AU2009251094B2 - Method and apparatus for physiological testing - Google Patents

Abstract

A device and method to test the level of physical effort of an individual is disclosed. The device has a moveable member which may be a shaft, a sensor for measuring force applied to the shaft; and a resistance means to vary the resistance to movement of the moveable member such as an electric brake. The relationship 5 between the varied resistive force applied to the moveable member and the measured force may be determined to establish the level of effort of the user. Typically the resistance will be rapidly varied at a rate of five to ten times per second which is too quick for a person being tested and providing a sub-maximal effort, to sense a change in resistance and compensate for that change -11t Fig.2 --L Fig. 3

Description

Field of the Invention This invention relates to a method and apparatus for measuring the performance of human joints. 5 Background of the Invention The present invention is concerned with measuring the performance of a joint or combination of joints in the human body and, in particular, to measuring the effort exerted by a patient during the performance testing process. 10 When persons suffer injuries in accidents such as those which commonly occur in the workplace, and in road traffic accidents, it is usually necessary for the extent of the injured person's injuries to be determined in order to assess the correct amount of compensation which may be payable to the injured person as a result of the accident. Typically, the compensation payable will be related to the extent of the person's injuries 15 and the loss of use or performance of parts of the person's body due to the accident. For example, if a person injures their arm in an accident the compensation payable will depend on the extent to which that person's use of their arm has been impaired. Further, an accurate assessment of an injury allows a rehabilitation programme to be monitored and varied if necessary to provide the most effective treatment. 20 However, there is currently no satisfactory repeatable scientific method of assessing a person's maximal joint performance to determine to what extent the performance of the joint has been impaired due to injury or accident or the like. Currently, most injuries are assessed subjectively by doctors or physiotherapists. The assessment process is generally unscientific and open to inaccuracies. One particular 25 problem occurs when patients pretend to be more seriously injured than they are for example by pretending to be unable to do particular tasks or by only providing a sub maximal effort when tested. This is a major problem for organisations which provide insurance payments related to injuries, particularly insurance companies. 30 A further related problem arises, in that since it is not possible to accurately measure confirmable joint performance, it is not possible to accurately measure improvement in joint performance. Thus if a patient is undergoing physiotherapy or other treatment for injuries associated with a joint it is not, for example, possible to accurately plot confirmable improvement or lack of fitness in the joint on a week by 35 week basis.

2 In some cases sub-maximal effort is provided due to fear of providing a maximal effort ( for example due to a belief it may be painful to do so), Such an effort may be a sincere effort, but is not maximal. The present invention aims to provide a device for repeatedly and accurately 5 measuring the performance of a joint in the body and which preferably includes means for determining whether the patient whose joint performance is being measured is making a reduced or at least sub-maximal effort, when tested. Throughout this specification the word "comprise", or variations such as "comprises" or "comprising", will be understood to imply the inclusion of a stated 10 element, integer or step, or group of elements, integers or steps, but not the exclusion of any other element, integer or step, or group of elements, integers or steps. Any discussion of documents, acts, materials, devices, articles or the like which has been included in the present specification is solely for the purpose of providing a context for the present invention. It is not to be taken as an admission that any or all of 15 these matters form part of the prior art base or were common general knowledge in the field relevant to the present invention as it existed before the priority date of each claim of this application. Summary of the Invention 20 In one aspect, the present invention provides a performance testing device for performance testing of a person's joints and measuring level of effort comprising: a moveable member, wherein the movable member may be moved against a variable resistance by action of one or more of the person's joints; a sensor for measuring force applied to the moveable member by the human, 25 wherein the sensor transmits a first signal indicative of the measured force to a control means and a resistance means for applying the variable resistance to the moveable member; and wherein the control means is arranged to rapidly vary the resistance to movement of the 30 moveable member at a rate of at least once per second during a single movement of the moveable member by the person; and including means for comparing, or determining the correlation between, the measured force applied to the movable member with the resistance to movement of the movable member for assessing the response of the human to the variation in resistance to 35 provide an indication of the person's level of effort in moving the movable member.

3 Typically, the control means is arranged to vary the resistance to movement of the moveable member at a rate of at least twice per second. It is preferred that the control means is arranged to vary the resistance to movement of the moveable member at a rate of at least five times per second. 5 Most typically, the control means is arranged to vary the resistance to movement of the moveable member at a rate of between five and ten times per second. Typically the resistance will be varied over a very short period which is too quick for a person to consciously react to. Depending on a person's reaction times it may take a person around 250 to 350ms to sense a change with a part of their body 10 either visually or by feel, signal that change to the persons brain, react to that signal and send signals to the persons muscles. If the change is quicker than that say 150 or I OOms then a person cannot consciously react to the change. In a related aspect, the present invention provides a performance testing device for performance testing of a person's joints and measuring level of effort comprising: 15 a moveable member, wherein the movable member may be moved against a variable resistance by action of one or more of the person's joints; a sensor for measuring force applied to the moveable member by the human, wherein the sensor transmits a first signal indicative of the measured force to a control means and 20 a resistance means for applying the variable resistance to the moveable member; and wherein the control means is arranged to rapidly vary the resistance to movement of the moveable member a plurality of times during a single movement of the moveable member by the person; and including 25 means for comparing, or determining the correlation between, the measured force applied to the movable member with the resistance to movement of the movable member for assessing the response of the human to the variation in resistance to provide an indication of the person's sincerity of effort in moving the movable member. The term "joint" may include a single joint knee or elbow or the like but also 30 includes multiple joints such as a person's back which could be considered to comprise a plurality of joints. The moveable member may be a shaft or a lever. Alternatively, the movable member may be a piston in a hydraulic cylinder. Many other types of movable member may be possible, such a brakes sliding on 35 a bar or shaft. It may be a linearly moveable member.

4 Mechanisms, such as chains or belt and sprocket drives, may be connected to the movable member to convert rotational or linear movement of the member to other types of movement. For example, a cable/capstan and angle sensing device could be used for handling linear/compound movement. 5 Where the moveable member is a shaft, the shaft may be rotatable. In this embodiment, the sensor may comprise a torque sensor for measuring torque applied to the shaft. Where the movable member is a piston of a hydraulic cylinder, the sensor may comprise a pressure sensor measuring the fluid pressure inside the cylinder. An 10 adjustable control valve may control the exit of fluid to of from the cylinder. Two or more cylinders acting together could be used. The resistance means may comprise a coupling means that variably couples the shaft to the torque sensor. Such variable coupling of shaft and torque sensor varies the resistance to the turning of the shaft. An example of such a resistance means is an 15 electric brake, linear brake, eddy coupling, servo motor or the like. Where the resistance means comprises a coupling means, typically the resistance is variable between a state where there is no coupling and no resistance is applied and the shaft is free to rotate relative to the torque sensor and a state in which the shaft is fully coupled to the torque sensor. 20 It is preferred that the device includes an encoder for measuring the position of the shaft. The device may also include a control means for receiving input data from the torque sensor. The control means may also be arranged to input control signals to the resistance means and to determine the relationship between the resistance applied to the shaft and the torque measured by the torque sensor. Further, the control means may 25 receive signals from the encoder in relation to the angular position of the shaft. Where the moveable member comprises a lever, said lever may be connected to a resistance means. The resistance means may comprise a pump member. The pump member typically has a control valve to vary resistance to the lever. Further, the pump member of this embodiment may be connected to a sensor, said sensor measuring the 30 force applied to the lever. The sensor may comprise a pressure gauge to measure the pressure change of fluid in the pump as force is applied to the lever. A number of devices may be operated together simultaneously to deal with movement in multiple axes. In one broad related aspect, the present invention provides a method of level of 35 effort while testing a person's joint performance by repeatedly measuring the response of that joint to a rapidly varying load.

5 More specifically, the present invention provides a method of measuring a person's joint performance and simultaneously measuring level of effort by: providing a movable member to be moved by a person: having the person to apply a force to that movable member; 5 varying the resistance to movement of the member at least once per second; measuring the force applied to the moveable member by the person, recording the resistance applied to the movable member; and assessing the correlation between the resistive force applied and the measured torque to thereby assess the level of effort applied by the person to movement of the 10 member. In a related aspect, the invention provides a method of testing level of effort of a person's joint performance by measuring the torque applied to a shaft by one of the person's joints comprising the steps of: applying a varying resistive force to turning of the shaft, the resistance to 15 turning of the shaft being varied at least once during a single movement; measuring the torque applied to the shaft by the person's joint; recording the resistive force applied; and assessing the correlation between the resistive force applied and the measured torque to provide an indication of the level of effort applied by the person to movement 20 of the shaft. Brief Description of the Drawings A specific example of the present invention will now be described by way of 25 example only and with reference to the accompanying drawings in which: Figure 1 is a schematic drawing of a device for repeated performance measuring to gauge level of effort; Figures 2 and 3 are graphs comparing the resistive load applied to the device against measured torque; and 30 Figure 4 is a schematic drawing of a second embodiment of a device for testing level of effort.

6 Detailed Description of a Preferred Embodiment Referring to the drawings, in particular Figure 1, the device generally indicated at 10, includes a rectangular box-like casing 12. One side of a torque sensor 14 is mounted to one interior wall 15 of the casing. Fixed to the opposite side of the torque 5 sensor 14 is a mounting plate 16 defining a central hole 18 through which one end of a movable member in the form of an elongate shaft 20 extends. The end of the shaft 20 is free to rotate relative to the mounting plate and the torque sensor 14. The shaft 20 extends from the mounting plate 16 co-axial with the torque sensor 14 and defines a free end 21 which projects through an aperture 22 defined in a wall 24 of the casing 10 opposite to the wall 15 to which the torque sensor 14 is mounted. The free end 21 of the shaft 20 defines a coupling 26 which can be attached to various joint testing interfaces for testing any joints or combinations of such which can be used to produce rotary motion about an axis, which most if not all joints are capable of. 15 A brake stator coil 28 defining a central bore 30 which is of greater diameter than the shaft is fixed to the mounting plate 16. The shaft 20 extends through that central bore 30. A brake rotor 32 is mounted on the shaft 20 and defines a friction surface 34 facing the brake stator coil 28 and in conjunction with the brake stator coil 28 defines an electric brake. Increasing the current supplied to the brake rotor 32 20 increases the resistance between the brake rotor 32 and the brake stator coil 28 and hence the coupling between the two. When the current is a maximum and the brake is fully on any torque applied to the shaft 20 is transmitted directly to the torque sensor 14. When the brake is fully disengaged, the shaft 20 spins freely and no torque is applied to torque sensor 14. A shaft encoder 36 mounted on the wall 24 of the casing 25 measures the angular position of the shaft 20. A computer control means in the form of a micro controller 50 is connected to the torque sensor 14 and the shaft encoder 36 and receives input signals indicative of the torque measured by the torque sensor and the angular position of the shaft as measured by the shaft encoder. The micro controller also controls the current applied 30 to the electric brake via a feedback loop. When a torque is applied to the shaft 20 to turn the shaft in the direction A, that torque is measured by the torque sensor 14. It will be appreciated that the device 10 works by using the brake rotor 32 and brake stator coil 28 to provide increasing resistance to the turning of the shaft 20 about 35 its longitudinal axis which is measured by the torque sensor 14. The resistance can be quickly and accurately controlled by varying the current applied to the brake rotor 32.

7 The torque applied to the shaft 20 is measured by the torque sensor 14 and this therefore gives a measurement of the performance of a patient's joint or combination. The performance of virtually any joint can be measured using a flexible rope and a capstan fitted to coupling 26 to monitor movement of the joint. It will be readily 5 appreciated that other mechanisms may be fitted to the coupling to convert rotational movement to other types of movement for testing other types of movement. It is also envisaged that two or three devices could be operated simultaneously in different axes at the same time to test the performance of more complex actions in three dimensions such as serving a tennis ball, kicking a football or the like. 10 However, simply measuring the performance of the joint as described above, by measuring the torque a joint may generate will not measure true joint performance unless a patient is trying as hard as they can i.e. giving maximal effort. Also simply measuring performance based on application of a fixed load does not provide an indication of the level of effort that a patient is applying to the task. 15 Thus, in order to make it more difficult to misrepresent the true performance test by making a sub-maximal effort, in a particularly preferred embodiment, the computer control means 50 is programmed to vary the resistive load provided by the electric brake, whilst the shaft 20 is being turned by the patient. This makes it much more difficult for a patient to misrepresent the test since whilst it is relatively straightforward 20 to decide to make a "50% effort, say, when moving against an unchanging resistance, when the resistance changes quickly and continuously, the patient is unable to accurately and quickly calculate the changing level of effort they need to apply to be consistent with their original level of effort. The system thus varies the resistive load applied to the electric brake, changing 25 the resistance to turning of the shaft by the patient. The device 10 measures the torque applied to the shaft 20 by the patient and correlates the measured torque with the resistance applied to the turning of the shaft 20.. In use, the person being tested is asked to apply a maximal force to the shaft 20. Typically the person will not apply force directly to the shaft but will do so indirectly 30 via a lever or mechanism such as the rope and capstan described above or an equivalent mechanism. The resistance to the resultant movement is controlled by the micro controller 50. Clearly the person is not advised what the changes are to be. The resistance is rapidly changed at a rate quicker than a person can consciously vary. Typically the resistance is changed between 5 and 10 times per second over the full 35 range of movement of the joint, however, depending on the person's reaction times the rate may be as low as once every second or once every two seconds. In order to cheat 8 the test the person being tested has to sense the change in load as a change in pressure resistance to movement of their joint and adjust their sub-maximal effort by the same percentage, so it involves not only the person's reaction time but also their ability to mentally calculate the percentage change in effort required. Depending on a person's 5 reaction times it may take them around 250 to 350ms to sense a change, signal that change to the person's brain, react to that signal by deciding on a change of level of effort, and send signals to the persons muscles concerning the change of effort from the brain. If the change is quicker than that, say 150 or 100ms or even 70ms then a person cannot consciously react to the change. 10 Thus the response testing should be at rate that it is impossible to react repeatedly to because of physiology constraints. This rate will differ from person to person, so ideally the response testing is set at a rate no one should be able to react repeatedly to. The changes in resistance are automatically made by the micro controller 15 dependent on either the angular position of the shaft/joint or the time that has elapsed since the movement has commenced. They are made without forewarning or advising the person being tested when a change is being made. The change in the resistance to movement of the shaft is achieved by varying the current supplied to the stator 28 of the brake 20 The device 10 thus rapidly varies the resistance to the turning of the shaft 20 during a single exercise performed by the patient. Thus, if the patient is asked to, say, pull his/her fist up to his shoulder, in that one movement, the resistance to the turning of the shaft would vary many times. Several patterns of resistance may be applied including sinusoidal, "saw tooth" 25 and non-uniform patterns. The amplitudes of the patterns may be increasing or decreasing. The patterns depicted in Figures 2 and 3 are of a step change nature. The key aspect of the test is that the resistance is changed at a rate that it is impossible for a person being tested to respond to. Only if the person is applying maximal effort will the moveable member/shaft follow the changes in resistive force. 30 With reference to Figure 2 for a patient who is making a 100% effort each time, the relationship L between the measured torque 52 and the resistance applied 54 is shown to be fairly constant. If however, a patient is attempting to cheat the test by making only a "50% effort", then they will not be able to maintain that sub-maximal 50% effort consistently as the load is varied and a greater variation/standard deviation 35 in the relationship L of the measured torque and the resistive force will be measured, as 9 shown in Figure 3. The tests may also be repeated, with variations in the patient's performance further indicating sub-maximal effort. The variation of the resistive load may be based on position of the shaft as measured by either the encoder or time. The variation may be continuously varied for 5 example by a ramped load or a stepped load or both. The variation may be increasing or decreasing or consistent stopping. The electric brake may be replaced by an equivalent element such as an eddy current coupling or similar controlled coupling device or servomotor. Further, the method of providing a variable resistance could be a hydraulic motor or actuator with a 10 variable flow control so that the oil flow could be restricted to provide a controlled resistive torque. The system may be active or passive. For example, in an active system, the resistive electric brake could be replaced by a variable torque servo drive. Because the device provides a repeatable way of measuring joint performance, it 15 is possible to measure improvement in joint performance, for example, the performance of an elbow could be measured on a weekly basis and increases in the strength and range of movement of the joint performance measured and tracked. It will appreciated by those skilled in the art that many of various well known algorithms and statistical techniques can be used for providing figures correlating the 20 patient's effort to the load or resistance. The particular algorithm used is not critical. Coefficient of Correlation - Mathematical and or Visual methods One suitable formula is: ExlV N r (

(X

2 (y 2 25 Using this algorithm, the correlation coefficient is used to determine the relationship between two properties, Y and X being values of the force applied by the patient and the applied resistance, respectively. 30 Another form is: 10 Correlation Coefficient = Cov (X, Y) StdDevX) (StdDevY) Where: -1 <= Correlation Coefficient <= 1 And: Cov (X, Y) = 1/n 7 (xc - (yi -y) where y and x are the values of the force applied by the patient and the applied resistance, respectively. 5 A correlation coefficient of +1.0 is a strong positive result. As x goes up, y always goes up. A correlation of +0.5 is a weak positive, with y tending to go up as x does. A correlation coefficient of 0 shows no correlation, with 0.5 being weak negative and -1.0 being a strong negative. A positive number close to I indicates a high degree of correlation and strongly 10 suggests sincerity of effort. Figure 4 illustrates a further embodiment of a device for performance testing of joints. The movable member in this embodiment is a piston 102 slideable within a cylinder 104 containing hydraulic fluid. Forces F acting to push the piston into the cylinder cause the pressure in the hydraulic cylinder to increase and the discharge of 15 hydraulic fluid through an exit pipe 106. An electrically operable adjustable control valve 108 controls the ease of flow through the exit pipe by varying its degree of closure. Expelled hydraulic fluid may pass into a reservoir 110. A pressure sensor 112 in the hydraulic cylinder measures the pressure therein which depends on the force F applied to the piston. The sensors measurements are sent to a computer control means 20 120 which also controls the valve 108. The degree of resistance to movement of the piston may be varied by the control valve 108. By comparing that with the measure pressure the correlation between the force applied and the resistance to movement can be calculated by a computer control means 120 which controls the degree of opening of the valve and receives and input from the pressure sensor 112 measuring the hydraulic 25 pressure in the cylinder. By varying the resistance to movement of the piston as a patient pushes the piston into the cylinder, the relationship between the applied force and resistance can be measured, to test the patient's level of effort by determining the variation between the two. It will be appreciated by persons skilled in the art that numerous variations 30 and/or modifications may be made to the invention as shown in the specific 11 embodiments without departing from the spirit or scope of the invention as broadly described. The present embodiments are, therefore, to be considered in all respects as illustrative and not restrictive.

Claims (22)

1. A performance testing device for performance testing of a person's joints and measuring level of effort comprising: a moveable member, wherein the movable member may be moved against a 5 variable resistance by action of one or more of the person's joints; a sensor for measuring force applied to the moveable member by the human, wherein the sensor transmits a first signal indicative of the measured force to a control means and a resistance means for applying the variable resistance to the moveable member; 10 and wherein the control means is arranged to rapidly vary the resistance to movement of the moveable member at a rate of at least once per second during a single movement of the moveable member by the person; and including means for comparing, or determining the correlation between, the measured 15 force applied to the movable member with the resistance to movement of the movable member for assessing the response of the human to the variation in resistance to provide an indication of the person's level of effort in moving the movable member.

2. The device of claim 1 wherein the control means is arranged to vary the resistance to movement of the moveable member at a rate of at least twice per second. 20

3. The device of claim I wherein the control means is arranged to vary the resistance to movement of the moveable member at a rate of at least five times per second.

4. The device of claim I wherein the control means is arranged to vary the resistance to movement of the moveable member at a rate of between five and ten times 25 per second.

5. The device of any preceding claims wherein a single change in resistance is made over a period of less than 350ms, preferably less than 250ms, more preferably less than 150ms.

6. The device of claim I wherein the moveable member comprises a shaft and 30 wherein the sensor comprises a torque sensor for measuring torque applied to the shaft and further comprising a coupling means for variably coupling the shaft to the torque sensor, under control of the control means thereby varying the resistance to turning of the shaft.

7. The device of claim 6 wherein the resistance is continuously variable between a 35 state where there is no coupling between the shaft and the torque sensor and a state in which the shaft is fully coupled to the torque sensor. 13

8. The device of claim 6 wherein the coupling means comprises an electric brake.

9. The device of claim 5 wherein the control means receives input data from the torque sensor, said input data being indicative of the torque applied to the shaft by a user. 5

10. The device of claim 5 including an encoder for measuring the position of the shaft and wherein the control means also receives signals indicative of the angular position of the shaft from the encoder.

11. The device of claim 5 wherein the control means is arranged to calculate the correlation between the resistance to turning of the shaft and the torque measured by 10 the torque sensor.

12. A method of measuring a person's joint performance and simultaneously measuring level of effort by: providing a movable member to be moved by a person: having the person to apply a force to that movable member; 15 varying the resistance to movement of the member at least once per second; measuring the force applied to the moveable member by the person, recording the resistance applied to the movable member; and assessing the correlation between the resistive force applied and the measured torque to thereby assess the sincerity of effort applied by the person to movement of the 20 member.

13. The method of claim 12 wherein the resistance to movement of the member is varied at a rate of at least twice per second.

14. The method of claim 12 wherein the resistance to movement of the member is varied at a rate of at least five times per second. 25

15. The method of claim 12 wherein the resistance to movement of the member is varied at a rate of between five and ten times per second.

16. The method of any one of claims 12 to 15 wherein a single change in resistance is made over a period of less than 350ms, preferably less than 250ms, more preferably less than I 50ms. 30

17. A method of measuring the level of effort of a person's joint performance by measuring the torque applied to a shaft by one of the person's joints comprising the steps of: applying a varying resistive force to turning of the shaft, the resistance to turning of the shaft being varied at least once during a single movement; 35 measuring the torque applied to the shaft by the person's joint; recording the resistive force applied; and 14 assessing the correlation between the resistive force applied and the measured torque to provide an indication of the level of effort applied by the person to movement of the shaft.

18. The method of claim 17 wherein the resistance is varied a plurality of times 5 during the single movement and preferably a single change in resistance is made over a period of less than 350ms, preferably less than 250ms

19. A performance testing device for performance testing of a person's joints and measuring level of effort comprising: a moveable member, wherein the movable member may be moved against a 10 variable resistance by action of one or more of the person's joints; a sensor for measuring force applied to the moveable member by the human, wherein the sensor transmits a first signal indicative of the measured force to a control means and a resistance means for applying the variable resistance to the moveable member; 15 the control means is arranged to rapidly vary the resistance to movement of the moveable member a plurality of times during a single movement of the moveable member by the person; and including means for comparing, or determining the correlation between, the measured force applied to the movable member with the resistance to movement of the movable 20 member for assessing the response of the human to the variation in resistance to provide an indication of the person's sincerity of effort in moving the movable member.

20. The device of claim 19 wherein the patterns of resistance are selected from the group consisting of: sine waves, saw tooth pattern, waves including stepped changes, and non 25 uniform patterns.

21. The device of claim 19 wherein the resistance is varied according to time.

22. The device of claim 19 wherein the resistance is varied based on the angular position of the shaft.