100 and platform 102 in order to provide manipulation of hand movement while the patient arm and/or hand is movable in one, two, three or more degrees of freedom.

Fig. 7 shows an exemplary rehabilitation device 700, using a ball-in-socket joint, to which arm attachment base 100 can be connected using attachment interface 130. Rehabilitation device 700 and other exemplary rehabilitation devices usable with arm attachment base 100 are described in WO 2005/074373, the disclosure of which is incorporated herein by reference.

Briefly, device 700 comprises a base 704, for example a table containing a plate 716, with an aperture 717 defined therein and enclosing a ball 710. Ball 710 optionally rests on a plurality of rollers 712. An arm 702 extends from ball 710 and is optionally balanced by a , counter- weight 718 attached by a rod 722 to an opposite side of ball 710. Rod 722 optionally passes through a slot in an optional guide plate 720, described in greater detail below.

In use, ball 710 turns and/or rotates, allowing a tip 708 of arm 702, and therefore arm attachment base 100, to define various trajectories in space. Optionally, arm 702 is extendible, so that the trajectories fill a volume of space. Optionally, arm 702 includes a motor or brake 724 (e.g., an oil brake), to actively move or passively resist such extension. In an exemplary embodiment of the invention, multiple motors are used to control motion and/or force of arm 702. The motors optionally include optical position encoders, to determine an arm position, hi an embodiment of the invention, a patient exercising with device 700 and an arm attachment such as those described herein, is expected to perform certain motions with the arm attachment in line with a prescribed exercise plan or program. For example as arm 702 moves, the patient is expected to maintain handle 304 in a "neutral" position, for example parallel to the floor. Gyroscope-like movement is provided to the patient's arm and/or hand as device arm 702 moves during exercise by arm attachments described herein. For example, movement directly to the patient's right is countered by rotation of arm attachment platform 102 about axis 128

and/or axis 120. Movement obliquely forward and to the right is countered by rotation of arm attachment platform 102 about axis 128 and/or axis 120 and axes 106 and/or 124. Motion and/or velocity and/or orientation of ball 710, arm attachment base 100, and any arm attachments are optionally monitored by sensors which transmit their sensed data to a controller for storage, analysis and/or action by the controller. As described above, motion by the patient's arm and/or hand ranges from entirely patient initiated and/or controlled to entirely automatically initiated and/or controlled by the rehabilitation device. An Exemplary Manually Operated Arm Attachment Base

In an embodiment of the invention, the arm attachment platform 730 such as those described with respect to Figs. 9-10, is situated on an arched rack 732 between two sides of the arch 734 created by arched rack 732. The arched rack 732 forms half of a circle, wherein arm attachment platform 730 is in rotating joint within the arched rack 732 and is mounted on arched rack 732 according to the diameter of the circle. The arched rack 732 is supplied by first manual turning and fixing means, accordingly 736 and 738 (see Fig. 10). In an exemplary embodiment of the invention, the arched rack 732 is supplied with angle scales 740 on external surfaces of the both ends of the arch 734 near the longitudinal axis of the arm attachment platform 730. These angle scales 740 may be also used in different- embodiments for controlling by crew the angle positions of the arm attachment platform 730 relative to the arched rack 732. Angle scales or just graduations or other position markings may be provided on only one side and/or for one or more of the joints. Different indications (e.g., visual, audio, fixed or electronic display, such as numbers) may be provided for different joints. Optionally, such graduations are provided alternatively to or additionally to sensors which may be connected to the system (optionally provide din the attachment component) and feed a central processing and control unit used for guiding rehabilitation. Optionally, the arched rack 732 is manually moved and is supplied by the manually fixed means 742, 744 and an angle scales 746 on the both sides of the arch 734.

In an exemplary embodiment of the invention, the manually fixed means 742, 744 is used to provide a controllably slide connection between support means 748 and arched rack 732 (Figs. 9-10). The arched rack 732 is rotary mounted in support means 748. The angle scales 746 may be used in this embodiment, such as in different embodiments of the invention for controlling by crew the inclination of the arched rack 732 relative to the support means 748. In an exemplary embodiment of the invention, the angle scales are mounted outside of the support for sliding. Optionally or alternatively, the support for sliding is made transparent.

In an exemplary embodiment of the invention, the support means 748 is supplied by the second manual turning and fixing means, accordingly the hafts 750 and the stop 752 (figs. 9, 10) for turning and fixing the arched rack 732 near the vertical axis 754 and an angle scale 756 on its top 758. The angle scale 756 serves for controlling turning of the arched rack 732 near the vertical axis 754. The support means 748 is supplied with the bayonet elements 760, 762 (Fig. 9, 10) on its external cylindrical surface 764 for connection with the attachment interface (not shown) and with means 768 for fixing on this attachment interface.

Optionally, the arm attachment platform 730 has a removable and turning connector means 770 with a pin 772 for the arm attachment and arm attachment component which is mounted on this arm attachment platform 730 (Figs. 9-10). This connector means 770 with a pin 772 is fixed on the arm attachment platform by handle 774 (Fig. 10) to mount the arm attachment platform 730 in related position.

In this embodiment of the invention, the support means 748 and arched rack 732 rotate in relation to each other around a vertical axis 754 by the toothed wheel mechanism (not shown) which is controlled by the hafts 750 and fixed by the stop 752. The arm attachment platform 730 and the arched rack 732 rotate in relation to each other around a horizontal axis 776 (Figs. 9-10) by the toothed wheel mechanism (not shown) which is controlled by manual turning means 736 and fixed by fixing means 738. Optionally, the slidable connection keeps the arm attachment platform 730 horizontal in relation to the floor or relative to another plane. Optionally, weights or a resilient element (not shown) are added to bias the attachment component to a desired starting angle. Exemplary Methods of Exercise

Fig. 8A is a flowchart 800 of a method of using a rehabilitation device with an arm attachment such as those described herein, in accordance with an exemplary embodiment of the invention.

At 802, the rehabilitation device with an arm attachment is powered on (for electrical devices). Optionally, the rehabilitation device with an arm attachment turns on when arm 702 is touched or moved a certain amount. Alternatively, motion of arm 702 may provide power for the rehabilitation device with an arm attachment. At 804, an exercise to be performed is selected. Optionally, selection is performed on a display provided to the rehabilitation device. In a more automated device, the selection may be automatic. In a less automated device, for example, a patient may follow a chart provided to him by a rehabilitation center or by a guiding therapist.

At 806, arm 702 is optionally moved to a start position thereof, for example by the rehabilitation device with an arm attachment or by the patient. It should be noted that in some trajectories no start position is predefined. Instead, the actual starting position is used to define the rest of the trajectory. In some embodiments of the invention, the position of the patient relative to the system is indicated or measured (e.g. by vision system, by mechanical attachments) and the exercise program is adjusted accordingly.

In some cases, the rehabilitation device with an arm attachment is adjusted in another manner. For example, a particular arm attachment and/or arm attachment component may be attached to arm attachment base 100, or legs of the device may be raised or lowered, hi a collapsible device (e.g., folding legs), the device may be set up. Optionally, such setting up is carried out before activating (802) the rehabilitation device with an arm attachment.

At 808, an optional warm-up session is carried out on the patient, to ensure that the patient is ready for the exercise. Optionally, one or more physiological sensors, for example a muscle temperature sensor (e.g., skin surface) are used to ensure (e.g., as a safety feature) that the patient is sufficiently warmed up.

At 810, the patient is optionally tested to confirm an expected current ability.

At 812, the results of the test are optionally used to modify one or more parameters of the selected exercise or to select a different exercise, for example, due to an under- or over- achievement of the patient during testing. Exemplary modifications include: slowing down expected speed, reducing expected or resistive force, reducing expected or allowed range of motion and reducing number of repetitions.

At 814, the exercise is carried out, for example, as arm 702 moves the patient attempts to keep a hand flat on hand plate 206. In another example, the patient grips handle 304 and attempts to maintain handle 304 in a particular orientation as arm 702 moves.

At 816, various measurements which are optionally made during the exercise, are optionally logged. Such logging may also be carried out concurrently with the exercise.

At 818, feedback may be provided based on the exercise, for example, to the patient, a rehabilitation expert and/or to the rehabilitation device with an arm attachment. Optionally, feedback is provided on a patient physiological condition as well, for example, determining fatigue based on increased irregularities of motion and/or based on pulse rate or other physiological parameters.

At 820, a decision is optionally made to repeat an exercise and/or to select a new

exercise. Such a decision may be made, for example, based on patient progress and/or fatigue.

Fig. 8B is a flowchart 830 of a long term use of a rehabilitation device with an arm attachment, in accordance with an exemplary embodiment of the invention.

At 832, a new patient who is identified as needing rehabilitation is tested, possibly using the rehabilitation device with an arm attachment. For example, such tests may include range of motion tests, tests of maximum applied force at different points in space, and/or tests of fineness of force control and motion control. In an exemplary embodiment of the invention, the rehabilitation device with an arm attachment calculates limb size (or detects them using a camera or receives an input from a therapist) and uses the limb size to adjust pre-stored exercises, for example to adjust their trajectories and/or starting point.

At 834, the results of the tests are analyzed to determine the needs of the patient and to formulate objectives of the rehabilitation. This act may be, for example, manual, automated or manual with support from the rehabilitation device with an arm attachment.

At 836, a rehabilitation plan is drawn up, including, for example one or more of an expected progress chart, various allowed and/or required exercises and exercise parameters for different parts of the plan, definitions of increased and decreased difficulty levels for the exercises, allowed and/or required exercise sequences, number of cycles for each exercise, warm-up requirement, list of data to log, list of patient-modifiable information, one or more safety parameters which should not be passed and/or one or more parameter alert values at which an alert should be provided to the patient and/or a rehabilitation expert monitoring the patient's progress. It should be noted that while generating a rehabilitation plan is a known activity, in an exemplary embodiment of the invention, such a plan is useful, for example, taking into account one or more of the possibility of long term rehabilitation, the possibilities involved in having a device available at a home for multiple short sessions, the provision of multiple activities with a single device, the needs of remote monitors and/or the programmability and responsiveness of a device in accordance with some embodiments of the invention.

At 838, the plan is carried out, while being monitored. In an exemplary embodiment of the invention, the monitoring is manual. Alternatively, at least some of the monitoring is automatic.

At 840, the plan may be modified in response to the monitoring, for example, if slow progress is detected, the plan time frame may be changed.

In some cases, as rehabilitation progresses, new problems may come up or become

emphasized. In some cases, the plan may be modified (840). In others, testing may be repeated (842), generally to a lesser extent than when the patient was initially evaluated.

In some plans, periodic testing (for example on the rehabilitation device with an arm attachment at the patient's home) is part of the plan. Such evaluative testing may also be used to determine when rehabilitation is complete.

At 844, rehabilitation is mostly completed and a training plan is optionally made, for example to ensure maintenance of the rehabilitation or for other reasons (such as prevention of worsening or prevention of limb or joint neglecting).

At 846, long term monitoring of the patient may be performed, for example, testing the patient's abilities once a week or once a month.

At 848, new needs of the patient may be identified, for example based on the monitoring or based on a periodic general test, hi one example, a patient being rehabilitated for stroke may be determined after a time to need rehabilitation for a progressing arthritic condition, hi an exemplary embodiment of the invention, a personal profile is created for a patient. For example, such a profile may include a series of items to work on, for example smoothness of motion, which can be tackled one by one over time or if a certain threshold . value is detected during testing (e.g., quality of motion went below a threshold).

As noted herein, a particular property of some embodiments of the invention is that a rehabilitation device with an arm attachment may be used over a wide range of situations, including long range treatment and following a patient from initial rehabilitation through follow-up rehabilitation (e.g., to maintain an ability) and diagnosis.

In some embodiments of the invention, an arm attachment is provided which provides sensing, control and/or feedback for one or more degrees of motion of a hand and/or arm. hi some embodiments, the applied forces act as a force field, optionally continuous, which impedes and/or guides a patient. Alternatively or additionally to spatial trajectories, orientation trajectories and/or speed trajectories are guided, supported and/or measured, hi some embodiments of the invention, the arm attachment assists with and/or instigates hand movement of the patient, for example: pinching, gripping, opening and/or closing the hand.

Optionally, the device is programmable with various trajectories (paths and/or velocities) and/or forces. Optionally, the forces at one point in the trajectory can vary responsive to an actual trajectory by the patient, possibly a same trajectory (e.g. at an earlier point thereof) and/or responsive to a rehabilitation plan and/or improvement of the patient.

Optionally, the device learns the patient motion and repeats it with a correction (e.g. a

smoothing of trajectory and or speed). Alternatively or additionally, the device can learn a motion entered by a physiotherapist and replay it for the patient, with an optional adjustment (e.g. a limb size adjustment).

In an exemplary embodiment of the invention, the programming comprises programming an electronic controller. In an exemplary embodiment of the invention, the programming comprises mechanical programming.

In some embodiments of the invention, at least one sensor is provided to the rehabilitation device and/or the arm attachment. Sensors optionally include force sensors and/or velocity/acceleration sensors and/or position sensors. In some embodiments of the invention, the at least one sensor is in operative communication with the controller.

In an exemplary embodiment of the invention, the device ensures that a patient is correctly positioned. Optionally, the patient is notified to correct his position. In an alternative embodiment of the invention, the device recalibrates itself to take the patient position into account. In an exemplary embodiment of the invention, the device is usable (e.g. by programming, attachments, attachment components and/or settings) for a plurality of different treatments, for example, a plurality of different body sizes, a plurality of different ages, a plurality of different joints and/or a plurality of different appendages.

In an exemplary embodiment of the invention, the device senses motion of the patient and provides feedback regarding that motion (or attempted motion). In some embodiments of the invention, the feedback is used to develop an exercise program for the patient based on an analysis of the feedback. In some embodiments of the invention feedback is used to measure the progress of the patient's exercise. Optionally, feedback is provided to the patient during exercise in order to instigate patient motion, for example in a desired trajectory. Optionally, the motion of the arm is substantially balanced over the entire range of motion thereof. In an exemplary embodiment of the invention, the balancing includes prevention of a resting torque. Alternatively or additionally, balancing includes correction for an existing moment of inertia or an expected moment of inertia during use. Optionally, the device is configured to include a resting force which tends to stabilize or destabilize the device, depending on the embodiment.

In some embodiments of the invention, the device is interchangeable with other attachments for use with a rehabilitation system.

Examples of types of situations where embodiments of the invention may be useful,

follow. In some exemplary embodiments of the invention, a range of treatment lengths are supported, including for example, goal oriented treatment, short term treatment, long term treatment and/or preventive activities, hi some exemplary embodiments of the invention, treatment over multiple stages in rehabilitation, possibly an entire rehabilitation process, are supported, in some cases with a same device. In some exemplary embodiments of the invention, multiple body portions may be rehabilitated, either simultaneously or separately, in some cases, with a same device. In some embodiments of the invention, multiple modalities are rehabilitated, either together or using a same device, for example, motor control, motor feedback, vision, audio ability and/or speech. A range of complexities and hierarchies of motion are supported by some embodiments, for example, simple motion of one joint and complex planning of multi-limb motion. Multiple treatment locations are supported by some embodiments of the invention, for example, ICU, bed, clinic, home and/or outdoor. Multiple activity types are supported in some embodiments of the invention, for example, dedicated rehabilitation exercises, training exercises, daily activities, outdoor activities and/or diagnosis activities. In some embodiments of the invention, multiple body positions are supported, for example, lying down, standing and/or sitting. In some embodiments of the invention, a range of mental, cognitive and/or motor ability states are supported. It should be noted that not all the embodiments of the invention support all the various ranges and the extents of the ranges described above. Other Devices

Various designs for exercise apparatuses, robots and positioning devices are known in the art. It should be appreciated that the various arm attachment embodiments described herein may be adapted for such exercise apparatuses and/or robots and/or positioning devices, in accordance with exemplary embodiments of the invention. Alternatively or additionally, software may be provided for such exercise apparatuses and/or robots and/or devices for carrying out various exercise methods, such as those described herein, all in accordance with exemplary embodiments of the invention.

It should be noted that the rehabilitation devices described herein are optionally usable not only at a home but also at care centers, such as old age homes, hospitals and rehabilitation centers.

It will be appreciated that the above described methods of rehabilitation may be varied in many ways, including, omitting or adding steps, changing the order of steps and the types of devices used. In addition, a multiplicity of various features, both of method and of devices

have been described. In some embodiments mainly methods are described, however, also apparatus adapted for performing the methods are considered to be within the scope of the invention. It should be appreciated that different features may be combined in different ways. In particular, not all the features shown above in a particular embodiment are necessary in every similar embodiment of the invention. Further, combinations of the above features are also considered to be within the scope of some embodiments of the invention. Also within the scope of the invention are kits which include sets of a device, one or more tearing pins, one or more attachments and/or software. Also, within the scope is hardware, software and computer readable-media including such software which is used for carrying out and/or guiding the steps described herein, such as control of arm and/or hand position and providing feedback. Section headings are provided for assistance in navigation and should not be considered as necessarily limiting the contents of the section. When used in the following claims, the terms "comprises", "includes", "have" and their conjugates mean "including but not limited to". It should also be noted that the device is suitable for both males and female, with male pronouns being used for convenience.

It will be appreciated by a person skilled in the art that the present invention is not. limited by what has thus far been described. Rather, the scope of the present invention is limited only by the following claims.