AU711074B2 - An integrated movement analyzing system - Google Patents

Description

WO 97/13454 PCT/US95/13505 AN INTEGRATED MOVEMENT ANALYZING

SYSTEM

TECHNICAL

FIELD

The invention pertains to the general field of electro-diagnostic equipment and more particularly to an integrated movement analyzing system that combines electromyography with range of motion and functional capacity measurements, to provide a non-invasive and non-loading method for analyzing myofacial injuries and repetitive stress injuries.

BACKGROUND

ART

Myofacial injuries represent the second largest medical problem today, with back pain alone accounting for the largest medical visits. Carpal tunnel syndrome (CTS), repetitive stress injuries (RSI) account for the most days lost and are predicted to become the most costly health problem of our time. With the implementation of the American's with disability

(ADA)

law worker's compensation claims such as CTS can now WO 97/13454 PCT/US95/13505 sue in the federal court system allowing for the initiation of suits in excess of 10 million dollars.

These claims could damage the economy and force employers to go outside of the United States.

A recent study in the New England Journal of Medicine indicates that over 58% of asymptomatic low back pain patients who underwent an MRI found evidence of disc pathology. How reliable is an MRI it appears to have no correlation to pain, impairment and may not be clinically significant.

A recent study revealed that over 45 percent of individuals who have undergone CTS release surgery were no better two years past the surgical intervention because they were misdiagnosed. The individuals probably had cervical pathology that can refer pain and mimic the symptoms of carpal tunnel, ulnar neuopathy, cubital tunnel, tendonititis, DeQuarian's syndrome repetitive stress injuries. The problem is that until the development of the instant invention, there was no way to ascertain if the problem was proximal (cervical or distal,

CTS).

In the past, many doctors have prescribed a profalatic work restriction limiting the amount an individual can lift. More often than not, the lifting restriction is too general and too limiting which prohibits the individual to return back to their usual or any job. For example, a typical work restriction of no lifting over 50 pounds is highly restrictive.

Doctors impose this restriction because they have no means of evaluating the muscle and disc pathology during movement.

The inventive integrated movement analyzer (IMA) is a portable, non-loading electronic instrument that simultaneously monitors muscle activity with silver-silver chloride standard ECG electrodes, cervical, thoracic and lumbar flexion, extension, right WO 97/13454 PCT/US95/13505 rotation, left rotation, right lateral movement, and left lateral movement as well as monitoring the extremities. The IMA also simultaneously combines a non-loading load cell and strain gauge that with a computer and software correlates the weight lifted by pulling on the strain gage. The EMG, Range of Motion and FCE (functional capacity evaluation) are all conducted at the same time.

The IMA is portable and can be battery operated to allow the patient to be monitored anywhere including at the work sight, at home and performing any activity even their job, no matter what or where it is. The IMA also complies with the new ADA law, and includes a special device that allows for heart rate in the filter system. This is important because when heart rate is found in the paraspinal muscles over the EMG, in the upper trapezius and in the low back, the amplitude of the ECG activity that overlaps the EMG correlates to disc pathology or spinal changes on an MRI. Since the IMA monitors active range of motion, it takes the MRI one step further and can help determine if the monitored ailment, can in fact, be treated with conservative methods that do not involve surgery.

WO 97/13454 PCT/US95/13505 A search of the prior art did not disclose any patents that read directly on the claims of the instant invention. However, the following U.S. patents were considered related: PATENT NO. INVENTOR

ISSUED

5,042,505 Mayer et al 27 August 1991 4,688,581 Moss 25 August 1987 4,667,513 Konno 26 May 1987 The 5,042,505 Mayer, et al patent discloses an electronic device for measuring relative angular positional displacement and angular range of motion for body segments and articulating joints of the human skeleton. The device has a hand-held interface unit which is placed against the body segment or joint to be tested. Mounted within the housing of the interface unit is a shaft with a pendulum at one end and an optical encoder at the other. As the body segment rotates or the joint articulates, the pendulum swings in the direction of gravity, causing the shaft to rotate. The optical encoder generates an electrical signal representative of the amount of rotation of the shaft. The generated signal is fed to a microprocessor which processes the information and can produce on a display the change in angular position relative to initial angular position or the angular range of motion of the body segment or articulating joint.

The 4,688,581 Moss patent discloses an apparatus and a method for non-invasive in vivo determination of muscle fiber composition. The method includes the steps of electrically stimulating a chosen muscle; determining the stimulation current; measuring the electrical potential of the muscle; the contraction time; and the force produced by the contraction; and by intercorrelating the data by multiple regression, determining the type, percentage and size of muscle WO 97/13454 PCT/US95/13505 fibers within the muscle stimulated. Apparatus for determining the muscle composition includes a muscle stimulator of controlled voltage; electromyogram equipment; and a force transducer providing a tension curve as well as force measurements.

The 4,667,513 Konno patent discloses an apparatus and a method for estimating the degree of the fatigue and pain of muscles. The apparatus composes subjects of different weights on the same basis by deriving the variation in the muscular strength such as the dorsal muscular strength, shoulder muscular strength, the grasping power, and the like. An analogous electric signal integrated the muscular output on one hand, and provides an integrated value of the electromyo amplitude by processing the voltage induced from the muscle to be tested through an electromyogram amplitude and a waveform processor. The ratio between these integrated values, after correcting the ratio with a weight/muscular strength coefficient is digitally displayed.

For background purposes and as indicative of the art to which the invention relates, reference may be made to the following remaining patents found in the search: PATENT NO. INVENTOR

ISSUED

5,056,530 Butler et al 15 October 1991 5,050,618 Larsen 24 September 1991 5,038,795 Roush, et al 13 August 1991 5,012,820 Meyer 7 May 1991 4,886,073 Dillon et al 12 December 1989 4,845,987 Kenneth 11 July 1989 4,834,057 McLeod, Jr. 30 May 1989 4,805,636 Barry et al 21 February 1989 4,742,832 21 February 1989 4,742,832 Kauffmann et al 10 May 1988 WO 97/13454 PCT/US95/13505 DISCLOSURE OF THE INVENTION The integrated movement analyzing system combines electromyography with range of motion and functional capacity measurements to provide doctors and other clinical practitioners with a method for accurately analyzing myofacial injuries. The system in its basic form is comprised of an integrated movement analyzer (IMA) that functions in combination with a surface electromyography (SEMG) cable having a set of noninvasive SEMG electrodes that attach to a patient, a range-of-motion arm (ROMA), and a functional capacity sensor (FCS). The IMA is connected to a computer that produces data representative of the patient's problems being analyzed.

The IMA is a portable, non-loading electronic instrument that incorporates a surface electromyography section that receives and processes the signals produced by the set of SEMG electrodes; a range of motion section that processes the signals from the ROMA; and a functional capacity section that processes the signals from the FCS. The signals from all the sections are routed to an analog-to-digital converter (ADC) that further processes the signals before they are applied to the computer. The IMA has the capability to sample up to 32 channels of the SEMG cable, six channels of the ROMA signals and one channel of the FCS. All the signals are simultaneously measured at sampling speeds of up to 10 KHz for testing time frames.

The ROMA is a non-load bearing electro-mechanical device that includes three articulated sections. When performing back protocol testing, the ROMA is attached from the patient's shoulder to the patient's lower back by use of a shoulder harness and waist belt. When WO 97/13454 PCT/US95/13505 performing cervical testing, the ROMA is attached from the patient's head to the upper back by use of a cervical cap and the shoulder harness. The

FCS

produces a signal that is representative of a pulling force exerted by the patient. The FCS is comprised of a strain gauge mounted on a plate on which the patient stands. Attached to the stain gauge is a pull cable having attached to its upper end a handle grip. When the grip is pulled by the patient, the stain gauge measures the patient's pulling force which is analogous to the patient's lifting power. The IMA also includes a lead failure detection section having a circuit that causes a specific LED to illuminate when a corresponding specific lead failure has occurred from a SEMG electrode.

The simultaneous monitoring of the muscle groups allowed by the system measures muscle tone, muscle spasms, muscle activity and response, as well as muscle recovery and fatigue. This is accomplished for each muscle group monitored while several muscles are being monitored at the same time above and below the area of complaint. This allows the analyst with the system, to outline a specific therapy program for the problem and traces the referred pain problem. With the site specific treatment protocol, physical therapy is reduced to 50-60 percent less sessions, decreases costs, treatment time and directs the specific type of treatment like electrical stimulation, ultra sound massage or nerve block to a specific location. Thus, medical costs related to treatment and use of medication are greatly reduced.

In view of the above disclosure, it is the primary object of the invention to provide doctors and other diagnostic personnel with a system that simultaneous utilizes surface electromyography in combination with range of motion and functional capacity testing to f WO 97/13454 PCT/US95/13505 monitor any muscle groups in the human body.

In addition to the primary object, is is also an object of the invention to provide a system that: o measures compliance without the patient's cooperation. Because the range of motion,

FCS

are combined with specific EMG readings, the system can tell if the patient could not complete the range of motion or the lifting task. This is very important to the insurance 1 0 industry to reduce and defer fraudulent worker's compensation and personal injury claims and reduce long term disability.

o includes a specific protocol for carpal tunnel syndrome (CTS) that monitors the testing and range of motion readings for all cervical and upper extremity muscle groups. This interactive protocol with the system allows doctors to look at the relationship between muscle groups and to diagnose if the problem is cervical, CTS or cubital tunnel. The system also allows doctors to determine if it is a repetitive stress injury.

o is beneficial to sports in that it can tell an athlete what muscle groups to work out with what procedure and for how long before the muscle fatigues; thus, it maximizes the work-out period without causing injury.

o is beneficial for pre-employment screening to have a "finger print" of muscle activity if there is a subsequent injury and with ADA laws to determine how the work site needs to be altered to comply with the law o can diagnose soft tissue injury.

o can tell if disc pathology is present and if it is clinically significant, o can provide site-specific treatment protocols, WO 97/13454 PCT/US95/13505 9 o can eliminate the need for most oarpal tunnel and cubital tunnel surgeries.

These and other objects and advantages of the present invention will become apparent from the subsequent detailed description of the preferred embodiment and the appended claims taken in conjunction with the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS FIGURE 1 is a block diagram of the overall of the integrated movement analyzing system.

FIGURE 2 is a block diagram showing the interface between the integrated movement analyzer, the computer and a patient having the range of motion arm attached to a patient by means of a cervical cap and shoulder harness.

FIGURE 3 is a perspective view of the range of motion arm.

FIGURE 4 is a perspective view of a patient that has attached a range of motion arm between a cervical cap and a shoulder harness, and a shoulder harness and a waist belt.

FIGURE 5 is a perspective view of the shoulder harness.

FIGURE 6 is a perspective view of the waist belt.

FIGURE 7 is a perspective view of a cervical cap.

FIGURE 8 is a perspective view of a typical functional capacity sensor.

FIGURE 9 is an overall block diagram of the integrated movement analyzer.

FIGURE 10 is a block diagram of the surface electromyography section.

WO 97/13454 PCT/US95/13505 FIGURE 11 is a block diagram of the lead failure detection section.

FIGURE 12 is a block diagram of the range of motion section.

FIGURE 13 is a block diagram of the functional capacity sensing section.

FIGURE 14 is a block diagram of the IMA power supply.

FIGURE 15 is a schematic diagram of the instrumentation amplifier circuit and the lead-fail input circuit.

FIGURE 16A-16K are computer flow diagrams of the patient's data collection software program.

FIGURE 17A and FIGURE 17B are computer flow diagrams of the patient's data plotting software program.

WO 97/13454 PCT/US95/1350 THE BEST MODE FOR CARRYING OUT THE INVENTION The best mode for carrying out the invention is presented in terms of a preferred embodiment that utilizes surface electromyography in combination with range of motion and functional capacity testing to monitor any muscle group in the human body.

The preferred embodiment of the integrated movement analyzing system 10 as shown in FIGURES 1-14, is comprised of the following seven major elements: a surface electromyography (SEMG) cable assembly 12, a range of motion arm (ROMA) 14, that operates in combination with a shoulder harness 40, a waist belt 42, and a cervical cap 44; a functional capacity sensor (FCS) 16, an integrated movement analyzer 18, and a computer 34 that operates with software 36.

The overall integrated movement analyzing system is shown in FIGURES 1 and 2. As shown in the figures, the integrated movement analyzer (IMA) 18 is the focal point of the system 10 and receives inputs from the surface electromyography (SEMG) cable assembly 12, the range of motion arm (ROMA) 14 and the functional capacity sensor (FCS) 16; all of which are connected to a human patient 80. The output of the IMA 18 is provided to the computer 34 which produces comparative analytical data which is primarily in the form of graphic plots.

The surface electromyograph (SEMG) cable assembly 12 as shown in FIGURE 2, consists of a plurality of paired SEMG leads having a first end 12A and a second end 12B. The first end terminates at a multipin cable connector that preferably consists of a male twist-lock connector 12C that is sized to be attached to a mating female connector 18A located at the IMA 18. The two leads of the second end 12B each terminate with a 4 4 WO 97/13454 PCTYUS95/13505 finger-operated spring electrode attachment clip 12D.

In FIGURE 2, only three paired SEMG leads are shown for illustrative purposes; in the actual cable design, the paired leads can number from 8 to 32.

The SEMG electrode pads 13, which preferably consists of standard silver-silver chloride electrodes, include two clip attachment protrusions that interface with two skin contact points. To the protrusions are releasably attached the electrode attachment clips 12D as shown in FIGURE 2. The two skin contact points are adapted to be attached to selected areas of a human patient 80 as also shown in FIGURE 2. The electrodes produce a differential analog signal that is representative of the resistance between the two skin contact points of the patient.

The cable assembly 12 is manufactured from light weight materials to prevent or at least minimize the dislodgment of the clips 12D attached to the SEMG electrode pads 13 and is manufactured in selectable lengths that range from 4 to 40 feet. The cable wiring consist of individual, shielded coax wires that are twisted in pairs for each channel. To eliminate ground loops, each wire shield terminates at an instrumentation amplifier circuit 20A which is the input circuit of the integrated movement analyzer 18 which is described infra. The cable assembly also includes a single, non-coax wire 12C that is used as a signal ground for setting the ground reference from the patient 80 to the integrated movement analyzer 18.

The range of motion arm (ROMA) 14 as shown in FIGURE 3, includes electrical circuit means and mechanical means for producing range of motion analog signals representative of the angular distance produced from selected areas of the patient 80. The mechanical means is encompassed in a non-load bearing device that includes an upper knuckle 14A having an attachment pin r WO 97/13454 PCT/US95/13505 /3 14E, a middle junction 14B and a lower knuckle 14C also having an attachment pin 14E. Power to the ROMA 14 is supplied through cable 14D.

The upper knuckle is designed to rotate in three directions to measure up and down, side to side, and rotary movements of the patient's shoulders for back measurements or the top of the patient's head for cervical movements in the X, Y and Z planes. The middle junction rotates in an angular motion to measure the angular distance in the X-plane, and the lower knuckle rotates in two directions to measure the angular distance in the Y-plane as well as the rotation in the Z-plane.

The ROMA 14, when performing upper back protocol testing, is attached as shown in FIGURE 4, from the patient's upper back to the patient's lower back, by means of a shoulder harness 40 as shown in FIGURE When performing lower back protocol testing, the ROMA is attached between the shoulder harness 40 and a waist belt 42 as shown in FIGURES 4 and 6. For cervical testing, the ROMA 14 as also shown in FIGURE 4, is attached from the top of the patient's head to the patient's upper back, by means of a cervical cap 44 as shown in FIGURE 7 and the shoulder harness 40 as shown in FIGURE 6.

The ROMA 14 is shown attached in two places in FIGURE 4. However, in actual testing, the ROMA 14 is attached to either the cervical cap 44 and the shoulder harness 40, or from the shoulder harness 40 to the waist belt 42.

The shoulder harness 40 as shown in FIGURE typically comprised of a right shoulder support 40A, a left shoulder support 40B, a horizontal back strap and a ROMA attachment structure The right and left shoulder supports 40A,40B each have an upper section 40C and a lower section 40D. The WO 97/13454 PCT/US95/13505 lower sections are looped under the upper arms and are adjustably attached to the upper section by an attachment means 40F that allows the harness 40 to be adjusted to fit the anatomy of the patient undergoing the testing as shown in FIGURE 4. The preferred attachment means consists of a complimentary hook and loop fastener 40F as shown in FIGURE 5. The horizontal back strap 40E is integrally attached to the inward edges of the back of the right and left shoulder supports 40A,40B across the upper back of the patient protruding outward from the center of the back strap is the ROMA attachment structure 40G. This structure includes a pin cavity 40H that is sized to accept an attachment pin 14E located on the ROMA 14.

The waist belt 42 as shown in FIGURE 6, consists of an attachment means 42A that allows the belt to be adjustably adjusted across the waist of the patient undergoing testing as shown in FIGURE 4. The preferred belt attachment means comprises a hook and loop fastener 42A as shown in FIGURE 6. Protruding outward from the back of the belt 42 is a ROMA attachment structure 40B. This structure includes a pin cavity that is sized to accept an attachment pin 14E located on the ROMA 14.

The cervical cap 44 as shown in FIGURE 7 consists basically of a head band 44A having a means for being adjusted to fit the head of the patient undergoing testing as shown in FIGURE 4. Across the head band 44A is attached a head support 44C that includes a means for being adjustably attached to the patient's head.

The preferred adjustment means is a complimentary hook and loop fastener 44B. On the center top of the head band 44C is a ROMA attachment structure 44D as shown in FIGURE 7. This structure also includes a pin cavity 44E that is sized to accept an attachment pin 14E located on the ROMA 14. As also shown in FIGURE 7, the WO 97/13454 PCT/US95/13505 cervical cap 44 may also include an adjustable skull mount 44F that has a movable chin support 44G and resilient head cushions 44G located on the inside of the head band 44A.

The ROMA's 14 electrical circuit means is comprised of a set of potentiometers. The upper knuckle has three potentiometers, the middle junction has one potentiometer, and the lower knuckles has two potentiometers. The potentiometers provide six channels of range of motion analog signals. The range of motion analog signals are in the form of voltage levels ranging from 0 to 5-volts d-c; where 0-volts is representative of 0-degrees of angular displacement and d-c is representative of 27 0 -degrees of angular displacement. The analog signals are applied to the IMA 18 through connector 14E of the cable 14D which attaches to IMA connector 18B as described infra.

The functional capacity sensor (FCS) as shown in FIGURES 2 and 8, includes electrical circuit means and mechanical means for producing a differential analog d-c signal representative of a pulling force exerted by the patient.

The mechanical means for a preferred embodiment as shown in FIGURE 8, is comprised of a strain gauge mounted on a flat metal plate 52 on which the patient stands. Attached to the metal is a pull cable 54 having a first end 54A that is attached to the metal plate 52 and a second end that 54B has attached a two-handed grip 54C. When the grip is pulled by the patient 80, the strain gauge 50 measures the pulling force of the patient which is analogous to the lifting power of the patient.

The lifting force is measured by a range of d-c voltage levels that are representative of the force exerted upon the FCS 16 by the patient 80. The d-c 3 voltage range from 0 to 5-volts, where 0-volts is WO 97/13454 PCT/US95/13505 /b representative of zero lbs and 5-volts d-c is representative of the specific calibration of the sensor bridge. The resulting differential analog d-c signals are applied through connector 52 of cable 56 to IMA connector 18C to as described infra.

The integrated movement analyzer (IMA) 18 as shown in FIGURES 2 and 9, is a self contained unit, that is comprised of a surface electromyography section having circuit means for receiving and processing the differential analog signals from the SEMG cable assembly 12; a lead failure detection section 22 having circuit means for receiving and processing the differential analog signals from the SEMG cable assembly 12; a range of motion section 24 having circuit means for receiving and processing the analog signal from the range of motion arm 14; a functional capacity sensing section 26 having circuit means for receiving and processing the analog signals from the functional capacity sensor (FCS) 16 and an isolated power supply section 28 having circuit means for supplying the power required to operate the

IMA

circuits. The circuit means of the IMA 18 allows the sampling of up to 32 channels of the SEMG analog signals; six channels of the motion arm analog signals and one channel of the functional capacity sensor analog signal, where all the signals are simultaneously measured at sampling speeds of up to 10 KHz at any testing time frame.

The surface electromyography (SEMG) section circuit means for receiving and processing the differential analog signals from the set of SEMG electrodes 12B, as shown in FIGURE 10, comprises: an instrumentation amplifier circuit 20A having means for detecting the resistance between the contact points of each SEMG electrodes 12A, which corresponds to the patient's skin resistance, and converting this WO 97/13454 PCT/US95/13505 17 resistance to a representative analog voltage. The analog voltage is then applied to a voltage-to-ourrent circuit 20B having circuit means for converting the analog voltage to a linear current drive signal.

Following the circuit 20B as shown in FIGURE 10 is an optical isolation circuit 20C that isolates the patient from the system 10. The circuit 20C consists of an optically isolated amplifier having circuit means for converting the linear current drive signal to a voltage representative of the differential analog signal from the SEMG electrodes 12A. The final circuit comprising the SEMG section 20 is a filtering circuit 20D that is comprised of: a 10 Hz high-pass filter that eliminates any d-c component of the output signal from the optical isolation circuit a notch filter that eliminates 60 Hz are applicable harmonics noise inherently generated in the air, and a low-pass filter that eliminates frequencies above 2.5 KHz. The output signal of the filtering circuit 20D, represents the resistance detected at the SEMG electrode 12B connected to the patient The instrumentation amplifier circuit means 20A as described above, is further comprised as shown in FIGURE 15 of a SEMG input circuit 20A1, a low pass filter 20A2 and a voltage amplifying circuit 20A3.

WO 97/13454 PCT/US95/13505 The SEMG input circuit 20A1 is comprised of an instrumentation amplifier U1 having a positive and negative input and an output. The input is connected across a pair of current limiting resistors R1 and R2 respectively with each resistor having an input side and an output side. To the resistor's input side is applied respectively, the positive and negative input signals from the SEMG electrodes. The resistor's output side is connected across a capacitor C1 and a network of four diodes CR1-CR4. The capacitor provides stability between the two inputs of the instrumentation amplifier U1 by filtering high common mode noise and the four diodes prevent static charge or over voltage from damaging the instrumentation amplifier. Any difference in voltage potential between the positive and negative inputs of the instrumentation amplifier

UI

is equal to the difference in potential between the two leads of the SEMG electrodes and is also the output of the instrumentation amplifier.

The low pass filter 20A2 is comprised of a coupling capacitor C2 having an input side and an output side.

The input side is applied to the output of the instrumentation amplifier U1 and the output side is connected to the input of a 10 KHz low pass filter that filters all frequencies above 10 KHz. The filter consist of a series resistor R4 that is connected across a resistor R5 and a capacitor C3 that is connected to circuit ground.

The voltage amplifying circuit 20A3 is comprised of a voltage amplifier U2 having a positive and negative input and an output. Connected to the positive input of the amplifier U2 is the output from the low pass filter 20A2. The voltage amplifier U2 has a gain of at least The gain is produced by a pair of voltage-dividing feedback resistors R3 and R6 that have their junction connected to the negative input of the voltage WO 97/13454 PCT/US95/13505 amplifier U2.

The differential analog signals from the set of SEMG electrode 12B are also applied to a lead failure detection section 22 as shown in FIGURE 11. The section 22 comprises a lead-fail detection circuit 22A having means for detecting when the input from the SEMG electrodes 12B cross over a threshold differential voltage level of 2.5 volts d-c. This voltage level indicates that at least one of two electrode leads 12B has failed. When such a failure occurs, the lead-fail detection circuit 22A produces an output digital signal that is applied to a lead-fail optically coupled circuit 22B. This circuit is comprised of an optical coupler that converts the digital input signal from the lead-fail detection circuit 22A to an isolated optical signal optic then back to a digital signal. The digital signal is applied to a set of lead-fail indicators 22C that consist of light emitting diodes (LED's) that are located on the front panel of the integrated movement analyzer as shown in FIGURE 2. The signal that drives the LED's is also sensed by an analog to digital converter and is monitored by the computer software program to allow the particular LED's corresponding to the failed lead, to illuminate so that connection action can be taken to fix the problem.

The lead-fail detection circuit 22 as described above, is further comprised, as also shown in FIGURE of a lead-fail input circuit 22A1 and a comparator circuit 22A2.

The lead-fail input circuit 22A1 is comprised of a pair of voltage amplifiers U3 and U4 each having a positive and negative input and an output. To the positive inputs is applied the positive and negative input signals respectively from the SEMG electrodes.

The amplifiers U3 and U4 are configured as voltage followers to assure that the lead-fail detection WO 97/13454 PCT/US95/1350 circuit 22A does not interfere with the surface electromyography section The comparator circuit 22A2 is comprised of a Pair of amplifiers U5 and U6 each having a Positive and negative input and an output. To the ositive inputs are applied the outputs from the voltage amplifiers U3 and U4 respectively through input resistors R9 and respectively. Both the amplifiers operate with a positive feedback Path that is applied through resistors R11 and R12 respectively. The comparator circuit further includes a bias circuit. This circuit sets a bias level at the negative inputs of the amplifiers U5 and U6, by means of a Pair of resistors R13 and R14 and capacitor C4, where resistor R13 is connected to a positive voltage and capacitor C and resistor R14 are connected to circuit ground. The bias circuit assures that if the positive inputs of the amplifiers U5 and U6 drop below a specified threshold level, the output of either amplifier will change to a zero output. This zero output is applied to an OR logic circuit consisting of diodes CR5 and CR6 which also drops to zero to produce the digital signal that is applied to the lead-fail optically coupled circuit 22B as shown in FIGURE 11.

The range of motion section 24 circuit means as shown in FIGURE 12, for receiving and Processing the range of motion analog signals produced by the range of motion arm 14 comprises a voltage follower buffering and low-pass filtering circuit 24A having means for: providing a d-c excitation voltage and an isolated ground that is applied across each of the potentiometers in the range of motion arm

(ROMA),

retaining the integrity of the potentiometer wiper voltage by eliminating any a-c component above 50 Hz.

WO 97/13454 PCT/US95/13505 From the circuit 24A is produced a processed analog signal that is applied to a voltage-to-current circuit that converts the analog voltages representative of angular distance to a linear current drive signal. In turn, the drive signal is then applied to an isolation circuit consisting of an analog optically isolated amplifier. The amplifier converts the signal to an analog voltage representative of the angular displacement of the ROMA potentiometers.

The functional capacity sensing section 26 circuit means as shown in FIGURE 13 for receiving and processing the differential analog signals supplied by the functional capacity sensor (FCS) 16 is comprised of an instrumentation amplifier circuit and sensor bridge driver voltage 26A having means for: providing a d-c excitation voltage and an isolated ground for a sensor bridge excitation, receiving a differential signal from the sensor bridge, whereby the difference in resistance is sensed to provide a representative d-c voltage signal.

Following the sensor bridge is a voltage to current circuit 26B which is applied and converts the representative d-c voltage signal to a linear current drive signal. The drive signal is then applied to an optical isolation circuit 26C that isolates the patient from the system 10. The circuit 26C consists of an optically isolated amplifier having circuit means for converting the drive signal signal to a d-c voltage representative of the force exerted upon the FCS. The circuit 26C can be calibrated for variable outputs in a typical calibration, the d-c voltage ranges from 0 to -volts, where 0-volts is representative of zero lbs.

and 5-volts d-c is representative of the specific calibration of the sensor bridge.

WO 97/13454 PCT/US95/13505 The final electronics circuit described is the power supply circuit as shown in FIGURE 14. The input to the power supply is derived from the utility 120-volts a-c power which is applied to a bridge rectifier and d-c filter circuit where the a-c utility power is rectified and filtered to produce a d-c voltage output. The system can also be designed to operate with an internal battery that is selected to produce the required d-c voltage level to operate the sytem The d-c voltage is applied a set of d-c power regulation circuits 28B that produce: +5 volts d-c, +12 volts d-c, -12 volts d-c and -5 volts d-c. These voltages are applied: directly to the system 10 circuits that are not optically isolated, and to a set of three isolated d-c to d-c converting circuits 28C that convert the non-isolated d-c voltages to isolated d-o voltages, and to an isolated ±5 volts d-c and ±12 volts d-c voltage regulator circuit 28D which further regulate and produce the d-c regulated voltages required for the optically isolated circuits.

From the respective SEMG, ROMA and FCS sections as shown in FIGURE 9, the respective output signals are applied to an analog-to-digital converter (ADC) for further processing. The ADC in the preferred embodiment is a 16 bit, 16 channel device that also includes 8 lines of digital I/O. However, multiple assemblies can be connected to provide up to 32 channels.

The processed signals from the ADC 30 are terminated at an output connector such as an IEEE 488 interface. From the interface connector, the signals are routed through a cable assembly 32 and applied to a WO 97/13454 PCT/US95/13505 computer 32 shown in FIGURE 2. The computer 34 operates with a software program 36 as shown in the computer flow diagram included as FIGURES 16A-16 to produce the comparative analytical data representative of the patient's problem being analyzed. The software program 36 which is protected under registered and pending copyright registrations consists of a patient's data collection program and a patient's data plotting program.

The patient's data collection program which is shown in the computer flow diagrams of FIGURES 16A-16K allows the selection of the following options: a) cervical/carpal tunnel syndrome (CTS) protocol testing, b) extremities protocol testing, c) mid and lower back protocol testing, d) technical information covering lead setup and muscle groups, e) lead-fail integrity check, and f) return to main screen option selection.

The data collection software program: a) interfaces with a parallel interface connector, b) selects the voltage level that each channel will respond to, c) initializes the sampling frequency rate of the

ADC,

d) selects the appropriate testing protocol, e) samples each cable lead during the test to detect if a lead failure has occurred, f) prompts the system 10 user as to the location of a lead failure, g) starts the integrated movement analyzer when the testing should begin, h) prompts the technician as to the muscle groups that the individual leads should be connected to for a given protocol, WO 97/13454 PCT/US95/13505 i) prompts the technician as to the activities that the patient should be Performing during the test cycle, j) saves the data on hard drive at the completion of a test, k) converts the patient's data from binary data to computer graphics, and 1) time and date stamps each file as data is taken, The patient's data plotting program which is shown in the computer flow diagrams of FIGURES 17A and 178 allows the plotting of up to forty channels of the patient's data for use on a final report.

The data plotting software program: a) generates computer plots from 1 to 40 channels of data, b) plots range of motion data and correlates this data to angular displacement, c) plots functional capacity data and correlates this data to maximum force applied to the functional capacity sensor by the patient, d) sets the testing time for the test being performed, and e) produces plots which include patient information, location of test, the test performed and the muscle groups.

OPERATIONAL

PROCEDURE

The integrated movement analyzing system is operated by application of the following steps: a) connect the IMA 18 to a source of electrical power, b) connect the computer 34 to the IMA 18, c) connect the SEMG cable assembly 12 to the IMA and test the integrity of the SEMG cable assembly by means of the computer, d) connect the ROMA 14 to the IMA, WO 97/13454 PCTIUS95/13505 e) prepare a patient by cleansing the area of the patient's body encompassing a muscle group Pertaining to the test protocol that is to be analyzed, f) attach to each designated lead of the SEMG cable assembly 14, a SEMG electrode pad 13, g) mount said ROMA to patient, h) attach the electrode pads around the area of the selected muscle groups, as follows, i) for testing of repetitive stress injuries

(RSI)

Protocol, attach the SEMG electrode pads to the following muscle groups bilaterally: external sternocleidomastoid

(SCM),

scalene, paraspinal cervical, upper trapezii, deltoid, bioep, tricep and wrist, j) for testing the cervical region, attach the SEMG electrode pads to the following muscle groups bilaterally: external sternocleidomastoid

(SCM),

scalene, paracervical, and upper trapezii, k) for testing the middle back region, attach the SEMG electrode pads to the following muscle groups bilaterally: middle trapezii, lower trapezii, paraspinal set 1,and paraspinal set 2, WO 97/13454 PCT/US95/13505 1) for testing the lower back region, attach the SEMG electrode pads to the following muscle groups bilaterally: paraspinal set 1, paraspinal set 2, quadratus lumborum and gluteal, m) for testing the lower extremity region, attach the SEMG electrode pads to the following muscle groups: anterior thigh, posterior thigh, anterior calf, and posterior calf n) instruct the patient to perform a series of movements while maintaining either a sitting or standing position as follows; for the RSI test, instruct the patient to perform the actions pertaining to the cervical and extremity regions, for the cervical region test, instruct the patient to perform the actions Pertaining to the cervical region, for the extremities region, instruct the patient to perform the actions pertaining to the lower extremity region, and for the middle and lower back region, instruct the patient to perform the actions pertaining to the middle and lower back region.

When the operation procedure includes the use of a functional capacity sensor (FCS) 16, the following additional steps are required.

a) attach the FCS 16 to the IMA, WO 97/13454 PCT/US95/13505 b) instruct patient to: stand on the flat metal plate 52, pull on the pull cable 54 and allow the computer 34 to display and record the pulling force exerted by the patient.

While the invention has been described in complete detail and pictorially shown in the accompanying drawings it is not to be limited to such details, since many changes and modifications may be made to the invention without departing from the spirit and the scope thereof. For example, in FIGURE 6, the amplifiers U1-U6 are shown for explanatory purposes as individual discreet components. In the actual implementation of the circuit, amplifiers U1-U6 are packaged in a single integrated circuit. Hence, it is described to cover any and all modifications and forms which may come within the language and scope of the claims.

Claims (28)

1. An comprising: integrated movement analyzing system a) a surface electromyography (SEMG) cable assembly comprising a plurality of paired SEMG leads having a first end that terminates at a cable connector and a second end where each lead terminates with an electrode attachment clip, b) a plurality of SEMG electrode pads, where each pair of pads provides two clip attachment protrusions that interface with two skin contact points, where to the protrusions are releasably attached the electrode attachment clips, and where the two skin contact points are adapted to be attached to selected muscle group areas of a human patient, where each said SEMG electrode pad produces a differential analog signal representative of the resistance between the two skin contact points of the patient, c) a range of motion arm (ROMA) having electrical circuit means and mechanical means for producing range of motion analog signals representative of the angular distance produced from selected areas of the patient, d) a functional capacity sensor (FCS) having circuit means for producing a differential analog d-c signal representative of a pulling force exerted by the patient, e) an integrated movement analyzer (IMA) WO 97/13454 PCT/US95/13505 comprising: a surface electromyography section having circuit means for receiving and processing the analog signals from said SEMG electrodes attached to said SEMG cable assembly, a range of motion section having circuit means for receiving and processing the analog signals from said ROMA, a functional capacity section having circuit means for receiving and processing the analog signals from said FCS, and an analog to digital converter (ADC) that receives and further processes the SEMG electrode, ROMA and FCS analog signals from said respective section, f) an isolated power supply having circuit means for supplying the power requirements for operating the circuits of said integrated movement analyzing system, and g) a computer having installed a system software program where said computer receives the processed signals from said ADC for further processing and for the production of data representative of the patient's problems being analyzed.

2. The system as specified in claim 1 wherein said surface electromyography section having circuit means for sampling up to 32 channels of differential surface electromyography analog signals, said range of motion section having circuit means for sampling up to six WO 97/13454 PCT/US95/13505 channels of range of motion arm analog signals, and said functional capacity section having circuit means for sampling up to two channels of functional capacity sensor analog signals, where all the signals are simultaneously measured at sampling speeds of up to KHz for testing time frames.

3. The system as specified in claim 2 wherein said surface eleotromyography section circuit means for receiving and processing the differential analog signals from said surface electromyography (SEMG) electrodes comprises: a) an instrumentation amplifier circuit having means for detecting the resistance between the contact points of each SEMG electrode which corresponds to the patient's skin resistance and muscle activity and converting this resistance to a representative analog voltage, b) a voltage-to-current circuit that is applied the analog voltage from said instrumentation amplifier circuit and having circuit means for converting the analog voltage to a linear current drive signal, c) an optical isolation circuit that isolates the patient from said system and that is comprised of an analog optically isolated amplifier having circuit means for convert g the linear current drive signal to a voltage representative of the differential analog signal from said SEMG electrodes, and d) a filtering circuit comprising: a 10 Hz high-pass filter that eliminates any d-c component of the WO 97/13454 PCT/US95/13505 output signal from said optical isolation circuit, a notch filter that eliminates 60 Hz and applicable harmonics noise inherently generated in the air, and a low-pass filter that eliminates frequencies above 2.5 KHz, where the output signal of said filtering circuit represents the resistance detected at the SEMG electrode connected to the patient.

4. The system as specified in claim 3 wherein said instrumentation amplifier circuit means further comprises: a) a SEMG input circuit comprising an instrumentation amplifier U1 having a positive and negative input and an output, where the input is connected across a pair of current limiting resistors RI and R2 respectively with each resistor having an input side and an output side, where to the resistor's input side is applied respectively, the positive and negative input signals from said SEMG electrodes, and where the resistor's output side is connected across a capacitor C1 and a network of four diodes CR1-CR4, where the capacitor provides stability between the two inputs of the instrumentation amplifier U1 by filtering high common mode noise and the four diodes prevent static charge or over voltage from damaging the instrumentation amplifier, where any difference in voltage potential between the positive WO 97/13454 PCT/US95/13505 and negative inputs of the instrumentation amplifier U1 is equal to the difference in potential between the two leads of said SEMG electrodes and is also the output of the instrumentation amplifier, b) a low pass filter comprising a coupling capacitor C2 having an input side and an output side, where the input side is applied the output of said instrumentation amplifier U1 and the output side is connected to the input of a 10 KHz low pass filter that filters all frequencies above 10 KHz, where said filter comprises a series resistor R4 that is connected across a resistor and a capacitor C3 that are connected to circuit ground, and c) a voltage amplifier comprising a voltage amplifier U2 having a positive and negative input and an output, where connected to the positive input is the output from said low pass filter, with said voltage amplifier having a gain of at least 30 that is produced by a pair of voltage-dividing feedback resistors R3 and R6 that have their junction connected to the negative input of said voltage amplifier U3.

5. The system as specified in claim 1 wherein said integrated movement analyzer further comprises a lead failure detection section having circuit means for alerting a system operator when there is a SEMG electrode lead failure, where said lead failure detection section comprises: WO 97/13454 PCT/US95/13505 33 a) a lead-fail detection circuit having means for detecting when the input from said SEMG electrodes cross over a threshold differential voltage level of 2.5 volts d-c indicating that at least one of the two paired said electrode leads has failed or fallen off a patient, whereupon such a failure, said lead-fail detection circuit produces an output digital signal, b) a lead-fail optically coupled signal circuit that is comprised of an optical coupler that converts the digital input signal from said lead-fail detection circuit to an isolated optical signal then back to a digital signal, and c) a set of lead-fail indicators comprising light emitting diodes (LED's) that are located on a front panel of said integrated movement analyzer and that are energized by the output signal from said lead-fail detection circuit, where the signal that energizes the LED's is also applied to said analog to digital converter and is monitored by said computer through the digital port of said analog to digital converter.

6. The system as specified in claim 5 wherein said lead-fail detection circuit further comprises: a) a lead-fail input circuit comprising a pair of voltage amplifiers U3 and U4 each having a positive and negative input and an output, where to the positive inputs is applied the positive and negative input signals respectively from said SEMG WO 97/13454 PCT/US95/13505 electrodes through resistors R7 and R8 respectively, where the amplifiers U3 and and U4 are configured as voltage followers to assure that said lead-fail detection circuit does not interfere with said surface electromyography section, and b) a comparator circuit comprising a pair of amplifiers U5 and U6 each having a 1 0 Positive and negative input and an output, where to the positive inputs are applied the outputs from the voltage amplifiers U3 and U4 respectively through input resistors R9 and RiO respectively, and where the amplifiers operate with a positive feedback path that is applied through resistors R11 and R12 respectively, where said comparator circuit further includes a bias circuit that sets a bias level at the negative inputs of the amplifiers U5 and U6, by means of a pair of resistors R13 and R14 and capacitor C4, where resistor R13 is connected to a positive voltage and capacitor C4 and resistor 14 are connected to circuit ground, where the bias circuit assures that if the positive inputs of amplifiers U5 and U6 drop below a specified threshold level, the output of either amplifier U5,U6 will change to a zero output and their output will be applied to an OR logic circuit consisting of diodes CR5 and CR6 which also drops to zero to produce the digital signal that is applied to said lead-fail optically coupled circuit. WO 97/13454 PCT/US95/13505

7. The system as specified in claim 1 wherein said range of motion arm (ROMA) mechanical means comprises a non-load bearing device that includes an upper knuckle, a middle junction and a lower knuckle, where said ROMA is attached, by an attachment means, from the patient's shoulders to the patient's lower back for back protocol testing or from the patient's head to the patient's shoulders for cervical testing, wherein said ROMA's: a) upper knuckle rotates in three directions to measure up and down, side to side, and rotary movements of the patient's shoulders for back measurements or the top of the patient's head for cervical movements in the X, Y and Z planes, b) middle junction rotates in an angular motion to measure the angular distance in the X-plane, and c) lower knuckle rotates in two directions to measure the angular distance in the Y-plane as well as the rotation in the Z- plane.

8. The system as specified in claim 7 wherein said means for attaching said range of motion arm from the patient's upper back to the patient's lower back comprises a shoulder harness and a waist belt respectively.

9. The system as specified in claim 7 wherein said means for attaching said range of motion arm from the patient's upper back to the patient's head comprises a shoulder harness and a cervical cap respectively.

The system as specified in claim 8 wherein said shoulder harness comprises: WO 97/13454 PCT/US95/13505 a) a right shoulder support having an upper section and a lower section, where the lower section is adjustably attached to the upper section by an attachment means that allows the right shoulder support to be adjusted to fit the anatomy of the patient undergoing testing, b) a left shoulder support having an upper section and a lower section, where the lower section is adjustably attached to the upper section by an attachment means that allows the left shoulder support to be adjusted to fit the anatomy of the patient being tested, and c) a horizontal back strap that is integrally attached to the inward back edges of the right and left shoulder supports across the upper back of the patient, where protruding outward from the center of the back strap is a ROMA attachment structure that allows said ROMA to be removably attached.

11. The system as specified in claim 8 wherein said waist belt comprises: a) a means for adjustably attaching said waist belt across the waist of the patient undergoing testing and, b) a ROMA attachment structure that protrudes outward from the back of said waist belt and that allows said ROMA to be removably attached. WO 97/13454 PCT/US95/13505 37

12. The system as specified in claim 9 wherein said cervical cap comprises: a) a head band having means for being adjusted to fit the head of the patient undergoing testing, b) a head support that is attached across the head band, and c) a ROMA attachment structure that protrudes outward from the top of the 0 head support and allows said ROMA to be removably attached.

13. The system as specified in claim 1 wherein said range of motion arm (ROMA) circuit means comprises a set of potentiometers where said ROMA's upper knuckle has three potentiometers, the middle junction has one potentiometer, and the lower knuckles has two potentiometers where the potentiometers provide six channels of range of motion analog signals.

14. The system as specified in claim 13 wherein the range of motion analog signals from said ROMA are in the form of voltage levels ranging from 0 to d-c, where 0-volts is representative of 0-degrees of angular displacement and 5 -volts d-c is representative of 270 -degrees of angular displacement.

15. The system as specified in claim 13 wherein said integrated movement analyzer circuit means for receiving and processing the range of motion analog signals from said range of motion arm comprises: a) a voltage follower buffering and low-pass filtering circuit having means for: providing a d-c excitation voltage and an isolated ground that is applied across each of the WO 97/13454 PCT/US95/13505 38 potentiometers in said ROMA, retaining the integrity of the potentiometer wiper voltage by eliminating any a-c component above 50 Hz, b) a voltage-to-current circuit that receives the processed analog signal from said voltage follower buffering and low-pass filtering circuit and converts the analog voltages representative of angular distance to a linear current drive signal, and c) an isolation circuit consisting of an analog optically isolated amplifier which receives the linear current drive signal from said voltage-to-current circuit and converts the signal to a voltage representative of the angular displacement of the ROMA potentiometers.

16. The system as specified in claim 1 wherein said integrated movement analyzer circuit means for receiving and processing the differential analog d-c signals from said functional capacity sensor (FCS) comprises: a) an instrumentation amplifier circuit and sensor bridge driver voltage having means for: providing a d-c excitation voltage and an isolated ground for sensor bridge excitation, receiving a differential signal from said sensor bridge, whereby the difference in resistance is sensed to Provide a representative d-c voltage signal, l- WO 97/13454 PCT/US95/13505 b) a voltage to current circuit which is applied and converts the representative d-c voltage signal to a linear current drive signal, and c) an optical isolation circuit consisting of an optically isolated amplifier which receives the linear current drive signal from said voltage to current circuit and converts the signal to a d-c voltage representative of the force exerted upon said FCS.

17. The system as specified in claim 16 wherein the range of voltage levels for the d-c voltage representative of the force exerted upon said FCS range from 0 to 5-volts, where 0-volts is representative of zero Ibs. and 5-volts d-c is representative of the specific calibration of the sensor bridge.

18. The system as specified in claim 17 wherein said functional capacity sensor mechanical means comprises: a) a strain gauge mounted on a flat piece of metal on which the patient stands, and b) an adjustable cable having an end attached to the flat piece of metal and the other end having a two handed grip, where when the grip is pulled by the patient, the strain gauge measures the pulling force of the patient which is analogous to the lifting power of the patient.

19. The system as specified in claim 1 wherein said isolated power supply circuit means comprises: a) a bridge rectifier and d-c circuit filter WO 97/13454 PCT/US95/13505 that is applied a-c utility power which is then rectified and filtered to produce a d-c voltage output, b) a set of d-c power regulation circuits that are applied the d-c voltage from said bridge rectifier and d-c filter and that produce: +5 volts d-c, +12 volts d-c, -12 volts d-c and -5 volts d-c which are applied: directly to said system circuits that are not optically isolated, and to a set of three isolation d-c to d-c converting circuits that convert the non-isolated d-c voltages to isolated d-c voltages, and to an isolated ±5 volts d-c and ±12 volts d-c voltage regulators which further regulate and produce the d-c regulated voltages required for the optically isolated circuits. The system as specified in claim 1 wherein said surface electromyography cable assembly varies in length from 4 to 40 feet in configurations consisting of individual shielded coax wires twisted in pairs for each channel, where the shields for each wire terminate at the input circuit of said integrated movement analyzer to eliminate ground loops, and where said cable further includes a single, non-coax wire that is used as signal ground for setting the ground reference from the patient to the integrated movement analyzer, where said cable terminates at the first end with a twist lock connector and the second end with a pair of finger-operated spring clips that releasably attach to the clip attachment protrusions on said SEMG electrode pads.

WO 97/13454 PCT/US95/13505

21. The system as specified in claim 1 wherein said data produced by said combination computer and software program produces comparative analytical data which is in the form of graphic plots.

22. The system as specified in claim 21 wherein said system computer software: a) interfaces with a parallel interface connector, b) selects the voltage level that each channel will respond to, c) initializes the sampling frequency rate of the ADC, d) selects the appropriate testing protocol, e) samples each cable lead during the test to detect if a lead failure has occurred, f) prompts the system user as to the location of a lead failure, g) starts the integrated movement analyzer when the testing should begin, h) prompts the technician as to the muscle groups that the individual leads should be connected to for a given protocol, i) prompts the technician as to the activities that the patient should be performing during the test cycle, 3) saves the data on hard drive at the completion of a test, k) converts the patient's data from binary data to computer graphics, 1) time and date stamps each file as data is taken, m) generates computer plots from 1 to channels of data, WO 97/13454 PCT/US95/13505 n) plots range of motion data and correlates this data to angular displacement, o) plots functional capacity data and correlates this data to maximum force applied to the functional capacity sensor by the patient, P) sets the testing time for the test being performed, and q) produces plots which include patient information, location of test, the test performed and the muscle groups.

23. The system as specified in claim 22 wherein said system software program further comprises: a) a patient's data collection program which allows the selection of the following options: cervical/carpal tunnel syndrome (CTS) protocol testing, extremities protocol testing, mid and lower back protocol testing, technical information covering lead setup and muscle groups, lead-fail integrity check, and return to main screen option selection, where said data collection software program: WO 97/13454 PCT/US95/13505 43 interfaces with a parallel interface connector, selects the voltage level that each channel will respond to, initializes the sampling frequency rate of the ADC, selects the appropriate testing protocol, samples each cable lead during the test to detect if a lead failure has occurred, prompts the system user as to the location of a lead failure, starts the integrated movement analyzer when the testing should begin, prompts the technician as to the muscle groups that the individual leads should be connected to for a given protocol, prompts the technician as to the activities that the patient should be Performing during the testing cycle, saves the data on hard drive at the completion of a test, (11) converts the patient's data from binary data to computer graphics, and (12) time and data stamps each file as data is taken, WO 97/13454 PCT/US95/13505 b) a patient's data plotting program that allows the plotting of the patient's data for use on a final report, where said data: generates computer plots from 1 to channels of data, plots range of motion data and correlates this data to angular displacement, plots functional capacity data and correlates this data to maximum force applied to the functional capacity sensor by the patient, sets the testing time for the test being performed, and produces plots which include patient information, location of test, the test performed and the muscle groups. 1 1 2,2 0 0 00 00 0 0 5 9

24. A process for analyzing myofacial injuries by use of an integrated movement analyzer (IMA) that operates in combination with a computer that includes a system software program, a range of motion arm (ROMA), a surface electromyography (SEMG) cable assembly comprising a plurality of paired SEMG leads having a first end that terminates at a cable connector that attaches to a mating connector on said IMA and a second end where each paired SEMG lead terminates with a designated electrode attachment clip, and the use of a functional capacity sensor (FCS) that includes a flat metal plate having a strain gauge and on which the patient sits or stands, and a pull cable attached to the metal plate, said process comprising the following steps: 0 a) connect said IMA to a source of electrical power, b) connect said computer to said IMA, c) connect said SEMG cable assembly to said IMA and test the integrity of said SEMG cable assembly by means of said computer, d) connect said ROMA to said IMA, 5 e) prepare a patient by cleansing the area of the patient's body encompassing a muscle group pertaining to the test protocol that is to be analyzed, f) attach to each designated lead of said SEMG cable assembly, a SEMG electrode pad, 3 g) mount said ROMA to patient, h) attach said electrode pads around the area of the selected muscle groups, as follows, i) attach said FCS to said IMA, j) for testing of repetitive stress injuries protocol, attach the SEMG electrode pads to the following muscle groups bilaterally: external sternocleidomastoid (SCM), scalene, paraspinal cervical, upper trapezii, deltoid, bicep, tricep and wrist, k) for testing the cervical region, attach the SEMG electrode pads to the following muscle groups bilaterally: external sternocleidomastoid (SCM), scalene, paracervical, and upper trapezii, S* 9 S *5*9 S. S S. 0 0 35 .20 25 0 0 0 46 1) for testing the middle back resign, attach the SEMG electrode pace to the following muscle groups bilaterally: middle trapezii, lower trapezii, paraspinal set 1, and paraspinal set 2, m) for testing the lower back region, attach the SEMG electrode pads to the following muscle groups bilaterally: paraspinal set 1, paraspinal set 2, quadratus lumborum and gluteal, n) for testing the lower extremity region, attach the SEMG electrode pads to the following muscle groups: anterior thigh, posterior thigh, anterior calf, and posterior calf o) instruct the patient to perform a series of movements while maintaining either a sitting or standing position including to pull the pull cable and as follows: for the RSI test instruct the patient to perform the actions pertaining to the cervical and extremity regions, for the cervical region test, instruct the patient to perform the actions pertaining to the cervical region, for the extremities region, instruct the patient to perform the actions pertaining to the lower extremity region, and for the middle and lower back region, instruct the patient to perform the actions pertaining to the middle and lower back region, p) allow said computer to display and record the pulling force exerted by the patient.

25. The process as specified in claim 24 wherein said process further comprises instructing the patient to: stand on the flat metal plate, and pull on the pull cable. 0000 35 47

26. An integrated movement analyzing system comprising: a) a surface electromyograph (SEMG) cable assembly comprising a plurality of paired SEMG leads having a first end that terminates at a cable connector and a second end where each lead terminates with an electrode attachment clip, b) a plurality of SEMG electrode pads, where each pair of pads provides two clip attachment protrusions that interface with two skin contact points adapted to be attached to selected muscle group areas of a human patient, where to the protrusions are releasably attached the electrode attachment clips, and where each said SEMG electrode pad produces a differential analog signal representative of the resistance between the two skin contact points of the patient, c) a range of motion arm (ROMA) having electrical circuit means and mechanical means for producing range of motion analog signals representative of the angular distance produced from selected areas of the patient, d) an integrated movement analyzer (MA) comprising: 2 a surface electromyography section having circuit means for receiving and processing the analog signals from said SEMG electrodes attached to said SEMG cable assembly, a range of motion section having circuit means for receiving and 0• •processing the analog signals from said ROMA, an analog to digital converter (ADC) that receives and further processes the SEMG electrode, and ROMA analog signals from said respective section, e) a power supply having circuit means for supplying the power requirements for operating the circuits of said integrated movement S°analyzing system, f) a computer having installed a system software program where said computer receives the processed signals from said ADC for further processing and for the production of data representative of the patient's problems being analyzed, and g) a functional capacity sensor (FCS) that includes a flat metal plate having 35 a strain gauge and on which the patient sits or stands, and a pull cable attached to the metal plate, the FCS being attached to said IMA and being adapted such that a patient may be instructed to pull on the pull S...cable and said computer to display and record the pulling force exerted by the patient. 48

27. An integrated movement analyzing system substantially as herein described with reference to the accompanying drawings.

28. A process for analyzing injuries by use of an integrated movement analyzing system substantially as herein described with reference to the accompanying drawings. Dated this 11th day of March 1999 KINIMED INCORPORATED By their Patent Attorneys A.P.T. Patent and Trade Mark Attorneys 5* S S o o S