AU593856B2 - Repetitive strain injury assessment - Google Patents

Description

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INTERNATIONAL APPLICATION PUB A 7 N PAGONT OOPERATION TREATY (PCT) (51) International Patent Classification 4 (11) International Publication Number: WO 87/ 02567 A61B 5/10, 5/22 Al (43) International Publication Date: 7 May 1987 (07.05.87) (21) International Application Number: PCT/AU86/00328 (81) Designated States: AT (European patent), AU, BB, BE (European patent), BG, BR, CH (European patent), (22) International Filing Date: 30 October 1986 (30.10.86) DE (European patent), DK, FI, FR (European patent), GB (European patent), HU, IT (European patent), JP, KP, KR, LK, LU (European patent), MC, (31) Priority Application Numbers: PH 3180 MG, MW, NL (European patent), NO, RO, SD, SE PH 4419 (European patent), SU, US.

(32) Priority Dates: 30 October 1985 (30.10.85) 3 February 1986 (03.02.86) Published With international search report.

(33) Priority Country: AU (71)(72) Applicant and Inventor: COOK, Jonathan, Atkinson [AU/AU]; 65 Strangways Terrace, North Adelaide, S.A. 5006 (AU).

(74) Agent: COLLISON CO.; 117 King William Street, AUI-Al 6 5 4 9 9 8 6 Adelaide, S.A. 5000 (AU).

2A,.L& JUN 1987

AUSTRALIAN

19 MAY 1987 PATENT

OFFICE

(54) Title: REPETITIVE STRAIN INJURY ASSESSMENT

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(57) Abstract A method of assessment of a physiological state of a portion of an animal body such as the wrist of a human, the method recording the velocity of movement against a selected resistance level useful results being achieved with increasing resistance levels and increasing cycles of action being required when compared against controlled subjects. The invention includes assessment of electrical activity magnitude of controlling muscles at the same time and takes into account additional factors including grip in the case of wrist. The invention is also directed to apparatus which can retain the respective body portions such as the forearm and hand of subject and can record rate of change of position and as an additional feature, magnitude of electrical activity of controlling muscles against a common time base.

'1 -nr~ liO CiCI-C-~IPJ~--- IC-P- 1 i> F C A FOR THE PURPOSES OF INFORMATION ONLY Codes used to identify States party to the PCT on the front pages of pamphlets publishinginterational applications under the PCT.

Austria Australia Barbados Belgium Bulgaria Benin Brazil Central African Republic Congo Switzerland Cameroon Germany, Federal Republic of Denmark Finland FR France GA Gabon GB United Kingdom HU Hungary IT Italy JP Japan KP Democratic People's Republic of Korea KR Republic of Korea LI Liechtenstein LK Sri Lanka LU Luxembourg MC Monaco MG Madagascar ML Mali MR Mauritania MW Malawi NL Netherlands NO Norway RO Romania SD Sudan SE Sweden SN Senegal SU Soviet Union TD Chad TG Togo US United States of America WO 87/02567 1PCT/AU86Ioo328 "REPETITIVE STRAIN INJURY ASSESSMENT This Invention Is both a method and means related to providing objective information regarding physiological status surrounding a body joint and muscular and tendon status related to the joint.

Various attempts have hitherto been made to provide an objective assessment of such a physiological status, It is relatively self-evident that the availability of such information which is less dependent than hitherto on) volunteered responses, is of importance especially but not limited to cases where due to caused or perceived trauma, an organic pathology is claimed.

0. Such a claim can result in very significant compensation costs, and in many cases an inability to properly diagnose the specific pathology and provide an appropriate treatment and, of course monitor such results in an objective way.

According to this invention, it has been discovered that if a joint is caused to be used by the subject, and that there is applied during such movement, a resistance which is at least substantially consistent through a range of movement, and the subject applies a greatest effort to effect such movement, then information concerning the rate of change of position achieved can provide information that can be of significant value in an assessment of the status surrounding that joint.

Further, however, by measuring electrical activity within muscles controlling the movement of that joint including both an agonist and antagonist, will provide a correlation which when compared to results of other bodies, can further again provide information which is less dependent upon any volunteered response by the subject.

Indeed, in experiments thus far conducted, it has been found that when the results of a subject are compared In respect of others considered normal, and within a similar age bracket and within a similar size and of the same sex, then further valuable assessment of the results can be achieved.

Such valuable results appear at first to indicate the potential for a subject In respect of the joint being tested to be vulnerable to fat ique which t 3STITUTE Si":EET WO 87/02567 WO 87/02567 PCT/AU86/00328 may indicate signficant vulnerability to developing repetitive strain injury syndrome.

In other cases, however, the organic pathology assessment can indicate lateral epicondylitis of the humerus or other known difficulties.

The invention in one form can be said to reside in method of assessment of a physiological state of a portion of an animal portion wherein the body portion is moveable relative to an adjoining portion with muscular interaction, the method being characterised in that a first body portion is retained with respect to a first member, ana a second body portion is retained in respect to a second member, relative movement between the said two members being constrained with selected levels of resistance, the relative movement being caused by action of the muscles between the body portions, and means recording a rate of change of position of such movement against a selected level of resistance for a perceived effort to effect such movement through a plurality of repeat movements.

In order to provide an effective assessment, the extent of perceived effort must be assessed and this can be a reliance upon a request that the subject apply a best effort in respect of the movement.

Where, nowever, this may not be forthcoming or may be suspected as not being offered, there is then provided according to this invention means to measure the extent of electrical activity triggering at least one of the nmuscles effecting the motion during such effort.

It has been found, however, that the status of both an agonist and antagonist muscle controlling the joint can have a significant influence over the result and hence in preference, there are means to both measure the extent of electrical activity triggering in respect of both selected agonist and antagonist muscles in response to the resultant rate of change of position of movement achieved from this.

There can be some difficulties in respect of some joints where either the same muscles or other muscles in close collaboration effect additional pressures and where such additional pressures may be offering a different degree of electrical effect, there is provided according to this invention WO 87/02567 PCT/AU86/00328 means to separately assess such additional effect so as to provide a better asessment of the objective level of the muscles directly effecting the movement of the joint.

In this respect, when the movement of a wrist is examined, the extent of grip effected at the same time can significantly alter the results and hence there shall be provided means to assess such additional effects and provide an assessment for extraction of such results from directly controlling muscle effects in preference there being means to assess muscles acting as agonist and those acting as antagonist.

In preference, an assessment of rate of change of position can be achieved by a measurement of a relative position cf one part of the body portion as compared to the other when recorded against a selected time base so that the gradient of such a change of position at a given time can indicate the rate of change of position achieved of the particular body portion.

As such rate of change of position is achieved by rotation by one part of a body as compared to another, it will be well understood that the resistance is effected at a distance by providing the resistance as rotational torque resistance.

The invention in a further form can be said to reside in apparatus for asssessment of the physiological state of a body portion where the body portion is movable relative to an adjoining portion with muscular interaction, said apparatus being characterised in that there are provided means to hold one of the body portions relative to anotner, and there are means to engage with said second body portion and provide a consistent resistance to motion of the said second body portion relative to the first J said body portion, and there are means to record the rate of change of position achieved by any such motion. In preference, there are means to select different levels of resistance, I Sin preference, there are means to record the electrical activity triggering respective muscles effecting joint movement and recording such effects against a common time base with respect to the rate of change of WO 87/02567 PCT/AU86/00328 4 position achieved of the movement of the body portion in response to such muscular action relative to the other body portion.

Experiments thus far conducted have indicated significant value in respect to such tests associated with the wrist of a human wherein there is provided clamp means to hold a forearm of the person, a crank having a pivot axis whicn can De aligned with respect to the wrist axis of the subject arm, a handle on the crank adapted to be gripped by the subject hand, means with the handle to assess a level of grip effected, means rotatable by the crank which can be caused to effect a consistent resistance through any rotational position of the crank aoout its supporting axis, and means to record a relative positon of the crank against a selected time base whereby to provide rate of change of position of motion achieved through any such required action.

The invention will generally be better understood when described with 1s. respect to a preferred embodiment, at which time some information as to the value of the assessment technique will also be offered with respect to specific suoject instances.

Accordingly the invention will now be described with reference to the preferred embodiment which shall be described with the assistance of Orawirigs in which- FG. is a perspective view of an assembly incorporating a subject arrm in ad t position, FIG. 2 is a plan view of the same arrangement as in FIG. FIG. 3 is the same plan view as in FIG. 2 with the position of the hand relative to the forearm being moved throuhn a full extent of turn; FIG. 4 illustrates in a graphical arrangement, an illustration of the ranges within which a normal physiological status can be observed against as a vertical axis the extent of electrical activity as a percentage of selected maximum, and across the base, degrees gradient which is a measure of the tangential angle of the graphical position of the moved body portion ,7N. against a given time base, this thereby indicating a speed of motion, and the IC i t L1 ~I ~i -4 1 WO 87/02567 O 6 PCT/AU86/00328 respective levels in ranges, indicating results in respect to a selected relative resistance, level 0 being a lowest resistance and level 6 (18 inchpounds rotational torque) being a highest selected resistance the upper ranges being for the agonist and the lower ranges being for antagonist; FIG. 5 is a reproduction of actual results in respect of subject A snowing from top to bottom, an assessment of electrical activity provided by grip, the relative position of the hand relative to the forearm, the extent of electrical activity in the agonist muscle extensor difitorum, and finally the exrent of electrical activity in the antaqonist muscle flexor carpi radialis, ail of tnese against a common time oase whicn is in fact. 25 mms. per second, these results being recorded against a level 4 resistance (that is 12 inchpounds rotational torque); FIG. 6 illustrates in same arranoement as for FIG 5, the same subject A in respect to the same motion, in this case in respect of an increased level resistance 6; FIG. 7 iilustrates graphical results illustrating a person having clinically established organic pathology for a non-dominant wrist extension the subject being a female aged 57 years and having a height of 5' there being shown on the graph expected predicted level ranges, in the one case for level 2, and in another case at level 0 t.ne actual results being shown for read'ngs of level 0 the cross, level 1 (3 inch-pounds) the triangle and for level 2 (6 inch-pounds) the circle, the agonist readings being those all above electrical activity line and the antagonist all those below this, and FIGS 8 and 9 are the same readings as in FIGS. 5 and 6 against the same time base, in respect of FIG, 8 this being an action against level 1 resistance, arid in the case of FIG. 9 this being an action again by subject B agairst a level 2 resisance.

,Referring in detail to the drawings, and in particular to FIGS. 1, 2 and 3, there is shown a cradle I into which the forearm 2 of a subject is located so. positively by reason of its laterally extended v-shape, ard a strap 3 is available to be tightened across the forearm whereby to relatively rigidly affix the location of the forearm 2.

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l l ll l WO 87/02567 O PCT/AU86/00 3 2 8 By way of example, there is shown attached at relative positions along an agonist muscle of the forearm, three electrical detectors 4, the position of each of these detectors being established by clinical observation so that they are positively located over the centre of the belly of the selected muscle, that the surface of the forearm is appropriately treated, included if necessary the removal of insulating hair, and the addition of a conducting cream, which, however, should not extend between the respective electrodes so that there is no cross interference.

While there are shown three electrodes on a muscle which is indicated as being an agonist, an appropriate antagonist is also selected so that the results from both the agonist and antagonist muscles, as later illustrated, can be assessed against the same time base.

The location of each electrode must be located by a person able to clinically establish the location of the respective muscle and the position of each electrode should then be established so that the electrode is over the middle or belly part of the muscle and in each case a selected distance from the point of origin of the respective muscle The illustration is snowing only in the most schematic way the existance of electrodes rather than the exact alignment.

The selection of position of the electrodes for a wrist has been found to be best located in the case of the extensors of the wrist, at each of a and 30% position of the full length of the muscle from the point of origin of the muscle and in respect of the flexor of the muscle, at a 15%, 25% and from the point of origin of the muscle. In each case, the readings have been taken from each of the electrodes and the average on a route mean square basis has been taken for subsequent reference purposes.

It is to be emphasised that the magnitude of electrical activity is assessed for any one person with a common setting so that the readings are consistent in relative terms.

However, considerable value has been found in providing a reference level which can be assessed independant of any volutary control by the subject.

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WO 87/02567 PCT/ A 1 1 o Accordingly, a 100% electrical activity magnitude reference can be obtained when a full exertion from full flection to full extension of the wrist (in the case of the wrist) occurs the exertion being at a medium rate of change and the level of resistance being negligable or in other terms "level The electrical activity established at the point of full extention can then be used as the so called 100% reference figure in that it has been found as previously stated that. there appears to be a consistant magnitude which does not depent upon volunteered responses and in relation to which subsequent electrical activity can be assessed.

Both the agonist and antagonist muscles can be used to establisn in each case tne so called 100% electrical activity reference figure for each muscle and in each case against a level 0 for full wrist flextion and this provides good assessment for comparing further electrical activities.

Further to the forearm being located in a fixed position, the orientation about a lateral axis is also of relevance so that the axis of the wrist will be generally coincident with the axis of a crank, a rotor axis 6 being connectea to an electrical srator and rotor combination configured and driven such mtat by a selected current input into respective colls within the device, there will be caused a consistent selected level of resistance against ary mvotion of rotation of the axis 6. Such technology is readily available.

In respect of such selected resistance, however, the extent of relative S-osition f the grip 7 is adjusted by release of several adjustment nuts 8 so ,tiat a biest and miost comfortable grippingr position for the hand 9 can be acnievea wnile mainaining the coincience of the axis of ai gnment of the wr!st oinrt win tne rotor 6 i Furthiermore, however, there are means confining the position of the narns. narrmeiv straos 10 and 1 1.

The grip 7 is internally arranged so that by means of an assessment of the internal pressure caused around the grip, this will cause a change in resistance in sensitive material which thereby provides an assessment of the extent of grip providing an electrical voltage available through connection 12 which is used to provide one of the reference measurements proportional to grip used on the chart recorder 13.

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There are, of course, separate electrical controls providing for affixing of resistance against rotation of the rotor 6 and with this arrangement in place, a first resistance level arbitrarily selected as level 0, is selected and the subject is told to move with maximum possible effort the hand through a maximum movement range and to repeat such movements reciprocally through eight repeats for such movement.

It has been found that with a given rate of change of position at a medial point through such an extension range when correlated against the extent of electrical activity provided within the agonist muscle controlling such movement, then there appears in relation to expected and observable criteria of a person, a range of positions which can be realistically assessed as within a normal expected range for the joint of a non pathologically affected person of the selected height, and of the same sex and similar age.

The degree of accuracy of such an assessment will depend on a number of factors.

It has been observed, however, that for a person wishing to maintain a deliberately slow speed, there appears to be no antagonist electrical activity at a lowest level of resistance with only slight increase of this activity at higher levels of resistance as regards the median position of the wrist.

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Further, however, for those exhibiting significant organic pathology, the 30 marked shift by requiring significantly more agonist electrical activity with the same or a lesser rate of change of position resulting, and/or increased observable antagonist activity, can indicate, in the experiments thus far conducted, that there is some organic pathology Sand such indication can be independant of any volunteered information 35 from the subject.

4. -II 'I CIIllll 8a In a further situation, where for some agonist electrical activity magnitude, a lesser rate of change of position can also indicate organic pathology.

While the word "pathology" is used, it is intended that this be illustrative and not limiting in defining the value to which the method and apparatus can be put. For instance, the method has significant value on the

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-i Vt WO 87/02567 WO 87/02567 PCT/AU86/00328 9 results thus far assessed in indicating an organic physiological status which can be indicative of the fitness of the muscles controlling the joint concerned. Accordingly, some indication of fitness in the athletic sense can be gained in a quantative manner.

It must be emphasised that the extent of testing thus far has only illustrated that a significant proportion of those with organic pathology may indicate different results by which means there can be a relative assessment and appropriate reasonable diagnosis made.

Both the rate of cnanae of nositon achieved, and the electrical o1. activ ty, however, are referred to by relative levels so that recognition of an organic pathology depends upon a significant base of normal references and therefore an accurate assessment of a normal spread of such results taken for similar resistance levels and in respect of those people who have similar age,height and sex. Such factors as the dominance of a left arm as compared to a right arm must also be taken into account This will very directly depend tnerefore upon the numbers of samples against which references can be made and in due course this will be significantly improved even though the assessment technique can remain substantialiv the same.

The results thus far have been able to indicate the existence of organic path.ology which has been separately observable by clinical methods, and as such the r elative figures have been vindicated.

Accordingly, FIGS 5 and 6 indicating typical readings taken from a Snrma subject, illustrate minimal grip interference, and at level 4(12 inch- .iunds rotational torque) a gradient which is an assessnent of speed of 500 at a 50% median location between a maximum of extension and a maximum of fiextion in each case of the wrist, and for these levels of resistance, the relative magnitude of electrical activity being assessed as a percentage of the reference assessment as previously obtained in respect of the so called 100% electrical activity against a level 0 resistance as above identified.

The bottom line of Fig. 5 and of Fig. 6 illustrating the extent of the antagonist electrical activity can indicate any effect of anomalous causative t i II. WO 87/02567 PCT/AU86/00328 K action caused by voluntary attempts at alteration with any result, Antagonist electrical activity can indicate of itself especially at lower resistance levels and slow rate of change of position muscle spasim and to this extent organic pathology. For instance, the magnitude of electrical activity for the antagonist may be higher than normal while the agonist may remain high through the exersion.

Conversely, with voluntary slowing there may appear an increase in antagonist electrical activity and a decrease in antagonist activity at the point of slowing.

While reference has been made to an assesment at a mid point between the extension and flexion further information can be gained in assessment at other location points.

The remaining references, that is in FIG. 6 and in the graph 7 and the typcal results at FIGS. 8 and 9, are given to indicate the approach presently taken to make best use of the results achieved thus far.

The results of themselves have to be interpreted and as against a basis of controls, used to assist in a final assessment in an objective way of such results as are obtained.

While reference has now been made to the specific case of a wrist as being the arm of a person, such specific technique will illustrate the method which can be applied to other parts of a body.

For use of the method and similar apparatus in respect of other body portions, reference will now be made to typical other parts of the body.

Reference r he elbow joint In the elbow joint, the biceps brachii cause flexion of the elbow and the triceps brachii on contraction cause extension of the elbow. In the same way as witn rhe forearm and wrist, the subject is required to locate the upper arm in a resting cradle secured by a restraining strap, the elbow being placed on an elbow rest at the pivot point where a tool is inserted and this tool would have the capacity to change in length and have an upright bar for WO 87/02567 PCT/AU86/00328 the patient to grasp providing a crank effect so that there will be again a rotor having a common axis with the axis of the elbow, For the neck of a person, the patient shall sit,a head restraining device being connected to a rod which would have complete freedom of rotation of the rod providing thereby no resistance to movement of the head restraining device in a rotational manner about an essentially vertical axis, but, there is provided a crank connecting through to a rotational rotor having a parallel axis with the joint to be tested.

The same principles can apply to the lumbo-sacral spine where a restraining device can be positioned firmly against the anterior anterolateral and postero-lateral chest wall with the attachment from this restraining device going to the crank which would effect rotation within the rotor providing the consistent level of resistance selected. The axis of the lumbosacral spine should be coincident with the axis of a rotor providing resistance.

As in eacn of these cases, testing of tne respective muscles will require that alternate muscle effects must be allowed for, and accordingly in this case, testing of lumbar flexion extension in the median, or sagittal plane, requires measuring the electromyogram of the erector spinae muscles oiateraiiy (reoresenting the extensors o the iumbo-sacral soine) and ne psoas major/iliacus and tre a bdominal e.xternal oblique muscles causing flexion of the lumbo-sacral spine.

Tnese illustrations are given simply to indicate that the same principles can be applied to any individual part of the body and it is not intended that the invention should be necessarily limited to the specific performance related to the wrist of a huian.

This will now illustrate how by using information available in the manner described, an assessment and objective information can be obtained which can be of significant value in respect to aspects related to the animal ody Such results can be particularly useful in respect to an assessment that where fatigue is seen to occur at a lower than expected level of

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c II II WO 87/02567 PCT/AU86/00328 12 resistance, correction by way of exercise can be a means for assisting and removing the existing weakness.

The method can also be applicable to objective testing of the physiological status of an animal other than human, The method and apparatus therefore can be said to provide for an assessment of a fitness status in respect of muscles as applied to body joints.

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Claims (16)

1. A method of assessment of a physiological state of a body portion of an animal wherein the body portion is movable relative to an adjoining portion with muscular interaction, the method being characterised in that a first body portion is retained with respect to a first member, and a second body portion is retained in respect to a second member, relative movement between the said two members being constrained with selected levels of resistance, the relative movement being caused by action of the muscles between the body portions, and means recording a rate of change of position of such movement against a selected level of resistance for a perceived effort to effect such movement through a plurality of repeat movements.

2. A method of assessment as in claim 1 wherein the means o• 20 recording the rate of change of position of such movement are used to record such rate of change of position through at least one selected level of resistance, and in respect of a best effort to effect such movement. 25

3. A method of assessment as in either of claims 1 or 2 wherein the extent of electrical activity of at least one of the muscles effecting the motion during such effort is recorded.

S4. A method of assessment according to any one of the preceding e" 30 claims wherein the extent of electrical activity of at least one agonist and one antagonist muscle effecting such relative motion is recorded. s S oooo•

5. A method of assessment as in any one of the last two preceding claims, wherein the record of the extent of electrical activity is against a 35 time base comparable to a time base against which the relative position of the body portion is assessed. 0AN\ 4LLbj. a2. .L I Clf-~ 00 0 OS of 0 S. S S..0 S. S S S.. S 5 Si 14

6. A method of assessment as in any one of claims 3 to 5 wherein the activity of muscles, other than said agonist and antagonist muscles, that affect said rate of change.

7. A method of assessment of a physiological state of a portion of a human body as in claim 1 wherein electrical impulses within agonist 10 and antagonist muscles effecting any relative movement are recorded against the same time base as the relative position of the movement achieved against each of the selected levels of resistance of the said body portion, and the magnitude of the said electrical activity as compared to the speed of the body portion relative motion at a selected 15 medial body portion position is compared and such comparison is itself compared with the results obtained from reference subjects having characteristics of age, sex and height within a selected range as compared to the age and height of the test subject, detecting when a difference occurs in these results outside of a selected range of values 20 for each selected level.

8. A method of assessment as in the immediately preceding claim wherein the body portions are the forearm and hand of a person.

9. A method of assessment as in any one of the last two preceding claims wherein the comparison is taken at a mid-point of the extent of a full movement of the body portion.

An apparatus for assessment of a physiolog!cal state of a body portion of an animal wherein the body portion is movable relative to an adjoining portion with muscular interaction, said apparatus being characterised in that there are provided means to retain a first body portion with respect to a first member, means to retain a second body portion with respect to a second member, and means to provide selected levels of resistance to relative movement between the said two members caused by action of the muscles between the body portions, and there are means to record a rate of change of position achieved by such movement against a selected level of resistance and there are means to select the levels of resistance. i i j

11. Apparatus for assessment as in the last preceding claim further characterised in that there are means adapted to measure the extent of electrical activity of at least one of the muscles effecting such motion.

12. Apparatus for assessment as in any one of the immediately preceding two claims in which there are means adapted to record the extent of electrical activity triggering the agonist and antagonist muscles effecting any relative motion of the body portions.

13. Apparatus for assessment as in any one of the last three preceding claims further characterised in that there are means to record against the same time base concurrently the extent of electrical activity of agonist and antagonist muscles and the position of a first body portion during its moving with respect to the second body portion. l 20

14. Apparatus for assessment as in any one of the immediately opreceding four claims wherein the apparatus is specifically adapted to hold as a first body portion, the forearm of a person, and as the second 00. body portion, a hand.

15. Apparatus as in the immediately preceding claim but further characterised in that there are means to assess an extent of grip and to provide an electrical signal in accord with such an extent and means to record such extent of grip against a same time base as that by which rate of change of position of movement of one of the body portions is assessed and recorded, said extent of grip being pressure applied by the hand on said means to engage with the second body portion. S"

16. Apparatus according to any one of the immediately preceding six claims wherein the first member inclides a crank at an end of which are means to engage part of the body portion, the other end of which crank is secured to a rotor shaft, the axis of which is substantially coincident to the axis of rotation of the joint being tested. pA.i e-J~ "-L~L-C