CA2234537A1 - An integrated movement analyzing system - Google Patents

Abstract

An integrated movement analyzing system (10) that utilizes surface electromyography in combination with range of motion and functional capacity testing to monitor any muscle group in the human body (80). The system (10) consists of an integrated movement analyzer (18) that receives inputs from up to 32 channels of surface EMG electrodes (12), a range of motion arm (ROMA) (14) having six degrees of freedom, and a functional capacity sensor (FCS) (16) having one output channel. When performing upper and lower back protocol testing, the ROMA (14) is connected between the patient's upper back and lower back by a shoulder harness (40) and a waist belt (42). For cervical testing, the ROMA (14) is connected between the patient's head and upper back by a cervical cap (44) and the shoulder harness (40). The output of the IMA (18) is provided via an analog to digital converter (30) to a computer (34). The computer (34) in combination with a software program (36) produces comparative analytical data which is primarily in the form of graphic plots.

Description

CA 02234537 l998-04-09 AN INTEGRATE~:D MOVE;MENT ANALYZING SYSTEM

TECHNICAL FIELD

The invention pertains to the general field of electro-diagnostic equipment and more particularly to an integrated mo~ement ~n~lyzing system that combine~
electromyography with range of motion and funationAl c~pacity mea~urements. to provide a non-invasive And non-loading method for analyzin~ myofacial injuries and repetitive stress injuries.

BACKGROUND ART

Myof'acial injuries repreYent the second largest medical problem today, with back pain alone accounting for the largest medical visits. Carpal tunnel syndrome " (CTS), repetitive stres6 injuries ~RSI) account for the most d~ys lost and ~re predicted to become the mo~t costly health problem of our time. With the implement~tion OI- the American's with disability (ADA) law worker's compensation claims such as CTS c~ln now CA 02234~37 l998-04-09 W O 97/13454 PCT~US95/1350~

sue in the federal court system allowing for the initiation of suits in excess of 10 million dollars.
These claim~ could d~mage 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 b~ck pain patients who underwent an MRI ~ound evidenae of disc pathology. How reliable is an MRI - it Appears to have no correlation to pain, impairment and may not be alinically si~nificAnt.
A recent study revealed that over 45 peroent of individuals who have undergone CT~ release surgery were no better two years p~st the surgic~l intervention bec~use they were misdiagnosed. The individuals probably had cervical pathology th~t c~n refer pain and mimic the symptoms of carpal tunnel, ulnar neuopathy, cubital tunnel, tendonititis, DeQuarian'a syndrome i.e. J repetitive stress injuries. The problem is that until the development of the instant invention, there was no way to ~scertain if the problem Wa8 proxim~l tcervical or distal, CTS).
In the past, many doctors have prescribed a pro~alati~ work reatriction limitinc the amount an individu~l c~n 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 o~
no li~ting 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) i8 a portable, non-loading electronic instrument that simultaneously monitors muscle activity with ~ilver-silver chloride standard ECG electrodes, cervical, thoracic and lumbar flexion~ exten~ion, right W O 971134S4 PCT~US95/13SO5 rotation, left rotation, right l~teral movement, ~nd left lateral movement ~s well as monitorin~ the extremitie~. The IMA also simultaneously combines a non-loading lo~d cell ~nd strain gau~e that with a computer ~nd software correlates the weight li~ted by pullin~ on the strain gage. The EMG, R~nge of Motion a~ func-tion~l c~acity 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 per~ormin~ any activity e~en their job, no m~tter wh~t or where it i8. 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 i8 ~ound in the paraspinal mu8cles over the EMG, in the upper trapezius and in the low back, the amplitude o~
the ECG aativity that overlaps the EMG correlates to disc pathology or spinal chan~es on an MRI. Sinae the IMA monitors active range of motion, it takes the MRI
one step ~urther and can help determine if the monitored ~ilment, can in fact, be treated with conservative methoda that do not in~olve surgery.

CA 02234~37 l998-04-09 A search of the prior art did not di~close any patenta 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 Mos8 25 August 1987 4,667,513 Konno 26 May 1987 The 5,042,505 Mayer, et al patent discloses an 10 electronic device ~or measuring rel~ti~e angular positional displacement and angular range of motion for body segments and articulating joints of the human skeleton. The device has a hand-held inter~ace unit which i~ placed against the body segment or joint to be teated. Mounted within the houaing of the interface unit i8 a sha~t 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 ~ravity, causing the shaft to rotate. The optical encoder generates an electric~l signal represent~tive of the amount of rotation of the sha~t. The generated ~ignal is fed to a microprocessor which proces~es the information and can produce on a display the change in ~n~ular position relative to initial an~ular position or the angular ran~e of motion of the body segment or articulating joint.
The 4,688,581 Mos5 patent discloses an apparatus and a method for non-invasive in vivo determination o~
muscle fiber composition. The method includes the steps of electrically stimulating a chosen muscle;
determining the stimulation current; mea~uring the electrical potenti~l of the muscle; the contraation time; and the force produced by the contraction; and by intercorrelating the data by multiple regression, determining the type, percentage and size of muscle CA 02234~37 1998-04-09 fibers within the muscle ~timulated Apparatus ~or determining the muscle compo~ition include~ a muscle stimul~tor of controlled voltage; electr~myogram equipment; and a force transducer providing a tension curve as well as force measurements.
The 4,667,513 Konno patent discloses an apparatus and ~ method for e9timating the degree o~ the ~atigue and p~in of muscles. The apparatus composes subjects of different weights on the same basi~ by deriving the variation in the muscular strength such as the dor~al 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 electromyogrammatic ~mplitude by processin~ the voltage induced ~rom the muscle to be tested through an electromyogrAm amplitude ~nd a waveform processor. The ratio between these integrAted values, after correctin~ the ratio with ~
weight/muscular strength coefficient is digitally displ~yed.
For baakground purposes and a8 indicative o~ the art to which the invention relates, reference may be made to the following remainin~ patents ~ound in the search: -PATENT NO. INVENTO~ 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 4,886,0?3 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 ~ebruary 1989 6,742,832 Kauffmann et al 10 May 1988 CA 02234537 l998-04-09 W O 97/13454 PCT~US95/13505 DISCLOSURE OF THE INVENTION

The integrated movement analyzing system aomblnes eleatromyographY with ran~e oi motion and iunctional aapacity measurements to provide doctors and other clinical practitioner8 with a method for accurately analYzing myo~aci~l injuries. The ~ystem in its basic form i 8 comprised of an integrated movement analyzer (IMA~ that functions in combination with a surface eleatromyography ~SFMG) cable having a set of non-invasive S~MG electrodes that attach to a patient, arange-of-motion arm ~ROMA), and a ~unctional capaoity sensor (FCS). The IMA i8 connected to a computer that produces data representative of the patient's problems being analyzed.
The IMA is a portable, non-loading electronic instrument th~t incorporate~ a surface electromyo~raphy eection th~t receives and proce~ses the ~ignal~
produced by the set of SEMG electrode~; a r~nKe o~
motion section th~t processes the signals from the ROMA; and ~ functional capacity section that processes the signals from the FCS. The aignals from all the section~ ~re routed to ~n analo~-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 ch~nnel~ o~ 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-mech~nical deviae that includes three articulated sections. When performing back protocol testing~ the ROMA is attached ~rom the patient's ~houlder to the patient's lower back by use of a shoulder harness and waist belt. When CA 02234~37 1998-04-09 performin~ cervical testing, the ROMA is attached from the p~tient's head to the upper b-~ak by use o~ a cervical cap and the shoulder h~!Lrness. The FCS
produces a signal that i5 representative of a pulling force exerted by the p~stient. The FCS ia aomprised of a strain gauge mounted on a plate on which the patient standa. Attached to the stain gauge is a pull cable having attached to its upper end a h.lndle griP. When the grip is pulled by the patient, the stain g~luge 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 ~ 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. Thia is clccomplished f'or each muscle group monitored while several muscles are being monitored ~Lt the ~clme time ~bove and below the are~ 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 i8 reduced to 50-60 percent less sessions, decre,lses costs, treatment time clnd 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 ~3urface electromyogr~phy in combination with range of motion and functional capacity testing to CA 02234~37 1998-04-09 W O 97/134S4 PCT~US95/13505 monitor any mu~cle ~roups in the human body.
In addition to the primary objeat, is is al80 an object of the invention to provide a system that:
o mea~ures compliance without the patient'~
cooper~tion. ~ec~u~e the r~n~e o~ motion, FCS
are aombined with ~peci~ic EMG readings, the system can tell i~ the patient could not complete the range of motion or the lifting ta~k. This is very important to the insuranae industry to reduce and defer fraudulent worker's compensation and personal injury claims and reduce long term disability.
o includes a speci~ic protocol ~or aarpal tunnel syndrome (CTS) that monitors the testin~ and r~nge o~ motion readings for all cervical and upper extremity muscle groups. This interactive protocol with the system allows doctors to look at the rel~tionship between muscle groups and to diagnose if the problem i~ cervic~l, CTS or cubital tunnel. The system al~o allows doctors to determine if it i8 a repetitive stres~
injury.
o is bene~icial to ~ports in that it can tell an ~thlete 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 screenin~ to have a "finger print" of muYcle activity if there is a subsequent injury and with ADA law8 to determine how the work site needs to be altered to comply with the law .
o aan diagno~e soft tissue injury.
o can tell i~ di~c pathology i~ present ~nd if it is clinically significant, o can provide site-specific treatment protocols, W O 97/13454 PCT~US95/13505 o can eliminate the need for most aarpnl tunnel and cubital tunnel surgeries.
~hese and other objects and advantages o~ the present invention will become apparent ~rom 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 dia~ram of the overall of the integrated movement analyzing system.
FIGURE 2 i8 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 cervic~l 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 ~ shoulder harness, and a shoulder harness and a waist belt.
FIGURE 5 is a perspective view o~ the shoulder harness.
FIGURE 6 is a pergpective view of the waist belt.
FIGURE 7 i8 ~ 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 i9 a block diagram of the surface electromyography section.

CA 02234537 l99X-04-09 /~
FIGURE 11 is a bloak diagram of the lead failure detection section.
FIGURE lZ i8 a block diagram of the range of motion section.
FIGURE 13 is a block diagram of the ~unctional capaci ty ~ensing YeCt ion.
FIGURE 14 i~ a block diagram of the IMA power 5Upp ly .
FIGURE 15 i9 a schematic diagram of the instrumentation amplifier aircuit and the lead-~ail input circuit.
FIGURE 16A-16K are computer flow diagrams Or the patient's data collection ~oftware program.
FIGURE 17A and FIGURE 17B are computer flow di~rams of the patient'~ data plotting software program.

CA 02234~37 l998-04-09 W O 97/13454 PCTrUS95/13S05 THE BEST MODE FOR CARRYING OUT THE INVENTION

The best mode ~or ~arrying out the invention i8 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 ~roup in the human body.
The preferred embodiment of the integrated movement analyzing system 10 as shown in FIGURES 1-14, i8 comprised of the following 5even major elements: a surface electromyography (SEMG) cable assembly lZ~ a range of motion arm (ROMA) 14, that operates in combination with a shoulder harnesa 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 10 i9 shown in FIGURES 1 and 2. As shown in the ~igures, the integrated movement analyzer (IMA) 18 is the focal point of the system 10 and receives inputs ~rom the surfaae electromyography (SEMG) cable assembly 12, the range of motion arm (ROMA) 14 and the runctional capacity aensor (FCS) 16; all of which are connected to a human patient 80. The output of the IMA 18 is provided to the computer 36 which produces comparative analytical data which is primarily in the form of graphic plots.
The surface electromyograph (SEMG) cable a~sembly 12 a~ 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 terminate~ 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 e~ch terminate with a CA 02234~37 1998-04-09 W O 97/13454 PCTrUS95/13505 finger-operated spring electrode attachment clip lZD.
In FIGURE 2, only three paired SEMG lead~ are shown ~or illustrative purposes; in the aatual aable de~i~n, the paired leads aan number ~rom 8 to 32.
The SEMG eleatrode pads 13, whi¢h pre~erab~y consist~ of stand~rd silver-silver chloride electrodes, include two clip attachment protrusion~ that interface with two skin contact points. To the protrusions are relea~ably attached the electrode attachment clips 12D
0 ~8 shown in FIGURE 2. The two skin aontact points are adapted to be attached to selected areas of a human patient 80 a~ al~o shown in FIGURE 2. The electrodes produae a differential analog signal that i6 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 o~ 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 loop~, each wire shield terminate~ at an instrumentation amplifier circuit 20A which is the input circuit of the inte~r~ted movement analyzer 18 which is described infra. The cable assembly al80 includes a single, non-coax wire 12C that is used a8 a signal ground for setting the ground reference ~rom 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 si~nals representative of the angular distance produced from selected area5 o~ t~e patient 80. The mechanical means is encompassed in a non-load bearing device that includes ~n upper knuckle 16A having an attachment pin CA 02234537 l998-04-09 WO 97/13454 PCT/USgSl1350S

14E, a middle junction 14B and a lower knuckle 14C al80 having an attachment pin 14E. Power to the ROMA 14 ia ~upplied through cable 14D.
The upper knuckle is de3igned to rotate in three directions to measure up and down, side to side, and rotarY movement3 of the patient' 8 shoulders ~or back mea~urements or the top o~ the patient' 8 head l~or aervical 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 mea~ure the angular distanae 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, ~rom the patient's upper back to the patient's lower back, by means of a shoulder harness 40 as shown in FIGURE 5.
When performing lower back protocol testing, the ROMA
is attached between the shoulder harness 40 and a waist belt 4Z as shown in FIGURES 4 and 6. For cervical testing, the ROMA 14 a8 also shown in FIGURE 4, ie attached from the top of the patient' 8 he~d to the patient'a upper back, by means of a cervical cap 44 a~
shown in FIGURE 7 and the shoulder harness 40 a8 shown in FIGURE 6.
The ROMA 14 is ~hown attached in two places in FIGURE 4. However, in actual teating, the ROMA 14 is attached to either the cervical cap 44 and the shoulder harnes~3 40, or from the shoulder harness 40 to the waist belt 42.
The shoulder harness 40 as shown in FIGURE: 5,is typically comprised of a right shoulder support 40A, a le~t shoulder support 40B, a horizontal baclc strap 40E
and a ROMA attachment structure 40G.
The right and left shoulder 9uPports 40A,40B each have an upper section 40C and a lower section 40D. The W O 97/13454 PCT~US95/13505 lower sections are looped under the upper arms and are adju~tably attached to the upper section by an attachment means 40F that allows the harness 40 to be adjusted to fit the anatomy o~ the patient 80 undergoing the te8tin~ a8 shown in FIGURE 4. The preferred attachment means con~ists o~ a complimentary hook and loop ~stener 40F a5 shown in FIGUR~ 5. The horizontal back strap 40E i9 integrally attached to the inward edges of the back of the ri~ht and le~t shoulder supports 40A,40B across the upper back Or the patient protruding outward from the center o~ the back strap 40E is the ROMA attachment structure 40G. This structure includes a pin cavity 40H that is sized to accept an att~chment pin 14E located on the ROMA 14.
The waist belt 42 a8 shown in FIGURE ~, consists o~
an attachment means 42A that allows the belt to be adjustablY adjusted acro~s the waist o~ the patient 80 undergoing testing as shown in FIGUR~ 4. The pre~erred belt attachment me~ns compri~es a hook and loop ~astener 42A as shown in FIGURE 6. Protruding outward ~rom the back of the belt 42 is a ROMA attachment structure 40B. This structure includes a pin cavity 40C that is sized to accept an attachment pin 14E
located on the ROMA 14.
The cervical cap 44 as shown in FIGUR~ 7 consists basically of a head band 44A having a means ~or being adjusted to ~it the head of the patient undergoing testing as shown in FIGURE 4. Across the head band 44A
is ~ttached a head support 44C that includes a means ~or bein~ adjustably attached to the patient's head.
The pre~erred adjustment me~ns i~ a complimentary hook and loop fastener 44B. On the center top of the head b~nd 44C is a ROMA ~ttachment structure 44D a8 ~hown in FIGURE 7. Thi~t structure al80 includes a pin cavity 44E that i~ sized to accept ~n attachment pin l~F
located on the ROMA 14. As also shown in FIGURE 7, the CA 02234~37 1998-04-09 aervical cap 44 maY also include an adjust~lble skull mount 64F that h~s a movable ahin ~upport 44G and resilient head cu9hions 44G located on the inside o~
the head band 44A.
The ROMA's 14 electrical circuit means i~ compriaed o~ 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 8iX
channels of range of motion analog signals. The range of motion analog ~ nAls are in the form of voltaE~e levels ranging from O to 5-volts d-c; where O-volts is representative of O-degrees of angular di~placement and 5-volts d-c is representative of 270-degrees of angular displacement. The analog signal~ are applied to the lMA 18 through connector 14E of the cable 14D which attache~3 to IMA connector 18B as described in~ra.
The functional capacity sensor (FCS) as shown in FIGURES 2 and 8, includes electrical circuit mean~ and mechanic~l means for producing a differential analog d-c ~3i~nal representative of a pulling force exerted by the patient.
The mechanical means for a preferred embodiment a~3 shown in FIGURE 8~ is comprised of a strain gauge 50 mounted on a flat metal plate 52 on which the patient stands. Attached to the metal is a pull cable 54 having a ~irst end 54A that is attached to the metal plate 52 and a second end that 54B has attached a two-handed ~rip 54C. When the grip is pulled by the patient 80, the strain gauge 50 measures the pulling force o~ the patient which is analogous to the lifting power o~ the patient.
The li~ting ~orce is measured by a range of d-c voltage levels that are repre3entative of the ~orce exerted upon the FCS l~ by the patient 80. The d-c voltage range from O to 5-volts~ where O-volts is CA 02234537 l998-04-09 W O 97/13454 PCT~US95/13505 representative of zero lbs and 5-~olts d-o i8 representative of the specific calibration of the sensor bridge, The resulting differential analog d-c signals are applied through connector 52 Or c~ble 56 to IMA connector 18C to as described infra.
The integrated movement analyzer (IMA) 18 as shown in FIGURES 2 c~nd 9~ is a self contained unit, th~t i8 comprised of a sur~aae electromyography section 20 having circuit mean8 for receiving and proces~ing the di~ferential analog signals ~rom the SEMG cable assemblY 12; a lead failure detection section 2Z having circuit means for receiving and processing the differential analoe signals from the SEMG cable ~sembly 12; a range o~ motion section Z4 having circuit means for receiving and processing the analog signal from the ran~e of motion arm 14; a functional capacity sensing section 26 having circuit meana ~or receiving ~nd processin~ the an~lo~ si~nals Prom the functional capacity sensor (FCS) 16 and an isolated power supply section 28 having circuit means ~or supplying the power required to operate the IMA
circuits. The circuit me~ns of the IMA 18 ~llows the sampling of uP to 3Z channels of the SEMG analog signals; ~ix channels of the motion arm analog signals and one ahannel of the functional capacity sensor analog aignal, where ~ll the ~ignal~ ~re ~imult~neou~ly measured at sampling speeds of up to 10 KHz at any testing time frame.
The surface electromyography (SEMG) section 20 circuit me~ns for receiving and processing the differential An~log ~ignals from the set of SEMG
electrodes lZB, as shown in FIGURE 10, comprises: an instrumentation amplifier circuit ZOA havin~ means for detecting the resistance between the contact points o~
each SEMG electrodes 1ZA, which corresponds to the patient's skin re9i9tance) and converting this CA 02234~37 l998-04-09 W O 97/13454 PCTrUS95/13505 resistanoe to a representative analog voltage. The analog ~oltage i8 then applied to a voltage-to-aurrent circuit 20B having circuit means for converting the analog voltage to a linear aurrent drive signal.
Following the circuit ZOB as shown in FIGURE 10 i8 an optical isolation circuit 20C that isolates the patien~
80 from the system 10. The circuit 20C aonsists of an optiaally isolated ampli~ier having airauit mQans for converting the linear aurrent drive signal to a voltage representative o~ the di~erential analog signal ~rom the SEMG electrode~ 12A. The final circuit comprising the ~EMG seation 20 i8 a filtering airauit 20D that i8 comprised o~:
(1) a 10 Hz high-pas~ filter that eliminates any d-c component of the output signal from the optical isolation circuit 20C, (2) a notch ~ilter that eliminates 60 Hz are appliaable harmonics noise inherently generated in the air, and (3) a low-pass ~ilter that eliminates ~requenaies above 2.5 KHz. The output signal o~ the ~iltering airauit 20D, represents the resistance detected at the SEMG electrode 12B
aonnected to the patient 80.
The instrumentation amplifier circuit means 20A as described ~bove~ is ~urther comprised a8 shown in FIGURE 15 o~ a ~EMG input circuit ZOA1, a low pa88 ~ilter ZOA2 and a voltage ampli~ying circuit 20A3.

CA 02234~37 1998-04-09 1~' The SEMG input cirauit 20~1 is aomPrised o~ an instrument~tion ~mpli~ier U1 h~ving a positive and ne~ative input and an output. The input i8 connected across a pair of current limiting resistors R1 and R2 respectively with each resistor having an input ~ide and an output side. To the resistor's input side i8 applied respectively, the positive and negative input signals from the SEMG electrodes. The resistor's output side i9 connected ~cross a capacitor Cl and u network of ~our diode8 CR1-CR4. The capacitor provides stability between the two inputs of the instrumentation ampli~ier U1 by filtering high common mode noise and the four diodes prevent static charge or over voltage from dama~ing the instrumentation amplifier. Any di~ference in voltage potential between the positive and negative inputs o~ the instrumentation ampli~ier U1 i8 equal to the difference in potential between the two leads o~ the SEMG electrodes and i5 al80 the output o~
the instrùmentation ampli~ier.
The low pass ~ilter 20A2 is comprised o~ a coupling capacitor C2 having an input side and an output side.
The input side i8 applied to the output o~ the instrumentation amplifier U1 and the output ~ide is connected to the input of a 10 KHz low pass ~ilter that ~ilters all ~requencie~ above 10 KHz. The filter consist of a series resistor R4 that is connected ~cro~s a re~istor R5 and a capacitor C3 that i~
connected to circuit ground.
The volta~e amplifying circuit 20A3 is comprised of a voltage amplifier U2 having a positive and negative input ~nd an output. Connected to the positive input of the amplifier U2 is the output from the low pass ~ilter 20AZ. The voltage amplifier U2 has a gain of at least 30. The gain is produced by a pair of voltage-dividing feedback resistor~ R3 and R6 that have their junction connected to the negative input of the voltage CA 02234~37 l998-04-09 W O 97/13454 PCT~US95/13505 ~4 amplifier U2.
The differential analog signals from the set of SEMG eleatrode 12B are algo applied to a lead failure detection section 22 as shown in FIGURE 11. The section Z2 compri~e8 a lead-~ail detection circuit Z2A
having means for detecting when the input from the SEMG
electrodes lZB 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 lZB
has failed. When such a failure ocaurs, 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 i9 appl ied to a ~et of lead-fail indicators 22C that consi~t of light emitting diodes (LED's) that are located on the front panel of the integrated movement analyzer ~8 shown in FIGURE 2. The signal that drive8 the LED's i8 also ~ensed by An analog to digital converter and is monitored by the computer ~oftware program to allow the particular L~D's corresponding to the failed lead, to illuminate uo thAt connection action c~n be t~ken to fix the problem.
The lead-fail detection circuit 2Z a8 described above, is further comprised, a~ also shown in FIGURE
15, of a lead-fail input circuit Z2A1 and a comparator circuit Z2A2.
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 i8 ~pplied the positive and negative input si~nals respectively from the SEMG eleatrodes.
The amplifiers U3 and U4 are configured a8 voltage ~ollowers to assure that the lead-fail detection CA 02234537 l998-04-09 W O 97/13454 PCT~US95/13505 circuit 22A doe~ not interfere with the sur~aae electromyography section ZO.
The comparator circuit 2ZA2 i9 compriaed o~ a Pair o~ amplifier~ U5 and U6 eaoh having ~ po~itive and negative input and an output. To the po~itive inputs are applied the outputs from the voltage ampli~iers U3 ~nd U4 re~pectively through input re~i~tora R9 ~nd R10 respeatively. Both the amplifiers operate with a poaitive feedb~ck path that is applied through resistors R11 and R12 respectively. The comparator circuit further include~ a bias circuit. Thi~ circuit sets a bias level at the negative inputs o~ the amplifiers U5 and U6, by means of a pair of resistor~
R13 and R14 and capacitor C4, where resistor R13 is connected to a positive voltage and capacitor C4 and re~i~tor R14 are connected to circuit ground. The bias circuit ~ssure~ that i~ the positive inputs o~ the ampli~iers U5 ~nd U6 drop below a ~peci~ied thre~hold level~ the output of either ampli~ier will ch~n~e to a zero output. This zero output is applied to an OR
lo~ic circuit con~istin~ o~ diodes CR5 and CR6 whi~h al~o drops to zero to produce the digital si~nal that i~ ~pplied to the lead-fail optically coupled circuit 22B as ~hown in FIGURE 11.
The range of motion ~ection 24 circuit me~n~ as shown in FIGURE 12, for receiving ~nd processing the range o~ motion an~10~ ~ign~ls produced by the range o~
motion arm 14 compri~es a voltage ~ollower bu~ering and low-pas~ filterin~ circuit 24A having means ~or:
~1) providing a d-c excitation voltage and an isolated ground th~t is applied acro~s each o~
the potentiometers in the range o~ motion arm (ROMA), (2~ retaining the integrity of the potentiometer wiper voltage by eliminating any ~-c component above 50 Hz.

CA 02234~37 l99X-04-09 W O 97/13454 PCT~US9S/13505 From the cirauit 24A i9 produced a proaessed analog signal that is applied to a voltage-to-current cirauit that converts the analog voltages repre~entative o~
angular di~tanae to a linear current drive signal. In turn, the drive signal i8 then applied to an i~olation aircuit aonsisting o~ an analog optically i~olated ampli~ier. The amplifier converts the signal to an analog voltage represent~tive of the angular di~placement of the ROMA potentiometers.
The funational aapacity sen~in~ section 26 aircuit means as shown in FIGURE 13 for receiving and proce~sing the di~ferential analog signals supplied by the ~unational a~p~aity 9ensor (FCS~ 16 is aomprised of an instrumentation ampli~ier airauit and sensor bridge driver voltage 26A having means ~or:
(1) providing a d-a exaitation voltage and an isolated ground ~or a sensor bridge exaitation, (2) reaeiving a di~ferential signal from thé
sensor bridge, whereby the di~erenae in resistanae i~ sensed to provide a representative d-c voltage signal.
Following the sensor bridge is a voltage to current airauit Z6B whiah is applied and aonverts the representative d-a voltage signal to a linear aurrent drive signal. The drive 8 ignal i3 then ~pplied to an optic~l i801ation airauit 26C that isolate~ the patient 80 ~rom the system 10. The airauit Z6C aonsists of an optically isolated amplifier having cirauit means for aonverting the drive si~nal signal to a d-a voltage repre~entative o~ the forae exerted upon the FCS. The airauit Z6C aan be aalibrated for variable outputs in a typical calibration, the d-a voltage ranges from O to 5-volts, where O-volts i~ representative o~ zero lbs.
and 5-volts d-c i9 repre9entative of the specifia calibration of the sensor bridge.

CA 02234~37 l998-04-09 W O 97/13454 PCT~US95/1350S

The final electronics circuit described is the power supply circuit 28 shown in FIC~URE 14. The input to the power supply i8 derived i~rom the utility lZ0-volts a-c power which i8 applied to a bridge rectifier and d-c ~ilter circuit where the a-c utility power i8 rectified and filtered to produae a d-c voltage output. The ayatem can Cl18O be designed to operate with an internal battery that is ~elected to produce the required d-c voltage level to operate the 8ytem lO.
The d-c voltaae i~ applied ~ set o~ d-c power regulation circuits 28B that produce: ~5 volts d-c, +12 volt~ d-c, -12 volts d-c and -5 volts d-c. These vo1tages are applied:
15~l) directly to the sYstem lO circuits that are not optiaally isolated, and (2) to a set of three isolated d-c to d-c converting circuits 28C that convert the non-isolated d-c volt~ges to isolated d-a 20voltages, and (3) to an isolated i5 volts d-c and ~12 volts d-c volta~e regulator circuit 28D which ~urther regulate and produce the d-c regulated voltages required for the optically isolated 25circuits.
From the respective SEMG, ROMA and FCS sections a8 shown in FIGURE 9, the respective output signals ~re applied to an analog-to-digital converter ~ADC) ~or ~urther processing. The ADC in the preferred embodiment 30i9 a 16 bit, 16 channel device that also includes 8 lines of digital I/0. However, multiple assemblies can be connected to provide up to 3Z channels.
The processed signal~ from the ADC 30 are terminated at an output connector such as an IEEE 488 35interface. From the interface connector, the signals Are routed through a cable assembly 3Z and applied to a CA 02234~37 l998-04-09 W O 97/13454 PCT~US95/13~0~

oomputer 32 shown in FIGURE 2. The aomputer 34 operates with a software program 36 as shown in the computer flow diagram included as FI~URES 16A-16 to produce the comparative analytical data representative of the patient'8 problem being analyzed. The aoftware program 36 whiah is proteated under registered and pending copyright regi8trations consists of a p~tient' B
data collection progr~m ~nd ~ patient '8 data plotting program.
The patient's data collection program which i8 shown in the computer flow diagram~ of FIGURES 16A-16K
allows the seleatiOn 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 chec~, and f) return to main screen option seleation.
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 samplin~ frequency rate of the AD~, d) ~elects 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, CA 02234537 l998-04-09 o2 S~
i) prompts the technician as to the activitie~3 that the patient should be per~orming durin~ the tes~t cycle, j) saves the data on h~rd dri~e at the completion o:e a teat, k) converts the patient '9 data from binary data to computer graphic~ nd l) time and date stamps each file a8 dat~ is taken, The patient' 5 data plotting program which i~ ~hown in the computer flow di~gr~m8 o~ FIGURES 17A and 17B
c~llows the plottin~ of up to ~orty cho.nnelE~ of the patient's data for use on a final report.
The d~ta plotting softw~re program:
a) generates computer plots from 1 to 40 channels of data, b) plots range of motion data and correlates this d~Lt~ to angul~r displaaement, c) plots functional capaaity data and correlaten this data to maximum force applied to the function~l aapacity ~ensor by the patient, d) ~ets the testing time for the test being performed, and e) produces plots which include patient information, loaation of test, the test performed ~nd the muscle groups.
OPERATIONAL PROCE;DURE
~ The integrated movement analyzing system is operated by application of the following steps:
~) 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
~nd test the integrity of the SEMG cable assembly by means of the computer, d) connect the ROMA 14 to the IMA, CA 02234537 l998-04-09 e) prepare a patient by cleansing the area o~ the patient's body encompassing a muscle group pertaining to the test protocol that i8 to be analyzed, f) att~ch to ec~ch designated lead o~ the SEMG cclble assembly 14, a SEMG electrode pad 13, 6~ mount s3aid ROMA to patient, h) attach the electrode pad~ around the area o~ the ~elected mu~cle groups, ~8 follow~, i) for te~3ting of repetitive stress injuries (RSI) protocol, attach the SEMG electrode pad~ to the following mu~cle group~3 bilaterally:
~1) external sternocleidomastoid (SCM), (2) scalene, (3) paraspinal cervical, (4) upper tr~pezii, (5) deltoid, (6) bicep, (7) tricep and (8) wrist, J) for testing the cervical region, attach the SEMG
eleatrode pads to the ~ollowing muscle groups bilaterally:
(1) external sternocleidomastoid (SCM), (Z) Ycalene, (3) paracervical, and (4) upper trapezii, k) for testing the middle back region, attach the SEMG electrode pads to the following muscle groups bilaterally:
(1) middle tr~lpezii, (Z) lower trapezii, (3) par~aspinal Yet 1,and (4) para~pinal Yet Z, ~5 CA 02234537 l998-04-09 ~ 6 1) 170r testing the lower baak region, attach the SEMG eleatrode pads to the following musale groups bilaterally:
(l) paraspinal set 1, (2) paraapinal aet 2, (3) quadratus lumborum and ~4) gluteal, m) ~70r testing the lower extremity region, attach the ~MG electrode pads to the 170110wing muscle groups:
(1~ anterior thigh, (2) po~terior thigh, (3) anterior a~lf, ~nd (4) posterior cal~
n) in~truct the patient to perform a aeries Or mo~ement~ while maintaining either a sitting or Ftandin~ poaition aa followa:
(l) for the RSI test, instruct the patient to perl70rm the ~ctions pertaining to the cer~ical and extremity re~ions, (2) for the cervical region teat, inutruct the patient to per~orm the actions pertaining to the cervical region7 (3) ~70r the extremities region, instruct the patient to perf70rm the actions pertaining to the lower extremity region, and (4) 170r the middle and lower back region, instruct the patient to per~orm the actions pertaining to the middle and lower back region.
When the operation procedure includea the use of a functional capacity ~ensor (FCS) 16, the following additional ~tepa are required.
a) ~ttach the FCS 16 to the IMA, CA 02234537 l998-04-09 W O 97/13454 PCTrUS95/13505 ~ 7 b) instruct patient to:
(1) stand on the flat metal plate 52, (Z) pull on the pull cable 54 and (3) 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 aacompanying drawings it is not to be limited to such details, since many changes and modification5 may be made to the invention without departing from the spirit and the scope thereo~. For example, in FIGURF 6, the ampli~iers U1-U6 are shown for explanatory purposes as individual di~creet components. In the actual implementation of the circuit, ampli~iers U1-U6 are packaged in a single integrated circuit. Hence, it i8 described to cover any and all modifications and forms which may come within the language and scope of the claims.

Claims (26)

1. An integrated movement analyzing system comprising:
a) a surface eleotromyography (SEMG) cable assembly comprising a plurality of paired SEMG leads having a first end that terminates at a cable connector and 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 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 differential analog d-c signal representative of a pulling force exerted by the patient, e) an integrated movement analyzer (IMA) comprising:
(1) a surface eleatromyography section having circuit means for receiving and processing the analog signals from said SEMG electrodes attached to said SEMG cable assembly, (2) a range of motion section having circuit means for receiving and processing the analog signals from said ROMA, (3) a functional capacity section having circuit means for receiving and processing the analog signals from said FCS, and (4) 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 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 10 KHz for testing time frames.

3. The system as specified in claim 2 wherein said surface electromyography 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:
(1) a 10 Hz high-pass filter that eliminates any d-c component of the output signal from said optical isolation circuit, (2) a notch filter that eliminates 60 Hz and applicable harmonics noise inherently generated in the air, and (3) 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 R1 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 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 R5 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:

a) a lead-fail detection circuit having means for detecting when the input from said SEMG electrodes cross over 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

electrodes through resistors R7 and R8 respectively, where the amplifiers U3 and and U4 are configured as voltage followers to assure that said lead-rail 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 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 R10 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 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.

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.

10. The system as specified in claim 8 wherein said shoulder harness comprises:

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 a) 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.

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 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 5-volts 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:
(1) providing a d-c excitation voltage and an isolated ground that is applied across each of the potentiometers in said ROMA, (2) 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:
(1) providing a d-c excitation voltage and an isolated ground for sensor bridge excitation, (2) receiving a differential signal from said sensor bridge, whereby the difference in resistance is sensed to provide a representative d-c voltage signal, 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 lbs. 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 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:
(1) directly to said system circuits that are not optically isolated, and (2) 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 (3) 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.

20. 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.

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, 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, l) time and date stamps each file as data is taken, m) generates computer plots from 1 to 40 channels of data, 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:
(1) cervical/carpal tunnel syndrome (CTS) protocol testing, (2) extremities protocol testing, (3) mid and lower back protocol testing, (4) technical information covering lead setup and muscle groups, (5) lead-fail integrity check, and (6) return to main screen option selection, where said data collection software program:

(1) interfaces with a parallel interface connector, (2) selects the voltage level that each channel will respond to, (3) initializes the sampling frequency rate of the ADC, (4) selects the appropriate testing protocol, (5) samples each cable lead during the test to detect if a lead failure has occurred, (6) prompts the system user as to the location of a lead failure, (7) starts the integrated movement analyzer when the testing should begin, (8) prompts the technician as to the muscle groups that the individual leads should be connected to for a given protocol, (9) prompts the technician as to the activities that the patient should be performing during the testing cycle, (10) 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, 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:
(1) generates computer plots from 1 to 40 channels of data, (2) plots range of motion data and correlates this data to angular displacement, (3) plots functional capacity data and correlates this data to maximum force applied to the functional capacity sensor by the patient, (4) sets the testing time for the test being performed, and (5) produces plots which include patient information, location of tests, the test performed and the muscle groups.

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), and 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, said process comprising the following steps:
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, 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, g) mount said ROMA to patient, h) attach said electrode pads around the area of the selected muscle groups, as follows, i) for testing of repetitive stress injuries protocol, attach the SEMG electrode pads to the following muscle groups bilaterally:
(1) external sternocleidomastoid (SCM), (2) scalene, (3) paraspinal cervical, (4) upper trapezii, (5) deltoid, (6) bicep, (7) tricep and (8) wrist, j) for testing the cervical region, attach the SEMG electrode pads to the following muscle groups bilaterally:
(1) external sternocleidomastoid (SCM), (2) scalene, (3) paracervical, and (4) upper trapezii, k) for testing the middle back region/ attach the SEMG electrode pads to the following muscle groups bilaterally:
(1) middle trapezii, (2) lower trapezii, (3) paraspinal set 1, and (4) paraspinal set 2, 1) for testing the lower back region, attach the SEMG electrode pads to the following muscle groups bilaterally:
(1) paraspinal set 1, (2) paraspinal set 2, (3) quadratus lumborum and (4) gluteal, m) for testing the lower extremity region, attach the SEMG electrode pads to the following muscle groups:
(1) anterior thigh, (2) posterior thigh, (3) anterior calf, and (4) posterior calf n) instruct the patient to perform a series of movements while maintaining either a sitting or standing position as follows:
(1) for the RSI test instruct the patient to perform the actions pertaining to the cervical and extremity regions, (2) for the cervical region test, instruct the patient to perform the actions pertaining to the cervical region, (3) for the extremities region, instruct the patient to perform the actions pertaining to the lower extremity region, and (4) for the middle and lower back region, instruct the patient to perform the actions pertaining to the middle and lower back region.

25. The process as specified in claim 24 wherein said process further comprises the use of a functional capacity sensor (FCS) that includes a flat metal plate having a strain gauge and on which the patient stands, and a pull cable attached to the metal plate, said process comprising:
a) attach said FCS to said IMA, b) instruct patient to (1) stand on the flat metal plate, (2) pull on the pull cable and c) allow said computer to display and record the pulling force exerted by the patient.

26. An integrated movement analyzing system comprising:
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 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:
(1) a surface electromyography section having circuit means for receiving and processing the analog signals from said SEMG electrodes attached to said SEMG cable assembly, (2) a range of motion section having circuit means for receiving and processing the analog signals from said ROMA, (3) 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 analyzing system, and 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.