CA1329264C - Upper extremity evaluation system - Google Patents

Abstract

UPPER EXTREMITY EVALUATION SYSTEM

Abstract of the Disclosure An upper extremity evaluation system in-cludes a computer and a directly connected three-dimensional position locator which may be used by a therapist to enter data corresponding to the location of the flexed and extended joints of the hand, wrist and elbow. The computer may then utilize these di-mensions in calculating angles of flexion and exten-sion, and a degree of disability in accordance with American Medical Association standards.

Description

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UPPER EXTREMITY EVAL~ATION SYSTEM

Background and Summary of the Invention Clinical evaluation of a patient's upper ex-tremities, and more particularly the hands, for dis-ability can be a time-consuming process for skilled therapists and physicians. Because of the unique complexity of the hands~ movements, multiple measure-ments must be ta~en across all joints of the fingers to determine their maximum angle of flexion and ex-tension. There are fourteen ~oints or knuckles in a normal hand, and each of these must be measured in flexion and extension to arrive at a measure of the disability of the hand as is often required for prop-er clinical evaluation and for the patient to obtain compensation for an in~ury which has limited his range lS of motion. At present, a therapist must sit with a patient and manually measure each individual angle of flexion and extension for each joint with a goniometer by isolating the jsint, aligning it with the legs of the goniometex, and manually recording the measured included angle. Not only is this process tedious and time-consuming, and thu~ expensive to perform, but ~.~

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less time remains for the therapist to perform physi-cal therapy with the patient. During the course of a ; patient's treatment, it is desirable to repeat these measurements over the time course of therapy to as-sess a patient's progress. Unfortunately, because there is some subjective element in the use of the goniometer and the current standard technique used in making hand function measurements, the repeatability of any particular examination is relatively poor. The variance of measurements from therapist to therapist has been so large with the standard goniometer so that the same therapist should measure the same patients each evaluation session. This is often not possible in a busy therapy center. This leads to uncertainty and ineffectiveness in assessing the patient~s func-tional status and in designing treatment protocols.
Some attention has been paid in the prior art to the problem of evaluating and measuring the range of motion in the knee. Examples of these are found in U.S. Patents 4,549,555 and 4,571,834. These references both contain the same disclosure relating to a knee laxity evaluator comprised of an instru-mented seat, a restraint for restraining the thigh of the patient to the instrumented seat, a motion module consisting of a mechanical coupling extending between the seat and the patient's leg with a number of elec-tromechanical rotary transducers for measuring the relative position of the leg, and a processor for analyzing the outputs of the seat and the motion mod-ules to provide an indication of applied force andrelative motion of the knee. The device disclosed is mechanically and operationally complex and is limited in its accuracy although it is probably adequate as measuring knee motion of a knee joint which is a very large joint whereas measuring finger motion requires -~, , 132~264 much more delicate instrumentation.
Perhaps because of the bulky, mechanically complex construction of the device disclosed in these prior patents, the inventors herein are aware of a later commercial model of this device which is adapted for use with the spine which is comprised of a wand mounted at the end of a multi-~ointed mechanical arm, the arm being adjustably mounted to a pole stand and having a rotary transducer at each of the joints of the arm. Apparently, a foot switch is also provided and the device is understood to be used by tracing an exterior outline corresponding to the perceived posi-tion of posterior elements and spinous processes in the spine with the wand as the foot switch is oper-ated to input data corresponding to the shape of thespine to a computer which then performs an analysis including flexibilty and range of motion measure-ment. However, as with the prior art device dis-closed in the patents mentioned above, the overall accuracy is limited by the use of the three rotary mono-angular (mono-articulated) single DOF trans-ducers in the multi-~ointed extension arm which are believed to generate only relative position data ob-tained by integrating a plurality of measurements over time, although the level of accuracy attainable is probably more than adequate for the measurement of the posterior elements of the dossal and lumbar spine.
The inventors herein are also aware of a prior art device consisting of a "data glove" as is described generally in U.S. Patent 4,542,291 and also in a Scientific American magazine article appearing on the cover and within the October 1987 issue. This device i8 essentially comprised of a glove which is slipped onto and encloses the hand and which contains a plurality of fiber-optic cables anchored at both 132926~

ends to an interface board which run the length of each finger and doubles back. As the hand is mea-sured, it i~ not visible to the operator. Each cable has a light-emitting diode at one end and a photo-transistor at the other with the cables being treatedso that light escapes when a finger flexes. Thus, a change in the amount of light received by the photo-transistor, when converted into an electrical signal, is directly representative of a change in position or flexion of the finger such that the data glove can measure relative movement of the finger as it is flexed or extended. Additionally, an absolute posi-tion and orientation sensor is mounted near the wrist of the glove to provide a single absolute point of reference for the entire hand, although it does not provide data as to the position or angle of flexion or extension of any of the fingers themselves. The data glove provides simultaneous real time measure-ments concerning the relative motion or movement of the fingers but does not provide data corresponding to the absolute position of any of the fingers. Thus, to measure an angle of maximum flexion at each joint, the finger must first be placed in a known position and then the finger flexed to its position of maximum flexion as the output of the data glove is continu-ously monitored. The maximum angle of flexion may then be determined by comparing this known starting position with the angle of flexion computed by inte-grating continuously recorded measurements. Of course, there i8 some uncertainty in determining and repeating a known initial position and angle for a finger before it is flexed, especially if that finger is incapable of a full and complete range of motion.
Once again, as with the prior art manual technique, and the rotary tran~ducers of the prior art knee de-1329~64 vice, significant potential for error and subjectiv-ity enter into the measurement of angles of flexion and extension with the data glove. There is no pro-vision for competent human intervention in the opera-tion of the data glove.
Still another problem in evaluating the hand is the complex nature of the wrist. Presently, in accepted standards of medical practice, the range of motion for the wrist is determined by having the patient grip a cylindrical object such as a pencil or the like, and holding the pencil in a vertical orien-tation which is defined as a neutral position. The patient is then told to rotate the pencil inwardly to its maximum extent and the angle i6 measured, and then to rotate the pencil outwardly to its maximum extent and that angle is measured as well. These angular measurements can then be used to determine the maximum pronation and supination. However, it is known that there is approximately 30 of additional total rotation contained in the ~oints between the radius and ulna and the fingers such that these mea-surements are not the true measurements of the range of motion of the wrist. Thus, there exists no proto-col or methodology in the prior art to properly fully evaluate the true range of motion of the wrist. Fur-; thermore, none of the prior art devices discussed above are capable of generating data which accurately provides the range of motion for the wrist. This is partially due to the fact that it is difficult to visualize the radius and ulna as the wrist is rotated, and for the further reason that the prior art systems have error~ of measurement which are significant in measuring the small distances which through the wrist rotates.
To solve these and other problems in the ,. .

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prior art, the inventors herein have succeeded indesigning and developing an upper extremity evalua-tion system which is particularly adapted to and use-ful in measuring the range of flexion and extension of the joints of the hand, wrist and elbow and auto-matically calculating a degree of disability in ac-cordance with American Medical Association (AMA) standards commonly used by the courts and workers compensation boards in determining the financial compensation due to a patient for an injury. In a distinct departure from the prior art, the inventors have succeeded in adapting a three-dimensional spatial absolute position and orientation sensor into a com-puter measurement system which permits the convenient collection of data by a therapist corresponding to the absolute position of the proximal and distal segments at a joint in the fully extended as well as the fully flexed position. In other words, a therapist can quickly and conveniently enter data automatically into the computer which corresponds to the position of the various joints of the patient's hand as the hand is manipulated into one of only several differ-ent positions and held for only a brief period of time therein. Because absolute position data is mea-sured and collected, much greater accuracy is attain-able. Furthermore, because of the convenient method-ology used to collect the data, an evaluation is also capable of a high level of repeatability. This has a dramatic impact on the accuracy of the initial as-sessment given to a patient, as well as the evalua-tion of treatment protocols through the course of the patient' 8 rehabilitation. Still another advantage with the inventors' system is that for the first time accurate range of motion information can be easily collected by measuring the exact location of the 132926~
radial and ulna styloid processes while the wrist is held in the neutral, supinated, and pronated posi-tions. The computer may then eliminate the transla-tion of these bones as they are moved from the compu-tation to arrive at a true and accurate measure ofthe wrist~s range of motion. Further information may also be obtained relating to the range of supination and pronation at the metacarpal level, which provide additional functional information of interest to the surgeon. However, perhaps the greatest advantage of the device is that it dramatically reduces the amount of therapists' time required to perform the clinical evaluation, and virtually eliminates the hand sur-geon~s time in evaluating the therapists~ results.
This is all achieved while significantly increasing the reliability and variability of the resultc.
In addition to measuring the angles of max-imum flexion and extension, a dynamometer and pinch gauge are also connected directly to the computer for the direct entry of data corresponding to the grip strength and pinching strength of the hand and fin-gers. Still further data may be taken corresponding to other measurements, such as sensitivity, through the keyboard provided with the computer. Thus, the upper extremity evaluation system of the present in-vention permits a therapist to make an evaluation of any of the upper extremities, to input data gained through sub~ective manual measurements, and to permit such desired manipulation and calculation of the data to arrive at a degree of disability in accordance with AMA standards.
Briefly, the protocol for entering data corresponding to the hand includes locating twent-four specific points on the dorsal surface of the hand in a sequence which permits the most rapid data collec-132926~
tion as well as to give maximum flexion values. Thisbegins with the four points on the fully flexed thumb, taken in a proximal to distal fashion, thus mea uring the metacarpal phalangeal ( MP ) and interphalangeal (IP) ~oints. Then, with the fingers maximally flexed in a fist and the thumb abducted, the first four points on the remaining digits are digitized, again proximal to distal, one digit at a time, beginning with the index finger and moving ulnarly. These four points correspond to a mid-thumb metacarpal, MP apex, IP apex, and thumb nail for the thumb. For each dig-it, five points correspond to the mid-metacarpal, MP
apex, proximal interphalangeal (PIP) apex, distal interphalangeal (DIP) apex, and fingernail. The first four points are digitized. This measures the -; MP and PIP joints. For the DIP joint, the fingers are extended at the MP ~oints and flexed at the PIP
and DIP joints. ~sing the same digit order, the third, fourth and fifth points are redigitized. As can be appreciated, this protocol can be routinely performed by an average therapist in less than two minutes. Data entry is achieved by touching the fin-ger or hand with a wand or pointer, and pressing a foot switch when the wand or pointer is in the appro-priate and desired location. This permits the thera-pist to choose the point in time for data entry to provide greater control over the evaluation.
A software package which operates on the control desktop personal microcomputer has been de-signed and developed by the inventors which guidesand instructs the therapist as he/she proceeds through the evaluation process. This ensures a complete examination taken with the same methodology and helps improve the accuracy of results. In the prior art, significant inconsistencies of results are often no-132g264 ticed between therapists examining the same patient.With the present invention, these inconsistencies are thought to be significantly reduced. Furthermore, the software calculates angles of flexion and exten-sion from the position data entered by the therapistand makes further calculations in accordance with AMA
standards to arrive at the degree of disability. A
hand surgeon may then review these results and verify them in accordance with accepted medical practice.
However, because of the increased reliability brought to the measurement and data entry portions of the evaluation, the amount of time and involvement of the hand surgeon can be significantly reduced thereby significantly reducing the cost of the evaluation to the patient while improving the results obtained thereby.
; While the principal advantages and features of the present invention have been briefly described, - a fuller understanding may be attained by referring to the drawings and description of the preferred embodiment which follow.
Brief Description of the Drawings Figure 1 is a perspective view of a work station including the computer, printer, three-dimensional locator, and peripherals;
Figure 2 is a top view of the work stationof Figure 1 with a patient and therapist depicted in a typical examination of an upper extremity (hand);
Figure 3 is a side view of the work station of Figure 1 detailing the mounting of the reference point for the three-dimensional point locator; and Figure 4 is a side view of a finger with joints flexed into maximum flexion with points of measurement indicated thereon.

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1329~64 ~ailed Descri~tion of the Prefer~ed_~mbodiment The upper extremity evaluation system 20 of the present invention can be conveniently mounted in a work station 22 wherein a small personal computer 24 such as a Macintosh~ SE computer (Apple Computer Corporation) with keyboard 26 and mouse may be installed. Additionally, a printer 28 or any other suitable peripheral output device may be utilized to permit automatic preparation of reports and the like as will be further explained herein. A three-; 10 dimensional position locator 30 may be interfaced to computer 24 and include a wand or pointer 32 along with a reference sensor 34 and foot switch 36 to permit a therapist to selectively input data to the computer 24 corresponding to the position of a point with respect to sensor 34. A three-dimensional position locator suitable for use herein is the 3SPACE tracker manufactured and sold - by Polhemus Navigation Sciences Division of McDonnell Douglas Electronics Company, Colchester, Vermont.
Additionally, a grip dynamometer 38 and a pinch gauge 40 may be connected through an interface 42 directly to the computer 24. Examples of typical devices used by the inventors herein include a catalog number 1113 Jamar grip meter and pinch gauge and a MacAdious II SE~ expansion system interface. The analog signal of the grip meter is converted to a digital signal which is then fed into the computer database through the interface system. To improve the accuracy of the three-dimensional position locator 30, an aluminum panel 44 is mounted along the floor of the work station 22 such that it is thirty inches below the top surface of work station 22, with the reference sensor 34 being mounted five inches below the top surface of the work station 22. It has been found with this arrangement that an 132~26~
improved accuracy can be achieved with the particular components incorporated by the inventors in the best mode of their invention.
To more fully explain the operation of the invention, a sample scenario is contained in Exhibit A
attached hereto and incorporated herein. This sample scenario describes in detail the steps required to complete an examination of the upper extremities. The software program which controls the data input and calculation is attached hereto and incorporated herein as Exhibit B. This program is written in the Microsoft~
Basic language for the Apple~ Macintosh~ computer (Version 3). Samples of reports which can be generated are exemplified by Exhibit C attached hereto. Although these exhibits are detailed explanations of the system of the present invention, the system may be more briefly described for convenience as follows.
Essentially, the invention provides for the collection of position data of joints placed in flexion and extension which are then used by the computer to calculate angles of flexion and extension.
Additionally, the computer provides for prompting of the therapist to enter other related data such as grip data, pinch strength data, sensitivity data, and other typical measurements as is known in the art. Data acquisition is achieved through the software program of Exhibit B.
The database software used to create the reports is a standard database software, such as FileMakerPlus~ as is marketed by Forethought for the Apple~ Macintosh~
computer.
Joint range of motion information is col-lected in a process which combines the three-dimensional position locator and the computer. The therapist must first specify the portions of the ~,\

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upper extremities that will be analyzed, and then designate any joints that are either amputated or fused, the computer assuming that any non-designated joints are normal. The therapist is then prompted to supply the appropriate data through the usage of the present invention. That includes the process of touching the wand 32 to a point such as the MP apex 50 in Figure 4 and then pressing foot switch 36 to cause entry of the data into the computer. This pro-cess is repeated at each of the points PIP apex 52,DIP apex 54, and fingernail 56. The three-dimensional position locator generates digital data corresponding to the relative position of those points 50-56 with respect to the reference sensor 34. From these sev-eral points taken about each of the fingers, anglesof flexion and extension for those joints may be cal-culated by the computer. When done quickly by the therapist, there is virtually no tendency for the hands of the patient to be moved and hence the frame of reference is not altered or intended to be altered during the measurement process. After the position information is used to calculate range of motion in-formation, that data is stored in an associated logi-cal record in the computerized database file which can then automatically generate the reports as shown in Exhibit C.
In addition to usage of the wand or pointer 32, grip and pinch strength information can be input to the computer through use of the dynamometer 38 and pinch gauge 40. This digital data is stored in a file, similar to the range of motion data file, and is available to the database software to produce the reports of Exhibit C.
The therapist generally follows the in-structions displayed on the screen of the computer to automatically enter range of motion data and grip and pinch strength data to any of the reports. As con-tained in Exhibit C, there are three separate reports or forms. These include a data collection form, a final evaluation form, and a second version of the final evaluation form. of course, any additional forms of any other desired nature may also be pro-duced through simple reprogramming of the database as would be well known to one of ordinary skill in the art. These completed forms may then be printed out on the printer at the request of the therapist.
There are various changes and modifications which may be made to the invention as would be ap-parent to those skilled in the art. However, these changes or modifications are included in the teaching -of the disclosure, and it is intended that the inven-tion be limited only by the scope of the claims ap-pended hereto.
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Section 2: Sample Scenario This sample scenario describes the general steps required to complete an examination of the upper extremities for a complete final evaluation. It has been provided to describe the needs of the therapist and to clarify how the product has met these needs.

The therapist will carry out the range of motion determination using the 3Space Tracker first. This requires the 3Space Tracker and an Apple Macintosh Personal Computer set up to operate the digitizer. The therapist will be asked to enter the patient information pertinent to carIying out the range of motion data collection process. The patient's name, current date, and the operator identification number must be entered. For the joints which are to be analyzed, the therapist must indicate if the joint is mobile, fused, or amputated. All calculations and principles of impairment calculation are based upon the AMA guidelines since it is the national standard. The values for sensation are not standard AMA guidelines but are based upon our published data. Amputation is considered to be a one hundred percent impai~nent of any joint involved. The digitizing process differentiates between fused and mobile joints since flexion and extension measurements are not necessarily valid for a fused joint, only a single angle can be measured in many cases.

If the joints of the hand are all to be measured and are all mobile, the process has been expedited by calculating the PIP and DIP joints of any finger and the MP and IP joints of the thumb using 1~

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only four points (Fig. 1) rather than three points per joint (Fig. 2).
The computer provides explicit directions to ensure proper usage of the 3Space Tracker.

Once the therapist has entered the appropriate information, the patient's range of motion is determined and analyzed by the Apple Macintosh Personal Computer. The computer provides the instructions necessary for the therapist to carry out the examination properly.

The pinch strength and gross grip strength is also determined digitally. Pinch strength is measured three times and then averaged;
gross grip strength is measured five times.

The final step in the process of data entry is for the therapist to fill in the remainder of the patient information. The therapist will choose the form required by the needs of the surgeon and patient.
The range of motion data is entered automatically when requested by the therapist. Range of motion impairrnent calculations are carried out by the database system once the data required by each impairment calculation is present in the database. The pinch strength and gross grip strength are entered upon request as well.
The average pinch strength and average gross grip strength are calculated by the computer as the data is made available. The average pinch strength and average gross grip strength is not used for impairment calculations. The therapist then carries out and enters the data from the other tests required by the surgeon as they ~ .

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are performed. The computer displays each page of the form as requested and the therapist fills in, by typing, the data in the available spaces. Impainnent values are displayed on the forms as they are calculated by the computer.

Upon completion of the process, the data is stored in the computer and on a diskette for later retrieval, The forms may also be printed out as desired.

Data collected over different therapy sessions can also be printed in table or graphic form to analyze a patient's progress over time.

Section 3: Range of Motion Evaluation using the 3Space Tracker The program to run 3Space Tracker for the upper extremity evaluation is written in Macintosh BASIC on the Apple Macintosh Personal Computer. This computer and software was chosen because `i it is easy to use for persons who are not previously familiar with computers.

Step 1:
The operator is asked to enter the patient's name, the current date and some sort of operator identification, the present the system asks for an operator number. This information is stored and will be used to identify the patient's data. `
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~ , Step 2:
The operator is asked if any portion of the right upper extremity is to be digitized. He or she must enter "Y" or "y" for yes and "N~' or "n" for no. Upon failure to enter the appropriate response, the system repeats the question until an acceptable response has been entered.

Step 2.1:
If "N" or "n" has been entered the system moves on to step 3. Otherwise, the system requires the following information which must be entered by the therapist. As before, upon failure to enter an acceptable response the system will repeat the question.
The therapist is asked the following:
(Note: acceptable responses are indicated.) Will you digitize the right elbow?
("Y" or "y" for yes, "N" or "n" for no) if"Y" or"y":
Is the right elbow mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) Will you digitize the right forearm?
("Y" or "y" for yes, "N" or "n" for no) if "Y" or "y":
Is the right forearm mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) ., , ~ ~ . . . ~ ,.
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13292~4 Will you digitize the right wrlst?
("Y" or "y" for yes, "N" or "n" for no) if"Y" or"y":
Is the right wrist mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) Will you digitize any part of the right hand?
("Y" or "y" for yes, "N" or "n" for no) if"N" or"n":
System transfers to step 3.
if "Y" or"y":
Are all the right finger and thumb joints present and mobile and to be measured?
("Y" or "y" for yes, "N" or "n" for no) if"Y" or"y":
The system indicates that all joints of the right hand are present, mobile and to be measured. This is done automatically. The system then transfers to Step 3.
If "N" or "n": The following series of questions are asked:

Will you digitize the right thumb?
("Y" or "y" for yes, "N" or "n" for no) if"Y" or "y":
Is the right thumb MP joint mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) Is the right thumb IP joint mobile, amputated or fused?
- (O for mobile, 1 for amputated, 2 for fused) 1~

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Will you digitize the right index finger?
("Y" or "y" for yes, "N" or "n" for no) if"Y" or"y":
Is the right index finger MP joint mobile, amputated or fused?
' (0 for mobile, 1 for amputated, 2 for fused) : Is the right index finger PIP joint mobile, amputated or fused?
(0 for mobile, 1 for amputated, 2 for fused) Is the right index finger DIP joint mobile, amputated or - fused?
(0 for mobile, 1 for amputated, 2 for fused) Will you digitize the right long finger?
. ("Y" or "y" for yes, "N" or "n" for no) if"Y" or"y":
Is the right long finger MP joint mobile, amputated or fused?
(0 for mobile, 1 for amputated, 2 for fused) Is the right long finger PIP joint mobile, amputated or fused?
(0 for mobile, 1 for amputated, 2 for fused) Is the right long finger DIP joint mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) . .
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Will you digitize the right ring finger?
("Y" or "y" for yes, "N" or "n" for no) if "Y" or "y":
Is the right ring finger MP joint mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) Is the right ring finger PIP joint mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) Is the right ring finger DIP joint mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) Will you digitize the right fifth finger?
("Y" or "y" for yes, "N" or "n" for no) if "Y" or "y":
Is thé right fifth finger MP joint mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) Is the right fifth finger PIP joint mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) Is the right fifth finger DIP joint mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) The system now transfers to step 3.
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Step 3:
The operator is asked if any portion of the left upper extremity is to be digitized. He or she must enter "Y'7 or "y" for yes, "N" or "n" for no. Upon failure to enter the appropriate response, the system repeats the question until an acceptable response has bee entered.

Step 3.1:
If "N" or "n" has been entered, the system moves on the step 4. Otherwise the system requires the following information which must be entered by the therapist. As before, upon failure to enter an acceptable response the system will repeat the question. If the amputation at one joint indicates that other distal joints must also be amputated, these are set automatically by the computer. For example, if the MP joint of a finger is amputated this indicates that the PIP and DIP joints of the finger have been amputated as well.
The therapist is asked the following: (Note: acceptable responses are also indicated.) Will you digitize the left elbow?
("Y" or "y" for yes, "N" or "n" for no) if "Y" or "y":
Is the left elbow mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) ~1 ~, . ,.- .. . . ..
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Will you digitize the left forearm?
("Y" or "y" for yes, "N" or "n" for no) if"Y" or"y":
Is the left forearm mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) Will you digitize the left wrist?
("Y" or "y" for yes, "N" or "n" for no) if"Y" or"y":
Is the left wrist mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) Will you digitize any part of the left hand?
("Y" or "y" for yes, "N" or "n" for no) if"N" or"n":
System transfers to step 3.
if"Y" or"y":
Are all the left finger and thumb joints present and mobile and to be measured?
("Y" or "y" for yes, "N" or "n" for no) if"Y" or"y":
The system indicates that all joints of the left hand are present, mobile and to be measured. This is done automatically. The system then transfers to Step 4.
If "N" or "n": The following series of questions are asked:

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Will you digitize the left thumb?
("Y" or "y" for yes, "N" or "n" for no) if "Y" or "y":
Is the left thumb MP joint mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) Is the left thumb IP joint mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) Will you digitize the left index finger?
("Y" or "y" for yes, "N" or "n" for no) if"Y" or"y":
Is the left index finger MP joint mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) Is the left index finger PIP joint mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) Is the left index finger DIP joint mobile, amputated or fused?
~ (O for mobile, 1 for amputated, 2 for fused) :' Will you digitize the left long finger?
("Y" or "y" for yes, "N" or "n" for no) if "Y" or"y":
Is the left long finger MP joint mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) : ~3 - . ~ -:.
; . ... .
~ , ' .:: ' Is the left long finger PIP joint mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) Is the left long finger DIP joint mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) . Will you digitize the left ring finger?
("Y" or "y" for yes, "N" or "n" for no) if"Y" or"y":
Is the left ring finger MP joint mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) Is the left ring finger PIP joint mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) Is the left ring finger DIP joint mobile, amputated or fused?
: (O for mobile, 1 for amputated, 2 for fused) :~`
Will you digitize the left fifth finger?
("Y" or "y" for yes, "N" or "n" for no) if"Y" or"y":
Is the left fifth finger MP joint mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) ~;~ , , .
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Is the left fifth finger PIP joint mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) Is the left fifth finger DIP joint mobile, amputated or fused?
(O for mobile, 1 for amputated, 2 for fused) ,~
The system now transfers to step 4.

Step 4:
^ If any portion of the right hand is to be evaluated, it is done at this time. If every joint in the hand is to be evaluated and is mobile step 4.1 is carried out, otherwise step 4.2 is carried out. Upon completion of either step 4.1 or 4.2, the system the system moves on to step 5. If no portion of the right hand is to be digitized, then the system moves on to step 5.

Step 4.1:
The process of evaluating the range of motion of the hand has been expedited under the assumption that all joints of the hand are mobile and are to be evaluated. Under these circumstances, the PIP and DIP joints are evaluated in a series rather than evaluating each joint individually. Each point that is digitized returns the location of that point in three dimensional space with respect to a frame of reference generated by the 3Space Tracker. From three of these points the computer is able to calculate the angle between c?S

.. , -~ :
- . , :

: . . ' 132926~
them. The evaluation is begun with the patient's right thumb in flexion.

Step 4.1.1:
The four points on the right thumb are digitized first.
The computer prompts the operator to enter the four points on the thumb. The operator uses the digitizing pen to enter the four points which are supplied to the computer program. Each point is a location in three dimensional space.

Once the operator has entered all four points on the thumb, the system calculates the angles of flexion for the MP and IP joints of the thumb.

The angles of fleYion are displayed on the screen as well as stored by the system.
'`
Step 4.1.2:
The PIP and DIP joints of the remaining four fingers of the right hand in flexion are digitized in a similar manner. The four points of the right index finger are digitized. (Fig. 3) .

Like the thumb, once the four points have been entered the angles of flexion are calculated automatically. (Fig. 4 and Fig. 5) ,, , . . . ~.

~32~64 These angles of flexion are displayed on the screen as well as stored by the system. The four points required to determine the angles of flexion for the right long finger, the right ring finger and the right fifth finger are digitized in the same manner. The operator is prompted when the system is ready to digitize the next finger.

Step 4.1.3:
The MP joints of the four fingers of the right hand in flexion are digitized as well. Three points are required to digitize the MP joint of each finger. The MP joint is held in flexion with the PIP
and with the DIP joint extended. (Fig. 6) Once the three points have been entered the system calculates the angle of flexion, displays it on the screen and stores it. (Fig 7) The operator is then prompted to digitize the next finger. In this manner the MP joints of the right index, long, ring and fifth fingers are evaluated.

Step 4.1.4:
If there are any joints of the right hand that do not extend fully, the therapist is given the opportunity to evaluate them now. Any joint that is not measured explicitly for extension is assumed to have normal extension. The computer automatically assumes normal extension unless otherwise indicated. The therapist is asked if there are any joints of the right hand which do not extend fully. The acceptable responses are "Y" or "y" for yes and "N" or "n"
o?7 ~ . . . .
' . :.

132926~
for no. If the response indicates no, the computer assumes that all joints extend normally and transfers ~o Step 5. If the response indicates yes the therapist is asked to identify the particular finger and specifically the joint of the finger. The system checks carefully to ensure that the therapist has requested a joint that actually exists.
For example, the DIP joint of the right thumb does not exist and the therapist would be asked to enter a valid joint. Once the joint has been determined the computer prompts the operator to digitize the three points that determine the angle of maximum extension.
(Figures 8, 9, 10, 11 and 12) Once locations of the points have been provided to the computer, the angle of extension is automatically calculated, displayed on the screen and stored. The therapist may then indicate that there are more joints to be analyzed, with respect to their maximum extension, or that this completes the evaluation of the joints of the right hand. If there are more joints to be evaluated the process is repeated, otherwise the system transfers to step 5.

Step 4.2:
The process of evaluating the range of motion of the hand must also account for the patients with amputated and/or fused joints of the fingers and thumb. Under the circumstances where special cases are present, each joint of each finger is evaluated individually. Each joint requires three points located using the digitizer to accurately determine the maximum joint flexion and/or extension. Every point that is digitized returns the location of that ~?8 point in three dimensional space with respect to a frame of reference generated by the 3Space digitizer. The computer takes these points and calculates the appropriate angle.

Step 4.2.1:
If the operator had previously indicated that the right thumb was not to be digitized, normal flexion values are assumed for the right thumb and the system transfers to step 4.2.2. If the joints of the right thumb are to be digitized, the system indicates that it is ready to accept the three points for the MP joint of the right thumb.
The system indicates whether the points measure the right thumb in flexion or the angle of fusion of the MP joint of the right thumb. (Fig.
13) . . , Once the points have been entered the computer automatically calculates, displays on the screen and notes the resulting angle. The process is repeated for the angle of flexion or angle of fusion of the IP joint of the right thumb. (Fig. 14) ., . ~
.1 Again the computer calculates the angle of flexion or fusion of the IP joint of the right thumb, displays on the screen and stores the results. The system then transfers to Step 4.2.2.

Step 4.2.2:
If the operator had previously indicated that the right index finger was not to be digitized, normal flexion values are assumed for the right index finger and the system transfers to Step i32926~

4.2.3. If the joints of the right index finger are to be digitized, the system indicates that it is ready to accept the three points for the MP
joint of the right index finger. The system indicates whether the pints measure the right index finger in flexion or the angle of fusion of the MP joint of the right index finger.

Upon completion of the entry of the three points, the computer calculates, displays on the screen and stores the resulting angle. The process is repeated for the PIP and DIP joints of the right index , . .
rmger.

Again, once the data is entered for a joint, the computer calculates the resulting angle, displays it on the screen and stores it for later reference. When both the PIP and DIP joints have been evaluated individually, the system transfers to Step 4.2.3.

Step 4.2.3:
If the operator had previously indicated that the right long finger was not to be digitized, normal flexion values are summed for the right ring finger and the system transfers to Step 4.2.4. If the joints of the right long finger are to be digitized, the system indicates that it is ready to accept the three points for the MP
joint of the right long finger. The system indicates whether the points measure the right ring finger in flexion or the angle of fusion of the MP joint of the right long finger.

13292~4 Once the three points have been entered through the 3Space digitizer, the computer automatically calculates, displays on the screen and stores the resulting angle. The PIP and DIP joints of the right long finger are evaluated in the same manner.

Again, once the data is entered for a joint, the computer calculates, displays on the screen and stores the resulting angle.
When both the PIP and DIP joints have been evaluated individually, -the system transfers to Step 4.2.4.
"
Step 4.2.4:
If the operator had previously indicated that the right ring finger was not to be digitized, normal flexion values are assumed for the right ring finger and the system transfers to Step 4.2.5. If the joints of the right ring finger are to be digitized, the system indicates that it is ready to accept the three pint for the MP
joint of the right ring finger. The system indicates whether the points measure the right ring finger in flexion or the angle of fusion of the MP joint of the right ring finger.

Once the three points have been entered the cornputer automatically calculates, displays on the screen and stores the resulting angle. The PIP and DIP joints of the right ring finger are evaluated in the same manner.

Again, once the data is entered for a joint, the computer calculates, displays on the screen and stores the resulting angle.

, - .

' 132926~
When both the PIP and DIP joints have been evaluated individually, the system transfers to Step 4.2.5.

Step 4.2.5:
If the operator had previously indicated that the right fifth finger was not to be digitized, normal flexion values are assumed for the right fifth finger and the system transfers to Step 4.3. If the joint of the right fifth finger are to be digitized, the system indicates that it is ready to accept the three pints for the MP
joint of the right fifth finger. The system indicates whether the points measure the right fifth finger in flexion or the angle of fusion of the MP joint of the right fifth finger.
..
Once the three pints have been entered the computer -automatically calculates, displays Qn the screen and stores the resulting angle. The PIP and DIP joints of the right fifth finger are evaluated in the same manner.

`j Again, once the data is entered for a joint, the computer calculates, displays on the screen and stores the resulting angle.
When both the PIP and DIP joints have been evaluated individually, the system transfers to Step 4.3.

Step 4.3:
If there are any joints of the right hand that do not extend fully, the therapist is given the opportunity to evaluate them now. Any joint that is not measured explicitly for extension is 3~

assumed to have normal extension. For a complete description of the process, see Step 4.1.4. This step is carried out in the same manner as Step 4.1.4. Upon completion of this step the system trar.sfers to Step 5.

StepS:
If any portion of the right upper extremity is to be evaluated, it is done at this time. If no portion of the right upper extremity is to be digitized the system moves on to step 6.

Step 5.1:
; If the right wrist is to be evaluated, it is done this time.
If the right wrist is not to be evaluated, the system automatically assumes that the mobility of the wrist is normal and transfers to Step 5.2. The system indicated that it is ready to begin the evaluation of the right wrist. For the angles of flexion and extension, the operator is required to enter three points to determine each angle. The system differentiates between mobile and fused wrist joints, but data is taken for extension and flexion in both cases. The operator is asked to digitize the angle of flexion and the angle of extension individually. (Figs. 15 and 16) Once the data is entered for a measurement, the computer automatically calculates the angle, displays it on the screen and stores it. Once the angles of flexion and extension have been determined, the angles of radial and ulnar deviation must be determined. As with flexion and extension, the computer ~s 132926~

differentiates between mobile and fused wrist joints but both angles are determined in either case. Three points are required to determine the radial deviation and a second set of three points determine the ulnar deviation. ( Fig. 17 ) Once the data is entered for an angle, the computer automatically calculates the angle, displays it on the screen and stores it. When both the radial and ulnar deviation have been determined indi~ idually, the system will evaluate the wrist supination and pronation. In order to deterrnine the wrist supination and pronation, the system must first determine the standard distal wrist position. Two points are required to determine the standard position, the system will prompt the operator to enter these points.
The operator is then asked to enter the two points that determine wrist supination. (Fig 18) ..
Once these have been entered. the system automatically calculates the angle of maximum wrist supination. This angle is displayed on the screen and stored. The operator is then asked to enter the two points that determine wrist pronation. (Fig. 19) Once these have been entered the system automatically calculates the angle of maximum pronation, displays it on the screen and stores it. This completes the evaluation of the wrist and the system transfers to Step 5.2.

132926~

Step 5.2:
If the right elbow is to be evaluated, it is done at this time. If the right elbow is not to be evaluated, the system automatically assumes that the elbow has normal mobility and moves on to Step 5.3. The angles of flexion and extension are evaluated for the right elbow. The system differentiates between mobile and fused elbow joints but both the angle of flexion and the angle of extension are determined in either case. Three points are required for each angle calculation. The system prompts the operator to enter these points. (Fig. 20) Once the data is available for an angle, the computer calculates, displays on the screen and notes the results. Once the angles of flexion and extension have been determined individually, the system moves on to Step 5.3.

Step 5.3:
If the right forearm is to be evaluated, it is done at this time. If the right forearm is not to be evaluated the system automatically assumes that the mobility of the right forearm is normal and moves on to Step 6. On order to determine the supination and pronation angles of the right forearm, the computer must determine the standard forearm position. This is done using two points. The operator will be asked to enter the two points which determine the standard forearm position.

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. . .
' ... ~

Once these points have been entered, the operator is asked to enter the two points that determine maximum forearm supination.
(Fig. 21) :,~
The computer automatically calculates the angle of supination, displays it on the screen and stores it. The computer then requests that the operator enter the two points that determine maximum forearm pronation. (Fig. 22) Again the computer automatically calculates the angle of maximum pronation, displays it on the screen and stores it. Once the angles of forearm supination and pronation have been determined, the system moves on to Step 6.

Step 6:
If no portion of the right hand was evaluated, the system fills in normal values for each of the angles that would normally have been explicitly determined. This encompasses all of the range of motion data for the fingers and thumb of the right hand.

Step 7:
If no portion of the right upper extremity, excluding the right hand was evaluated, the system fills in normal values for each of the angles that would normally have been explicitly determined.
This encompasses range of motion data for the right wrist, right elbow and right forearm.

13292g4 Step 8:
If any portion of the left hand is to be evaluated, it is done at this time. If no portion of the left hand is to be digitized then the system moves on to Step 9. This step is carried out like Step 4, where left has been substituted for right. Because the steps are the same they are not repeated here. Upon completion of Step 8, ~; the system will transfer to Step 9.
!
Step 9:
If any portion of the left upper extremity is to be evaluated, it is done at this time. ~f nor portion of the left upper extremity is to be digitized then the system moves on to Step 10.
This step is carried out like Step 5, where left has been substituted for right. Because the steps are the same, they are not repeated here. Upon completion of Step 9, the system will transfer to Step 10.

Step 10:
If no portion of the left hand was evaluated, the system automatically assumes normal values for each of the angles that would otherwise have been determined explicitly. This encompasses all the range of motion data for the left fingers and thumb.

Step 11:
If no portion of the left upper extremity was evaluated, the system automatically assumes normal values for each of the angles that would other~ise have been determined explicitly, This 132926~

encompasses the range of motion data for the left wrist, left elbow and left forearm.

Step 12:
All of the range of motion data is stored in a text file which is accessible to the database software that will continue and complete the evaluation process.

UPPER EXTRE~IITY STRENGTH

The data for the grip strength and pinch strength is generated with Jamar grip meter and pinch gauge, (catalog #113. Best Priced Products, P.O. Box 1174, Whiteplains, New York.) The analog signal form the grip rneter is then coupled to the Macintosh SE computer via a data acquisition product called a MacAdious I~ SE expansion system made by GW Instruments, Inc. (P.O. Box 2145, 264 Msgr.
O'Brien Hwy., Cambridge, MA 02141, 617-625-4096.) The therapist is prompted to ask the patient to place the grip meter on the correct setting. The patient grips the device at his maximum capacity and an analog signal is generated proportional to the force. This signal is converted to a digital signal by the MacAdious II card and entered into the database.

The therapist is then prompted to change the handle setting on the grip meter to position #2 and the process is repeated through the next three settings. The average of these five settings is calculated and displayed.
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132926~

Three readings of pinch strength are taken, averaged and displayed. These values for strength are displayed on the reports but is not used for any impairment calculations. Only range of motion and nel~e sensation measurements are considered objective enough for this determination.

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~tracker3-combined-ne] 23 February 1988 using the MCDonnell DOu99elaosf3msotlon da~a for the upper extrem;~
. ',' .
Hand: finger extension ~ finger flexion Wrist: extension flexion radial deviation ulnar deviation pronation (distal) supination (distal) Elbow: extension flexion Forearm: prona~ion suoination February 1 988 GOSUB Init DIM Iwrist~4) lelbow(2) larm(2) Is~and(2 3j Iwstrot(2) - G~

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1329~

DIM Isup(2,3), Ipro(2,3), Imdpnt(3,3), Itransl(2,3) DIM wsup(2,3), wpro(2,3), wmdpnt(3,3), wtransl(2,3), wstand(2,3) DIM Iwsup(2,3), Iwpro(2,3), Iwmdpnt(3,3), Iwtransl(2,3), Iwstand(2,3) DIM flex(14), ext(14), d(~,3) DIM Iflex(14), lex~(14) GOSUB InitArray GOSUB InitVariables GOSUB GetlD
i% = O
Main Procedure to Generated Digi~izer Data check1:
PRINT "Will you digitize any portion of the right "
PRINT "upper extremity (y/n)"
INPUT Rue$
PRINT " "
IF NOT(Rue$=nY" OR Rue$=~'y" OR Rue$="N" OR Rue$="n") THEN GOTO checkl IF Rue$="Y" THEN GOSUB RightStatus IF Rue$="y" THEN GOSUB RightStatus check2:
PRINT "Will you digitize any portion of the left "
PRINT "upper extremity (y/n)";
INPUT Lue$
PRINT ~ n IF NOT(Lue$="Y" OR Lue$=ny~ OR Lue$="N" OR Lue$ = nn") THEN GOTO check2 IF Lue$=nY" THEN GOSUB LeftStatus IF Lue$=ny" THEN GOSUB LeftStatus IF Rue$="YN THEN GOSUB DigitRight IF Rue$ = "y" THEN GOSUB DigitRight IF Rue$ = ny~ THEN GOSUB UpperRight IF Rue$ = ~y" THEN GOSUB UpperRight IF Rue$ = nN" THEN GOSUB FilllnRight IF Rue$ = nn" THEN GOSUB FilllnRight IF Rue$ = nN" THEN GOSUB FilllnRupper IF Rue$ = "n" THEN GOSUB FilllnRupper IF Lue$ = ny~ THEN GOSUB DigitLeft IF Lue$ = ny" THEN GOSUB DigitLeft IF Lue$ = ny~- THEN GOSUB UpperLeh IF Lue$ = "y" THEN GOSUB UpperLeft IF Lue$ = "N~ THEN GOSUB FilllnLeft IF Lue$ = "n" THEN GOSUB FilllnLeft --' 132~

IF Lue$ = "N~' THEN GOSUB FilllnLupper IF Lue$ = "n" THEN GOSUB FilllnLupper GOSUB Report END
::.
RightStatus:
GOSUB RDigUAbn : GOSUB RDigAbn RETURN
- LeftStatus:
GOSUB LDigUAbn GOSUB LDigAbn RETURN
;
RDigAbn:
GOSUB RAllThere checka1:
PRINT n ~
- PRINT "Are there any joints of the right hand"
PRINT "which are not to be evaluated or which"
PRINT are either fused or amputated (y/n);
PRINT " "
IF Y$=~N" THEN GOTO RYAIITRheY~$e= N OR y$= n") THEN GOT
IF y$="n" THEN GOTO RAllThere PRINT " "
GOSUB RAbn GOTO RAbnJnts RAbn:
GOSUB RGetFinger IF de=0 THEN RETURN
IF de=1 THEN GOTO RNoThumb IF de=2 THEN GOTO RNolndex IF de=3 THEN GOTO RNoLong IF de=4 THEN GOTO RNoRing IF de=5 THEN GOTO RNoFihh GOTO RAbn RNoThumb:
Rth$ = "N"
flex(13) = 60 ext(13) = 0 flex(14) = 80 ext(14) = 0 GOTORAbn '' . ~;

.

132926~

RNolndex:
Rin$ = ~N~
flex(1) = 90 ext(1) = 0 flex(2)= 100 ext(2) = 0 flex(3) = 70 ext(3) = 0 GOTO RAbn RNoLong:
Rlo$ = nN"
flex(4) = 90 ext(4) = 0 flex(5)= 100 ext(5) = 0 flex(6) = 70 ext(6) = 0 GOTO RAbn RNoRing:
Rri$ = "N"
flex(7) = 90 ext(7) = 0 flex(8)= 100 ext(8) = 0 flex(9) = 70 ext(9) = 0 GOTO RAbn RNoFifth:
Rfi$ = "N"
flex(10) = 90 ext(10) = o flex(11) = 100 ext(11) = 0 flex(12) = 70 ext(12) = 0 GOTO RAbn RGetFinger:
PRINT "Which digit (1-5, or 0 when finished)"
PRINT "is not to be evaluated";
PRINT " "
IF NOT(de=0 OR de=1 OR de=2 OR de=3 OR de=4 OR de=5) THEN GOTO RGetFinger RAbnJnts:
GOSUB RWhichJnt IF de=0 THEN RETURN
IF de=1 THEN GOTO RAbnThumb G~

. . , ` 1329264 IF de=2 THEN GOTO RAbnlndex IFde=~THENGOTO RAbnLong IF de=4 THENGOTO RAbnRing IF de=5 THEN GOTO RAbnFifth GOTO RAbnJnts RAbnThumb:
IF abnval = 1 THENGOTO RAbTamp 'fused not amputated IFj$=nM"THEN Rtmp = 2 IFj$=nm"THEN Rtmp=2 IF j~="i" THEN Rtip = 2 IF j$="l" THEN Rtip=2 GOTO RAbnJnts RAbnTamp:
'amputated IFj$="i"THEN GOTO RAbTip IF j$= l" THEN GOTO RAbTip Rtmp=1 RAbTip:
Rtip=1 GOTO RAbnJnts RAbnlndex:
IF abnval=1 THEN GOTO RAblamp 'fused not amputated IF j$=nM~ THEN Rimp=2 IF j$="m" THEN Rimp=2 IF j$="P" THEN Ripip=2 IF j$=np" THEN Ripip=2 IF j$=nD"THEN Ridip=2 IF j$=nd" THEN Ridip=2 GOTO RAbnJnts RAblamp:
'amputated IF j$=nD" THENGOTO RAbldip IF j$=nd" THENGOTO RAbldip iF ;$=np~ THENGOTO RAblpip IF j$=np" THEN GOTO RAblpip Rimp=1 RAblpip:
Ripip=1 RAbldip:
Ridip=1 GOTO RAbnJnts RAbni ong:
IF abnval=1 THENGOTO RAbLamp 'fused not amputated IFj$=~M"THEN Rlmp=2 IF j$=nm" THEN Rlmp=2 IF ;$=np~ THEN Rlpip=2 132926~

IFj$="p"THEN Rlpip=2 IF j$="D" THEN Rldip=2 IF j$="d" THEN Rldip=2 GOTO RAbnJnts RAbLamp:
'amputated IF j$="D" THENGOTO RAbLdip IF j$=~d" THENGOTO RAbLdip IF j$="P" THENGOTO RAbLpip ; IF j$="p" THENGOTO RAbLpip Rlmp=1 RAbLpip:
Rlpip=1 RAbLdip:
Rldip=1 GOTO RAbnJnts RAbnRing:
IF abnval=1 THEN GOTO RAbRamp 'fused not amputated IF j$="M" THEN Rrmp=2 IF j$=nm~THEN Rrmp=2 IF j$="P" THEN Rrpip=2 IF j$="p" THEN Rrpip=2 IF j$=nD~ THEN Rrdip=2 IF j$=~d~ THEN Rrdip=2 GOTO RAbnJnts RAbRamp:
'ampu~ated IF j$="D" THEN GOTO RAbRdip IF j$="d" THEN GOTO RAbRdip IF j$=~P" THEN GOTO RAbRpip IF j$="p" THEN GOTO RAbRpip Rrmp=1 RAbRpip:
Rrpip=1 - ~ RAbRdip:
Rrdip=1 GOTO RAbnJnts RAbnFifth:
IF abnval=1 THENGOTO RAbFamp 'fused not amputated IF j$="M" THEN Rfmp=2 IF j$="m" THEN Rfmp=2 IF j$=nP"THEN Rfpip=2 IF j$="p" THEN Rfpip=2 IF j$="D" THEN Rfdip=2 IF j$="d" THEN Rfdip=2 GOTO RAbnJnts RAbFamp:
~7 'amputated IF j$="D~' THEN GOTO RAbFdip IF j$="d" THEN GOTO RAbFdip IF j$="P" THEN GOTO RAbFpip IF j$="p" THEN GOTO RAbFpip Rfmp=1 RAbFpip:
Rfpip=1 RAbFdip:
Rfdip=1 GOTO RAbnJnts RWhichJnt:
PRINT "Which digit (1-5, or 0 when finished)"
PRINT "has a fused or amputated joint";
INPUT de PRINT " "
F dNOTO(de=O OR de-1 OR de=2 OR de=3 OR de=4 OR de=5) THEN GOTO RWhichJ t IF de=1 THEN d$="Right Thumb"
IF de=2 THEN d$="Right Index Finger"
IF de=3 THEN d$=nRight Long Finger"
IF de=4 THEN d$=nRight Ring Finger"
IF de=5 THEN d$="Right Fifth Finger"
checka2:
INPpRUTNT$ Which joint [M)P, P)IP, D)IP l)P]";
PRlNTn '~
IF NOT(j$=nM" OR j$-''m" OR j$ "D" OR j$ "d" OR
IF de=1 THEN IF j$=lpN THEN GOTO RWJntError IF de=1 THEN IF j$="p" THEN GOTO RWJntError IF de=1 THEN IF j$=~D" THEN GOTO RWJntError IF de=1 THEN IF j$="d" THEN GOTO RWJntError IF de=2 THEN IF j$=nl~ THEN GOTO RWJntError IF de=2 THEN IF j$=~i" THEN GOTO RWJntError IF de=3 THEN IF j$="l" THEN GOTO RWJntError IF de=3 THEN IF ;$=nj~ THEN GOTO RWJntError IF de=4 THEN IF j$="l" THEN GOTO RWJntError IF de=4 THEN IF j$=nj~ THEN GOTO RWJntError IF de=5 THEN IF j$="l" THEN GOTO RWJntError IF de=5 THEN IF ;$=nj~ THEN GOTO RWJntError IF j$=nM" THEN a$="MP"
IF j$="m" THEN a$="MP"
IF j$="P" THEN a$="PlP"
IF j$=np~ THEN a$="PlP"
IF j$="D" THEN a$=~DlP"
IF j$="d" THEN a$="DlP"
IF j$=nl" THEN a$="lP"
IF j$="i" THEN a$=nlP"
checka3:
PRINT "Is the ";a$;" joint of the ";d$
PRINT "amputated (1) or fused (2) or mobile (0)";
G~8 13292~4 INPUT abnval ~ PRINT " "
- IF NoT(abnval=1 OR abnval=2 OR abnval=0) THEN GOTO checka3 RWJntError:
PRINT "Wrong joint. Try Again."
PRINT n ~
GOTO RWhichJnt LDigAbn:
GOSUB LAllThere checkc1:
PRINT " "
PRINT Are there any joints of the le~t hand"
PRINT "which are not to be evaluated or which"
PRINT "are either fused or amputated (y/n);
PRINT " "
IF x$="N" THEN GOTo LYAIIOThRerXe$= N OR x$="n") THEN GOT
IF x$=nn" THEN GOTO LAllThere ` PRINT~U
PRINT "Please indicate each individual finger of the"
PRINT "left hand Ihat is not to be evaluated."
.; GOSUB LAbn GOTO LAbnJnts LAbn:
~,, GOSUB LGetFinger IF de=0 THEN RETURN
IF de=1 THEN GOTO LNoThumb IF de=2 THEN GOTO LNolndex IF de=3 THEN GOTO LNoLong IF de=4 THEN GOTO LNoRing IF de=5 THEN GOTO LNoFifth GOTO LAbn LNoThumb:
Lth$="N"
Iflex(13) = 60 lext(13)=o Iflex(14) = 80 lext(1 4)=0 GOTO LAbn LNolndex:
Un$="N"
If lex(1 )=90 lext(1 )=0 If lex(2)=1 00 l7~

132926~

lexl(2)=0 If lex(3) =70 lext(3)=0 GOTO LAbn - ~ LNoLong:
Llo$="N"
If lex(4)=90 lext(4)=0 If lex(5)=100 lext(5)=0 If lex(6)=70 lext(6)=0 GOTO LAbn LNoRing:
Lri$="N"
If lex(7)=90 lext(7)=0 If lex(8)=100 lex~(8)=0 Iflex(9)=70 lext(9)=0 GOTO LAbn ; LNoFifth:
Lfi$="N"
; If lex(10)=90 lext(10~=0 If lex(11)=100 lext(11)=0 :, If lex(12)=70 lext(12)=0 GOTO LAbn LGetFinger:
~, PRINT "Which digit (1-5, 0 when finished)"
PRINT "is not to be evaluated"
INPUT de PRINT ~ ~
IF NOT(de=0 OR de=1 OR de=2 OR de=3 OR de=4 OR de=5) THEN GOTO LGetFinger - LAbnJnts:
GOSUB LWhichJnt IF de=0 THEN RETURN
IF de=1 THEN GOTO LAbnThumb IF de=2 THEN GOTO LAbnlndex IF de=3 THEN GOTO LAbnLong IF de=4 THEN GOTO LAbnRing IF de=5 THEN GOTO LAbnFifth GOTO LAbnJnts LAbnThumb:
~0 IF abnval=1 THEN GOTO LAbTamp 'fused not amputated IFj$="M" THEN Ltrnp=2 IF j$="m" THEN Ltmp=2 IFj$="l" THEN Ltip=2 IFj$="i" THEN Ltip=2 GOTO LAbnJnts LAbTamp:
'amputated IFj$='-lHTHEN GOTO LAbTip IF j$="i" THEN GOTO LAbTip Ltmp=1 LAbTip:
Ltip=1 GOTO LAbnJnts LAbnlndex:
IF abnval=1 THEN GOTO LAblamp 'fused not amputated . IF j$="M" THEN Limp=2 IF j$="m" THEN Limp=2 - IF j$=~P" THEN Lipip=2 IF j$=Hp-' THEN Lipip=2 IFj$="D" THEN Lidip=2 IF j$="d" THEN Lidip=2 GOTO LAbnJnts LAblamp:
~, 'amputated IFj$="DHTHEN GOTO LAbldip IFj$=rd"THEN GOTO LAbldip IF j$=HP"THEN GOTO LAblpip IFj$="p~THEN GOTO LAblpip LAblpip:
Lipip=1 LAbldip:
Lidip=1 GOTO LAbnJnts LAbnLong:
IF abnval=1 THEN GOTO LAbLamp 'fused not amputated IF j$="M" THEN Llmp=2 IFj$=HmH THEN Llmp=2 IFj$=HP" THEN Llpip=2 IFj$="p" THEN Llpip=2 IF j$=~D" THEN Lldip=2 IFj$=HdH THEN Lldip=2 GOTO LAbnJnts LAbLamp:
'amputated -` 132~264 IFj$="D"THEN GOTO LAbLdip IF j$=~d~ THEN GOTO LAbLdip IFj$="P"THEN GOTO LAbLpip IF j$="p" THEN GOTO LAbLpip Llmp=1 LAbLpip:
Llpip=1 LAbLdip:
Lldip=1 GOTO LAbnJnts ~- LAbnRing:
; ~ IFabnval=1 THEN GOTO LAbRamp 'fused not amputated IF j$="M" THEN Lrmp=2 IF j$=nm" THEN Lrmp=2 IFj$=nP" THEN Lrpip=2 IF j$='~p" THEN Lrpip=2 IF j$="D" THEN Lrdip=2 IFj$="d" THEN Lrdip=2 GOTO LAbnJnts i:
LAbRamp:
:i 'amputated IF j$=nD" THEN GOTO LAbRdip IF j$=nd" THEN GOTO LAbRdip IFj$=UP'THEN GOTO LAbRpip IF j$=np~- THEN GOTO LAbRpip Lrmp=1 LAbRpip:
~ Lrpip=1 - LAbRdip:
' Lrdip=1 GOTO LAbnJnts , LAbnFif~h:
IF abnval=1 THEN GOTO LAbFamp 'fused no~ amputated IF j$=nM~ THEN Lfmp=2 ` IFj$=nm" THEN Lfmp=2 IF j$=np~ THEN Upip=2 IF j$=~p~ THEN Lfpip=2 IFj$="D" THEN Lfdip=2 IFj$-~d" THEN Lfdip=2 GOTO LAbnJnts LAbFamp:
'amputated IF j$="D"THEN GOTO LAbFdip IFj$=nd"THEN GOTO LAbFdip IF j$="P" THEN GOTO LAbFpip IF j$=np~ THEN GOTO LAbFpip Ump=1 LAbFpip:
1~

Lfpip=1 LAbFdip:
Lfdip=1 GOTO LAbnJnts LWhichJnt:
PRINT "Which digit (1-5, or 0 which finished)"
PRINT "has a fused or amputated joint";
INPUT de PRINT " "
IF NOT(de=0 OR de=1 OR de=2 OR de=3 OR de=4 OR de=5) THEN GOTO LWhichJnt IF de=0 THEN RETURN
IF de=1 THEN d$="Left Thumb"
IF de=2 THEN d$="Left Index Finger"
- IF de=3 THEN d$="Left Long Finger"
IF de=4 THEN d$="Left Ring Finger"
IF de=5 THEN d$="Left Fifth Finger"
checkc2:
PRINT "Which joint [M)P, P)IP, D)IP l)P]"
PRINT " "
IF NOTa$="M" OR j$="m" OR j$="P" OR j$="p" OR j$="D" OR j$="d" OR j$="l" OR
J$="i") THEN GOTO checkc2 IF de=1 THEN IF j$="P" THEN GOTO LWJn~Error IF de=1 THEN IF j$=~p" THEN GOTO LWJntError IF de=1 THEN IF j$="D" THEN GOTO LWJntError IF de=1 THEN IF j$="d" THEN GOTO LWJntError , IF de=2 THEN IF j$="l~ THEN GOTO LWJntError - IF de=2 THEN IF j$='i" THEN GOTO LWJntError IF de=3 THEN IF j$="l" THEN GOTO LWJntError IF de=3 THEN IF j$="i" THEN GOTO LWJntError IF de=4 THEN IF j$="l" THEN GOTO LWJntError IF de=4 THEN IF j$="i" THEN GOTO LWJntError IF de=5 THEN IF j$=NI" THEN GOTO LWJntError IF de=5 THEN IF j$="i" THEN GOTO LWJntError IF j$=~M" THEN a$="MP~
IF j$="m" THEN a$="MP"
IF j$="P" THEN a$="PlP"
IF j$="p" THEN a$="PlP"
IF j$="D~ THEN a$="DlP"
IF j$="d~ THEN a$="DlP"
IF j$=~l" THEN a$=~lP"
IF j$="i~ THEN a$="lP"
checkc3:
PRINT "Is the ";a$;" joint of the "-d$
PRINT "amputated (1) or fused (2) or mobile (0)"
INPUT abnval PRINT r ~
IF NOT(abnval=1 OR abnval=2 OR abnval=0) THEN GOTO checkc3 LWJntError:
PRINT "Wrong joint. Try again."
PRINT " "

-" 1329264 GOTO LWhichJnt RDigUAbn:
GOSUB UpRAllThere checkb1:
PRINT " "
PRINT UAre there any joints of the right upper"
PRINT "extremi~y (wrist, forearm, elbow) which"
PRINT "are not to be evaluated or which are"
PRINT "either fused or amputated (y/n)"
INPUT x$
PRINT " "
IF NOT(x$="Y" OR x$="y" OR x$="N" OR x$="n") THEN GOTO checkb1 IF x$="N" THEN GOTO UpRAllThere IF x$=~n" THEN GOTO UpRAllThere PRINT " "
GOSUB RUAbn GOTO RUAbnJnts UpRAllThere:
Rel$="Y"
Rev=0 Rfo$="Y"
Rfv=0 . Rwr$="Y"
Rwv=o RETURN
RUAbn:
GOSUB RGetUpper IF de=0 THEN RETURN
IF de=1 THEN GOTO RNoWrist IF de=2 THEN GOTO RNoForeamm IF de=3 THEN GOTO RNoElbow GOTO RUAbn RNoWrist:
Rwr$="N~
wrist(1) = 70 wrist(2)=60 wrist(3)=20 wrist(4)=30 wstrot(1 )=0 wstrot(2)=0 GOTO RUAbn RNoForearm:
Rfo$="N"
arm(1) = 80 arm(2) = 80 GOTO RUAbn RNoElbow:

`` 13292~4 Rel$="N"
elbow(1 )=1 50 elbow(2) = 0 GOTO RUAbn RGetUpper:
PRINT "Which portion (wrist (1), forearm (2),"
PRINT "elbow (3), or 0 when finished) is not"
PRINT "to be evaluated";
INPUT de PRINT " "
IF NOT(de=0 OR de=1 OR de=2 OR de=3) THEN GOTO RGetUpper RUAbnJnts:
GOSUB RUWhichJnt IF de=0 THEN RETURN
IF de=1 THEN GOTO RAbnWrist IF de=2 THEN GOTO RAbnForearm IF ded THEN GOTO RAbnElbow GOTO RUAbnJnts RAbnWrist:
IF abnval=1 THEN GOTO RUAbWamp 'fused not amputated Rwv=2 GOTO RUAbnJnts RUAbWamp:
'amputated Rwv=1 : GOSUB RHandAmp GOTO RUAbnJnts RAbnForearm:
IF abnval=1 THEN GOTO RUAbFamp 'fused not amputated Rfv=2 GOTO RUAbnJnts RUAbFamp:
'amputated Rfv=1 Rwv=1 GOSUB RHandAmp GOTO RUAbnJnts RAbnElbow:
IF abnval=1 THEN GOTO RUAbEamp 'fused not amputated Rev=2 GOTO RUAbnJnts RUAbEamp:
7~

`` I 329264 'amputated Rev=1 Rfv=1 Rwv=1 GOSUB RHanrlAmp GOTO RUAbnJnts . RUWhichJnt:
PRINT "Which portion (wrist (1), forearm (2),"
PRINT "elbow (3), or 0 when finished) is ei~her"
PRINT "amputated or fused"-INPUT de PRINT " "
IF NOT(de=0 OR de=1 OR de=2 OR de=3) THEN GOTO RUWhichJnt IF de=0 THEN RETURN
IF de=1 THEN d$="Right Wrist"
IF de=2 THEN d$="Right Forearm"
IF de=3 THEN d$="Right Elbow"
checkb2:
PRINT "Is the ";d$;" amputated (1) or "
..PRINT "fused (2) or mobile (0)"
INPUT abnval ~- PRINT"
IF NOT(abnval=1 OR abnval=2 OR abnval=0) THEN GOTO checkb2 ~.
:;RHandAmp:
,~Rha$="Y"
RAIIOK$="N"
Rth$ = "N"
Rtmp= 1 Rtip= 1 Rin$ = "N"
Rimp= 1 Ripip = 1 Ridip= 1 Rlo$ = "N~
Rlmp= 1 Rlpip = 1 Rldip= 1 Rri$ = "N"
Rrmp= 1 Rrpip = 1 Rrdip= 1 Rfi$ = "N~
Rfmp= 1 Rfpip = 1 Rfdip= 1 REl URN
LDigUAbn:
GOSUB UpLAllThere checkd1:
PRINT " "
i~

, PRINT "Are there any join~s of the left upper"
PRINT "extremity (wrist, forearm, elbow) which"
PRINT "are not to be evaluated or which are"
PRINT "either fused or amputated (y/n)"
INPUT x$
PRINT " "
IF NOT(x$="Y" OR x$="y" OR x$="N" OR x$="n") THEN GOTO checkd1 IF x$="N" THEN GOTO UpLAllThere IF x$="n" THEN GOTO UpLAllThere . PRINT""
GOSU8 WAbn GOTO LUAbnJnts UpLAllThere:
, Lel$="Y"
,~ Lev=O
Lfo$="Y"
Lfv=O
Lwr$="Y"
Lwv=O
RETURN
LUAbn:
GOSUB LGetUpper IF de=0 THEN RETURN
IF de=1 THEN GOTO LNoWrist IF de=2 THEN GOTO LNoForearm IF de=3 THEN GOTC) LNoElbow GOTO WAbn LNoWrist:
Lwr$="N"
Iwris~(1) = 70 Iwrist(2) = 60 Iwrist(3) = 20 Iwrist(4) = 30 Iwstrot(1) = 0 Iwst~ot(2) = 0 GOTO WAbn LNoForearm:
Lfo$="N"
larm(1) = 80 larmt2) = 80 GOTO WAbn LNoElbow:
Lel$ = "N"
lelbow(1)= 150 lelbow(2) = 0 GOTO WAbn LGetUpper:
PRINT "Which portion (wrist(1), forearm (2),"
7~

32926~

PRINT "elbow (3), or 0 when finished) is not "
PRINT "to be evaluated";
INPUT de PRINT " "
IF NOT(de=0 OR de=1 OR de=2 OR de=3) THEN GOTO LGetUpper RETURN
LUAbnJnts:
GOSUB LUWhichJnt IF de=0 THEN RETURN
IF de=1 THEN GOTO LAbnWrist IF de=2 THEN GOTO LAbnForearm IF de=3 THEN GOTO LAbnElbow GOTO WAbnJnts LAbnWrist:
IF abnval=1 THEN GOTO LUAbWamp 'fused not amputated Lwv=2 GOTO LUAbnJnts LUAbWamp:
'amputated Lwv=1 GOSUB LHandAmp GOTO LUAbnJnts LAbnForearm:
IF abnval=1 THEN GOTO LUAbFamp 'fused not amputated Lfv=2 GOTO LUAbnJnts LUAbFamp:
'amputated Lfv=1 Lwv=1 GOSUB LHandAmp GOTO WAbnJnts LAbnElbow:
IF abnval=1 THEN GOTO LUAbEamp 'fused not amputated Lev=2 GOTO LUAbnJnts LUAbEamp:
'amputated Lev=1 Lfv=1 Lwv=1 GOSUB LHandAmp GOTO WAbnJnts -` 1329264 LUWhichJnt:
PRINT "Which portion (wrist (1), forearm (2),"
PRINT "elbow (3) or 0 when finished) is "
PRINT "either amputated or fused~';
INPUT de PRINT " "
IF NOT(de=0 OR de=1 OR de=2 OR de=3) THEN GOTO LUWhichJnt IF de=0 THEN RETURN
IF de=1 THEN d$="Left Wrist"
IF de=2 THEN d$="Left Forearm"
IF de=3 THEN d$="Left Elbow"
checkd2:
PRINT "Is the ";d$;" amputated (1)"
PRINT "or fused (2) or mobile (0)"
INPUT abnval PRINT "
IF NOT(abnval=0 OR abnval=1 OR abnval=2) THEN GOTO checkd2 : LHandAmp:
Lha$ = "Y"
LAIIOK$ = "N"
Lth$ = "N"
Ltmp= 1 Ltip = 1 Lin$ = "N"
Limp= 1 Lipip= 1 Lidip = 1 Llo$-"N"
Llmp= 1 Llpip= 1 Lldip = 1 Lri$ = "N"
Lrmp = 1 Lrpip= 1 Lrdip= 1 Lfi$ = "N"
Lfmp = 1 Lfpip = 1 Lfdip= 1 RETURN

RAllThere:
RAIIOK$ =nY
Rth$=~Y~
Rtmp=0 Rtip=0 Rin$ = "Y"
Rimp=0 ~329264 Ripip=0 Ridip=0 Rlo$ = ny--Rlmp=0 Rlpip=0 Rldip=0 Rri$="Y~
: Rrmp=0 Rrpip=o Rrdip=0 Rfi$ = "Y"
Rfmp=0 Rfpip=0 Rfdip=0 RETURN
LAllThere:
LAIIOK$ = "Y"
Lth$ = "Y"
Ltmp=0 Ltip=0 Lin$=~yn Limp=0 Lipip=O
Lidip=0 Llo$="y"
Llmp=0 Llpip=O
Lldip=0 Lri$= Y
Lrmp=0 Lrpip=0 Lrdip=0 Lfi$=~Y' Ump=0 Upip=O
Udip=0 RETURN
DigitRight:
IF Rha$ = nN" THEN GOTO FilllnRight IF Rha$ = nn" THEN GOTO FilllnRight PRINT "The Right Hand Will Now Be Digitized ... "
IF RAIIOK$ = ny~ THEN GOTO RDigAII
IF RAIIOK$ = ny" THEN GOTO RDigAII
'Digitize Right Thumb flex(1 3)=60 ext~1 3)=0 flex(1 4)=80 ext(14)=0 IF Rth$ = nN" THEN GOTO RlnS~art IF Rth$ = nn" THEN GOTO RlnStart IF Rtmpo1 THEN GOTO RThDig ~0 flex(1 3)=0 flex(1 4)=o GOTO RlnStart ,~ RThDig:
:~ a$="MP"
d$ = "Right Thumb"
: f$="f~
~' e$="Flexion"
. ndx=13 :-~ IF Rtmp=0 THEN GOTO RThMNorm -' PRINT HDigitize points (3) for fused right thumb"
:~ PRINT ~MP joint now. . . "
PRINT " "
GOSUB Rdig ;. GOTO RThlPDig ~' RThMNorm:
PRINT "Digitize points (3) for right thumb"
PRINT "MP joint in flexion now . . ."
PRINT " "
GOSUB Rdig RThlPDig:
IF Rtipo1 THEN GOTO RThlDig flex(1 4)=0 GOTO RlnSlart RThlDig:
a$ = "Ip~
d$ = "Right Thumb"
f$ = ~f"
. e$="Flexion"
. ndx=14 IF Rtip=0 THEN GOTO RThlNorm . PRINT "Digitize points (3) for fused right thumb"
PRINT "IP joint now . . . "
PRINT " ~
GOSUB Rdig GOTO RlnStart RThlNorm:
PRINT ~Digitize points (3) for righl thumb "
PRINT "IP joint in flexion now . . ."
PRINT " "
GOSUB Rdig RlnStarl:
'Digitize Right Index Finger flex(1) = 90 ext(1) = 0 flex(2)= 100 ext(2) = 0 flex(3) = 70 ext(3) = 0 IF Rin$ = "N" THEN GOTO RLoStart IF Rin$ = nn" THEN GOTO RLoStart IF Rimpo1 THEN GOTO RlnDig flex(1) = 0 ~. :

flex(2) = 0 flex(3) = 0 GOTO RLoStart RlnDig:
a$ = nMP~I
d$ = "Right Index Finger"
~; f$ = "f"
. e$=~Flexion"
ndx=1 IF Rimp=0 THEN GOTO RlnMNorm PRINT "Digitize points (3) for fused right "
PRINT "index finger MP joint now. . ."
PRINT n U
GOSUB Rdig GOTO RlnPlPDig RlnMNorm:
PRINT "Digitize points (3) for right index"
PRINT "finger MP joint in flexion now. . ."
PRINT n ~
GOSUB Rdig RlnPlPDig:
IF Ripip<>1 THEN GOTO RlnPDig flex(2)=0 flex(3)=o GOTO RLoS~art RlnPDig:
a$ = nplp-~d$= nRight Index Finger"
f$ = Uf..
e$ = UFlexion"
ndx = 2 IF Ripip=0 THEN GOTO RlnPNorm PRINT "Digitize points (3) for fused righl"
PRINT "index finger PIP joint now. . ."
PRINT ~ n GOSUB Rdig GOTO RlnDlPDig RlnPNorm:
PRINT "Digitize points (3) for right index"
PRINT "finger PIP joint in flexion now "
PRINT n ~
GOSUB Rdig RlnDlPDig: .
IF Ridip<>1 THEN GOTO RlnDDig flex(3) =
GOTO RLoStart RlnDDig:
a$ = ~DIpn d$ = "Right Index Finger"
f$ = nf., e$ = ~FIexion"
ndx = 3 IF Ridip = 0 THEN GOTO RlnDNorm PRINT "Digitize points (3) for fused right"
8d PRINT "index finger DIP joint now. . ."
PRINT " "
GOSUB Rdig GOTO RLoStart RlnDNorm:
PRINT "Digitize points (3) for right index"
PRINT ~finger DIP joint in flexion now . . ."
PRINT " "
GOSUB Rdig RLoStart:
'Digitize Right Long Finger flex(4) = go ext(4) = 0 flex(5)= 100 ext(5) = 0 flex(6~ = 70 ext(6) = 0 IF Rlo$ = "N" THEN GOTO RRiStart IF Rlo$ = nn" THEN GOTO RRiStart IF Rlmpo1 THEN GOTO RLoDig flex(4) = 0 flex(5) = 0 flex(6) = 0 GOTO RRiStart RLoDig:
a$ = nMP"
d$ = "Right Long Finger"
f$ = "f"
e$ = "Flexion"
ndx = 4 IF Rlmp=0 THEN GOTO RLoMNorm PRINT "Digi~ize points (3) for fused right "
PRINT "long finger MP joint now. . ."
PRINT n n GOSUB Rdig GOTO RLoPlPDig RLoMNorm:
PRINT "Digitize points (3) for right long finger "
PRINT "MP joint in flexion now. . "
PRINT n ~
GOSUB Rdig RLoPlPDig:
IF Rlpipo1 THEN GOTO RLoPDig flex(5) = 0 flex(6) = 0 GOTO RRiStart RLoPDig:
a$ = ~plpn d$= nRight Long Finger"
f$ = f e$ = "Flexion"
ndx = 5 IF Rlpip=0 THEN GOTO RLoPNorm ~3 1~29264 PRINT UDigitize points (3) for fused right "
PRINT "long finger PIP joint now. . ."
PRINT " "
GOSUB Rdig GOTO RLoDlPDig R LoPNorm:
PRINT "Digitize points (3) for right long finger"
PRINT ~PIP joint in flexion now.
PRINT " "
GOSUB Rdig RLoDlPDig:
IF Rldip<>1 THEN GOTO RLoDDig flex(6) = 0 GOTO RRiStart RLoDDig:
a$ = "DIP"
d$ = nRight Long Finger"
f$ = "f"
e$ = "Flexion"
ndx=6 IF Rldip = 0 THEN GOTO RLoDNorm PRINT "Digitize points (3) for fused right "
PRINT Nlong finger DIP joint now . . ."
PRINT " "
GOSUB Rdig GOTO RRiStart RLoDNorm:
PRINT "Digitize points (3) for right long finger "
PRINT "DIP joint in flexion now. . ."
PRINT " "
GOSUB Rdig RRiStart:
'Digitize Right Ring Finger flex(7) = go ext(7) = 0 flex(8)= 100 ext(8) = o flex(9) = 70 ext(9) = 0 IF Rri$ = "N" THEN GOTO RFiStart IF Rri$ = "n" THEN GOTO RFiStart IF Rrmpo1 THEN GOTO RRiDig flex(7) = O
flex(8) = 0 flex(9) = 0 GOTO RFiStart RRiDig:
a$ = "MP"
d$ = "Right Ring Finger"
s$= r e$ = "Flexion"
ndx = 7 IF Rrmp = 0 THEN GOTO RRiMNorm , ... ..

- .

PRINT "Digitize points (3) for fused right "
PRINT "ring finger MP joint now . . .
PRINT " "
GOSUB Rdig GOTO RRiPlPDig RRiMNorm:
PRINT ~Digi~ize points ~3) for right ring finger "
PRINT "MP joint in flexion now. . ."
PRINT " "
GOSUB Rdig RRiPlPDig:
IF Rrpip<>1 THEN GOTO RRiPDig flex(8) = 0 flex(9)=0 GOTO RFiStart RRiPDig:
a$ nplpn d$= "Right Ring Finger"
f$ = "f"
e$ = nFiexion"
ndx = 8 IF Rrpip = 0 THEN GOTO RRiPNorm PRINT "Digitize points (33 for fused right "
PRINT "ring finger PIP joint now. . ."
PRINT n n GOSUB Rdig GOTO RRiDlPDig RRiPNorm:
PRINT "Digitize points (3) for right ring finger "
PRINT "PIP joint in flexion now . . . "
PRINT ~ n GOSUB Rdig RRiDlPDig:
IF Rrdip<>1 THEN GOTO RRiDDig flex(9) =
GOTO RFiStart RRiDDig:
a$ = IDlpn d$= "Right Ring Finger"
f$ = nf~
: e$.=nFlexion"
ndx = 9 IF Rrdip = 0 THEN GOTO RRiDNorm PRINT "Digitize points (3) for fused right n PRINT "ring finger DIP joint now . . ."
PRINT n n GOSUB Rdig GOTO RFiStart RRiDNorm:
PRINT "Digitize points (3) for right ring finger "
PRINT "DIP joint in flexion now. . ."
PRINT n ..
GOSUB Rdig O J

-` 132926~

R FiStart:
'Digitize Right Fifth Finger Flex(10) = 90 ext(1 0)=0 flex(11) = 100 ext(11) = 0 flex(12) = 70 ex~(12) = 0 IF Rfi$ = "N" THEN GOTO Rext IF Rfi$ = "n" THEN GOTO Rext IF Rfmp<>1 THEN GOTO RFiDig flex(10) = 0 fl0x(1 1 )=0 flex(1 2)=0 GOTO Rext RFiDig:
a$ = "MP'' d$= ~Right Fifth Finger"
f$= f"
e$ = nFlexion"
ndx = 10 IF Rfmp=0 THEN GOTO RFiMNorm PRINT "Digilize points (3) for fused right "
PRINT "fif~h finger MP joint now. . ."
PRINT n ~
GOSUB Rdig GOTO RFiPlPDig RFiMNorm:
. PRINT "Digitize points (3) for right fifth "
- PRINT "finger MP joint.in flexion now. . ."
PRINT ~ n GOSU8 Rdig RFiPlPDig:
IF Rfpip<>1 THEN GOTO RFiPDig flex(11) = 0 flex(1 2)=0 GOTO Rext R Fi PDig:
a$ = nPlP"
d$= nRight Fifth Finger"
f$ = "f"
., e$="Flexion"
ndx= 11 IF Rfpip=0 THEN GOTO RFiPNorm PRINT "Digitize points (3) for fused right "
PRINT "fifth finger PIP joint now. . ."
PRINT ~ n GOSUB Rdig GOTO RFiDlPDig RFiPNorm:
PRINT "Digitize points (3) for right fifth "
PRINT "finger PIP joint in flexion now. . ."
PRINT n n GOSUB Rdig ~/
0~

--~ 1329264 RFiDlPDig:
IF Rfdipo1 THEN GOTO RFiDDig flex(1 2)=0 GOTO Rext RFiDDig:
a$ = "DIP"
d$= ~Right Fifth Finger~
f$ = "f"
e$ = "Flexion"
ndx = 12 IF Rfdip= 0 THEN GOTO RFiDNorm PRINT ~Digitize points (3) for fused right "
PRINT "fifth finger DIP joint now. . ."
PRINT " "
GOSUB Rdig GOTO Rext RFiDNorm:
PRlNT"Digitize points (3) for right fifth "
PRINT "finger DIP joint in flexion now. . ."
PRINT " "
GOSUB Rdig Rext:
GOSUB RDigNormExt RETURN

DigitLeft:
IF Lha$ = nN" THEN GOTO FilllnLeft IF Lha$ = ..nu THEN GOTO FilllnLeft PRINT "The Left Hand Will Now Be Digitized ..."
PRINT u IF LAIIOK$ = "Y" THEN GOTO LDigAII
.~ IF LAIIOK$ = "y" THEN GOTO LDigAII
'Digitize Left Thumb Iflex(13) = 60 lext(13) = 0 Iflex(14) = 80 lext(14) = 0 IF Lth$ = nN THEN GOTO LlnStart IF Lth$ = "n~ THEN GOTO LlnStart IF Ltmp~>1 THEN GOTO LThDig Iflex(13~ = 0 If lex(1 4)=0 GOTO LlnStart LTh Dig:
a$ = "MP"
d$ =~Left Thumb"
f$ = "f"
e$ ="Flexion"
ndx= 13 IF Ltmp= 0 THEN GOTO LThMNorm PRINT "Digitize points (3) for fused left "

132926~

PRINT "thumb MP joint now . . ."
PRINT " "
GOSUB Ldig GOTO LThlPDig LThMNorm:
PRINT "Digitize points (3) for left thumb "
PRINT "MP joint in flexion now . . . "
PRINT " "
GOSUB Ldig LThlPDig:
IF Ltip<>1 THEN GOTO LThlDig Iflex(14) = 0 GOTO LlnStart LThlDig:
a$ = nlpll d$ = nLeft Thumb"
f$ = f e$ = nFlexion"
ndx= 14 IF Ltip = 0 THEN GOTO LThlNorm PRINT "Digitize points (3) for fused "
PRINT left thumb IP joint now. "
PRINT n n . .
GOSUB Ldig GOTO LlnStart LThlNorm:
PRINT "Digitize points (3) for left thumb "
. PRINT "IP joint in flexion now. "
PRINT n n . .
.GOSUB Ldig . LlnStart:
'Digitize Left Index Finger Iflex(1) = 90 lext(1 )=0 Iflex(2) = 100 lext(2) = 0 Iflex(3) = 70 lext(3) = 0 IF Lin$ = nN" THEN GOTO LLoStart IF Lin$ = "n" THEN GOTO LLoStart IF Limp<>1 THEN GOTO LlnDig Iflex(1) = 0 Iflex(2) = 0 Iflex(3) = 0 GOTO LLoStart LlnDig:
a$ = ~Mpn d$= "Left Index Finger"
f$ = f e$ = nFlexion"
ndx= 1 IF Limp=0 THEN GOTO LlnMNorm PRINT "Digitize points (3) for fused left "

---` 132926~

PRINT "index finger MP joint now. . ."
PRINT " "
GOSUB Wig GOTO LlnPlPDig LlnMNorm:
PRINT "Digitize points (3) for left index "
PRINT ~finger MP joint in flexion now . . .
PRINT " "
GOSUB Ldig LlnPlPDig:
IF Lipip<>1 THEN GOTO LlnPDig Iflex(2) = G
Iflex(3) = 0 GOTO LLoStart LlnPDig:
a$ = "PIP"
d$ = "Left Index Finger"
f$ = "f"
e$ = "Flexion"
ndx = 2 IF Lipip=0 THEN GOTO LlnPNorm PRINT NDigi~ize points (3) for fused left "
PRINT Nindex finger PIP joint now "
PRINT N N . ~ .
GOSUB Ldig GOTO LlnDlPDig LlnPNorm:
PRINT "Digitize points (3) for left index finger "
PRINT "PIP joint in flexion now. . ."
PRINT " ~
GOSUB Ldig LlnDlPDig:
IF Udip~>1 THEN GOTO LlnDDig Iflex(3) = 0 GOTO LLoStart LlnDDig:
a$ = ~DlPN
d$ = "Left Index Finger"
f$= r e$ = "FlexionN
ndx = 3 IF Lidip=0 THEN GOTO LlnDNorm PRINT "Digitize points (3) for fused left N
PRINT "index finger DIP joint now N
PRINT ~ n . ., GOSUB Wig GOTO LLoStart LlnDNorm:
PRINT NDigitize points (3) for left index finger"
PRINT NDIP joint in flexion now.
PRINT N N
GOSUB Wig LLoStart:

, . , -` 13~9~6~

'Digitize Left Long Finger Iflex(4) = 90 lext(4) = 0 Iflex(5)= 100 lext(5) = 0 Iflex(6) = 70 lext(6) = 0 IF Llo$ = HN" THEN GOTO LRiStart IF Llo$ = "nH THEN GOTO LRiStart IF Llmpo1 THEN GOTO LLoDig Iflex(4) = 0 Iflex(5) = 0 Iflex(6) = 0 GOTO LRiStart LLoDig:
a$ = HMP"
d$= "Left Long Finger"
f$ = ~f~
e$ = "Flexion"
ndx = 4 . IF Llmp=0 THEN GOTO LLoMNorm PFINT "Digi~ize points (3) for fused left "
PRINT "long finger MP joint now. . ."
PRINT H ~
GOSUB Ldig GOTO LLoPlPDig LLoMNorm:
PRINT HDigitize points (3) for left long finger "
PRINT MP join~ in flexion now. H
PRINT " "
GOSUB Ldig LLoPlPDig:
IF Llpip<,1 THEN GOTO LLoPDig Iflex(5) = 0 Iflex(6) = 0 ~OTO LRiStart LLoPDig:
a$ = "PlP~
d$= ~Left Long Finger"
f$ = "r e$ = "FlexionH
ndx = 5 IF Llpip=0 THEN GOTO LLoPNorm PRINT ~Digitize points (3) for fused left PRINT "long finger PIP joint now . . ."
PRINT " "
GOSUB Ldig GOTO LLoDlPDig LLoPNorm:
PRINT HDigitize points (3) for left long finger "
PRINT ~PIP joint in flexion now , H
PRINT H ~
GOSUB Ldig LLoDlPDig:
~0 13~926~

IF Lldip<>1 THEN GOTO LLoDDig Iflex(6) = 0 GOTO LRiStart LLoDDig:
a$ = ~DIP~
d$= "Left Long Finger"
f$ = "f"
e$ = "Flexion"
ndx = 6 IF Lldip=0 THEN GOTO LLoDNorm PRINT ~Digitize points (3) for fused left "
PRINT "long finger DIP joint now. . ."
PRINT " ~
GOSUB Ldig GOTO LRiStart LLoDNorm:
PRINT ~Digitize points (3) for left long finger "
PRINT "DIP joint in flexion now. . ."
PRINT " "
GOSUB Ldig LRiStart:
'Digitize Left Ring Finger Iflex(7) = 90 lext(7) = 0 Iflex(8) = 100 lext(8) = 0 Iflex(9) = 70 - lext(9) = 0 IF Lri$ = "N" THEN GOTO LFiStart iF Lri$ = ~nu THEN GOTO LFiStart IF Lrmp<>1 THEN GOTO LRiDig Iflex(7) = 0 Iflex(8) = 0 Iflex(9) =
GOTO LFiStart LRiDig:
a$ = "MP"
d$=~LeSt Ring Finger"
f$ =~f"
e$ = "Flexion"
ndx = 7 IF Lrmp=0 THEN GOTO LRiMNorm PRINT "Digitize points (3) for fused left "
PRINT "ring finger MP joint now. . ."
PRINT " "
GOSUB Ldig GOTO LRiPlPDig LRiMNorm:
PRINT "Digitize points (3) for left ring finger "
PRINT "MP joint in Slexion now. . ."
PRINT " "
GOSUB Ldig LRiPlPDig:
q/

132926~

IF Lrpip<>1 THEN GOTO LRiPDig Iflex(8) = 0 Iflex(9) = 0 GOTO LFiStart LRiPDig:
a$ = "PIP"
d$="Left Ring Finger~' f$ = "f"
e$ = "Flexion"
ndx = 8 IF Lrpip=0 THEN GOTO LRiPNorm PRINT "Digitize points (3) for fused left ring '~
PRINT "finger PIP joint now. . ."
PRINT " "
GOSUB Ldig GOTO LRiDlPDig LRiPNorm:
PRINT "Digitize points (3) for left ring finger "
PRINT "PIP joint in flexion now. . ."
PRINT ~ u GOSUB Ldig LRiDlPDig:
IF Lrdip~>1 THEN GOTO LRiDDig Iflex(9) = 0 GOTO LFiStart LRiDDig:
a$ = "DlP"
d$ = "Left Ring Finger"
f$ = "f"
~ e$=~Flexion"
- ndx = 9 IF Lrdip=0 THEN GOTO LRiDNorm PRINT "Digitize points (3) for fused left "
PRINT"ring finger DIP joint now . . . "
PRINT ~ r GOSU8 Ldig GOTO LFiStart LRiDNorm:
PRINT "Digitize points (3) for left ring finger"
PRINT "DIP joint in flexion now. . . n PRINT "
GOSUB Ldig LFiStart:
'Digitize Left Fifth Finger If lex(1 0)=90 lext(1 0)=0 If lex(11)=1 00 lext(1 1 )=0 If lex(1 2)=70 lext(1 2)=0 IF Ui$ = "N" THEN GOTO lext IF Lfi$ = "n" THEN GOTO lext IF Lfmp<>1 THEN GOTO LFiDig 9~

If lex(1 0)=0 If lex(11 )=0 If lex(1 2)=0 GOTO lext LFi Dig:
a$ = "MP"
d$= "Left Fifth Finger"
f$ Nf~
e$ = "Flexion"
ndx = 10 IF Lfmp=0 THEN GOTO LFiMNorm PRINT "Digitize points (3) for fused left "
PRINT "fifth finger MP joint now. . ."
PRINT ~ n GOSUB Ldig GOTO LFiPlPDig LFiMNorm:
PRINT "Digitize points (3) for left fifth finger "
PRINT "MP joint in flexion now. . .
PRINT " "
GOSUB Ldig LFiPI PDig:
IF Upip<>1 THEN GOTO LFiPDig Iflex(11) = 0 Iflex(12) = 0 GOTO lext LFiPDig:
a$ = "PIP"
d$= Left Fifth Finger"
f$ = f e$ = ~Flexion"
ndx= 11 IF Upip=0 THEN GOTO LFiPNorm PRINT rDigitize points (3) for fused left fifth "
PRINT "finger PIP joint now. . "
PRINT ~ n GOSUB Ldig GOTO LFiDlPDig LFiPNorm:
PRINT ~Digitize points (3) for left fifth finger "
PRINT "PIP joint In flexion now. . ."
PRINT " "
GOSU8 Ldig LFiDlPDig:
IF Lfdip~>1 THEN GOTO LFiDDig If lex(1 2)=0 GOTO lext LFi DDig:
a$ = "DIP"
d$="Left Fifth Finger"
f$ = "f"
e$ = "Flexion"
ndx= 12 IF Lfdip=0 THEN GOTO LFiDNorm q3 132926~

PRINT "Digitize points (3) for fused left fifth '~
PRINT "finger DIP joint now. . ."
PRINT " "
GOSUB Ldig GOTO lext LFiDNorm:
PRINT "Digitize points (3) for left fifth finger "
PRINT "DIP joint in flexion now. . ."
PRINT " "
GOSUB Ldig lext:
GOSUB LDigNormExt RETURN
RDigAII:
IF Rha$ = "N" THEN GOTO FilllnRight IF Rha$ = "n" THEN GOTO FilllnRight f$ = ~f ~
e$ = "Flexion"
PRINT "Begin with the right hand in flexion."
PRINT ~'Digitize points (4) on the right thumb now PRINT n ~
RWhileLoop:
FORd= 1 T05 GOSUB Rlabel IF d=2 THEN PRINT "For PIP and DIP joints. . ."
IF d=2 THEN PRINT " "
IF d=2 THEN PRINT "Digitize points (4) on the "
; IF d=2 THEN PRINT "right index finger now. . ."
IF d=3 THEN PRINT "Digitize points (4) on the "
IF d=3 THEN PRINT "right long finger now. . ."
IF d=4 THEN PRINT ~Digitize points (4) on the "
IF d=4 THEN PRINT "right ring finger now. . ."
IF d=5 THEN PRINT ~Digitize points (4) on the "
IF d=5 THEN PRINT "right fifth finger now. . ."
PRINT " "
FOR i% = 1 TO 4 GOSUB ClearBuffer: BEEP
GOSUB TransmitRecordToHost WHILE LOC(1) ~> Length%:WEND
Record$= INPUT$(Length%,1) sim$(i%)= MlD$(Record$,3,1) d(i%,1) = VAL(MlD$(Record$,5,7)) d(i%,2) = VAL(MlD$(Record$ 12 7)) d(i%,3) = VAL(MlD$(Record$ 2û 7)) NEXT i%
GOSUB Rcalc IF d=5 THEN GOTO RMP
NEXT d GOTO RWhileLoop RMP:

132926~

PRINT "The MP joinls of ~he right fingers in "
PRINT "flexion will now be digi~ized. . ."
PRINT n ~
FORd=2TO5 d1 = d GOSUB Rlabel a$ = "MP"
i$ = "m"
GOSU8 GetArraylndex iF d=2 THEN PRINT "Digitize points (3) for the "
IF d=2 THEN PRINT "right index finger now. . ."
IF d=3 THEN PRINT "Digitize points (3) for the "
IF d=3 THEN PRINT "right long finger now. . ."
IF d=4 THEN PRINT "Digitize poin~s (3) for the "
IF d=4 THEN PRINT ~right ring finger now. . . "
IF d=5 THEN PRINT "Digitize points (3) for the "
IF d=5 THEN PRINT "right fif~h finger now. . ."
PRINT " "
GOSUB Rdig IF d=5 THEN GOSUB RDigNormExt IF d1=5 THEN RETURN
NEXT d LDigAII:
IF Lha$ = "N" THEN GOTO FilllnLeft IF Lha$ = nn~ THEN GOTO FilllnLeft f$ = f e$ = nFlexion"
PRINT "Begin with the left hand in flexion."
PRINT "Digi~ize points (4) on the left thumb now..."
PRINT ~ n LWhileLoop:
FOR d= 1 TO 5 GOSUB Uabel IF d=2 THEN PRINT "For PIP and DIP joints"
IF d=2 THEN PRINT n n IF d=2 THEN PRINT "Digitize points (4) on the "
IF d=2 THEN PRINT "left index finger now. . ."
IF d=3 THEN PRINT "Digitize points (4) on the "
IF d=3 THEN PRINT "left long finger now. . ."
IF d=4 THEN PRINT "Digitize points (4) on the "
IF d=4 THEN PRINT "left ring finger now. . ."
IF d=5 THEN PRINT "Digitize points (4) on the "
IF d=5 THEN PRINT "left fifth finger now. . ."
PRINT " "
FOR i% = 1 TO 4 GOSUB ClearBuffer: BEEP
GOSUB TransmitRecordToHost WHILE LOC(1) <> Length%:WEND
Record$= INPUT$(Length%,1) sim$(i%) = MlD$(Record$,3,1) d(i%,1) = VAL(MlD$(Record$,5,7)) d(i%,2) = VAL(Ml[:)$(Record$,12,7)) d(i%,3) = VAL(MlD$(Record$,20,7)) NEXT i%
GOSUB Lca1c IF d=5 THEN GOTO LMP
NEXT d GOTO LWhileLoop LMP:
PRINT ~The MP joints of the left fingers in "
PRINT "flexion will now be digitized. . ."
PRINT n ~
FOR d=2 TO 5 d1 = d GOSUB Llabel a$ = "MP"
j$ = "m GOSUB GetArraylndex IF d=2 THEN PRINT "Digitize points (3) on the "
IF d=2 THEN PRINT "left index finger now. . ."
IF d=3 THEN PRINT "Digitize points (3) on the "
IF d=3 THEN PRINT "left long finger now. . ."
IF d=4 THEN PRINT "Digitize points (3) on the "
IF d=4 THEN PRINT "left ring finger now. . ."
IF d=5 THEN PRINT "Digitize points (3) on the "
IF d=5 THEN PRINT "left fifth finger now. . ."
PRINT " "
GOSUB Ldig IF d=5 THEN GOSUB LDigNormExt IF d1=5 THEN RETURN
NEXT d RDigNormExt:
FOR j=1 TO 14 exta) = O
NEXT j f$ = "e"
e$ = "Extension check41:
PRINT "
PRINT "Are there any joints of the right hand"
PRINT ~which do NOT extend fully (y/n);
INPUT y$
PRINT n IF NOT(y$="Y" OR y$="y" OR y$= N" OR y$="n") THEN GOTO check41 IF y$ = "N THEN RETURN
IF y$ = "n THEN RETURN
PRINT
PRINT Then digitize these joints individually "
PRINT in extension.
PRINT "
GOTO ROtherLoop LDigNormExt:
FOR j=1 TO 14 ~6 ~329264 lext(j) = 0 NEXT j f$ = "e"
e$ = "Extension"
check42:
PRINT ~ n PRINT "Are there any joints of the left hand "
PRINT "which do NOT extend fully (y/n)"
INPUT y$
PRINT " "
IF NOT(y$=~Y~ OR y$="y~ OR y$=~N~ OR y$=~n~) THEN GOTO check42 IF y$ = "N" THEN RETURN
IF y$ = "n" THEN RETURN
PRINT n 1l PRINT "Then digitize these joints individually "
PRINT "in extension."
PRINT n 1l GOTO LOtherLoop FilllnRight:
FOR j=1 TO 14 exta)=
NEXTj flex(1) = 90 flex(2)= 100 flex(3) = 70 flex(4) = go flex(~)= 100 flex(6) = 70 .. flex(71 = 90 flex(8)= 100 flex(9) = 70 flex(10) = 90 flex(1 1 ) = 1 00 flex(12) = 70 flex(13) = 60 flex(14) = 80 Rtmp=0 Rtip=0 Rimp=0 Ripip=0 Ridip=0 Rlmp=0 Rlpip=0 Rldip=0 Rrmp=0 Rrpip=0 Rrdip=0 Rfmp=0 Rfpip=0 Rfdip=0 RETURN

~7 FilllnLeft:
FOR j=1 TO 14 lext(j) =
NEXT j Iflex(1) = 90 Iflex(2) = 100 Iflex(3) = 70 Iflex(4) = 90 Iflex(5) = 100 Iflex(6) = 70 Iflex(7) = 90 Iflex(8) = 100 Iflex(g) = 70 Iflex(10) = 90 If lex(11 ) = 100 Iflex(12) = 70 Iflex(13) = 60 Iflex(14) = 80 Ump=o L~ip=O
~imp=0 Lipip=O
Lidip=0 Llmp=0 Llpip=0 Lldip=0 Lrmp=0 Lrpip=0 Lrdip=0 Lfmp=0 Lfpip=0 Udip=0 RETURN
InitVariables:
Rel$ = "N"
Rev=1 Rfo$ = "N
Rfv= 1 Rwr$ = "N"
Rwv = 1 Rha$ = "N"
RAIIOK$ = "N"
Rth$ = "N"
Rtmp= 1 Rtip= 1 Rin$ = "N"
Rimp= 1 Ripip= 1 Ridip= 1 Rlo$ = "N"
Rlmp= 1 Rlpip = 1 Rldip = 1 ~8 Rri$ = "N"
Rrmp= 1 Rrpip= 1 Rrdip= 1 Rfi$ = N"
Rfmp= 1 Rfpip = 1 Rfdip= 1 Lel$ = "N"
Lev = 1 Lfo$ = ~N~
Lfv= 1 Lwr$ = "N"
Lwv= 1 Lha$ = "N"
LAIIOK$ = ~N"
Lth$ = "N"
Ltmp = 1 Ltip= 1 Lin$ = "N"
Limp= 1 Lipip= 1 Lidip = 1 Llo$ = "N"
Llmp= 1 Llpip = 1 Lldip = 1 Lri$ = "N"
Lrmp= 1 Lrpip= 1 Lrdip= 1 Ui$ = nN"
Ump= 1 Lfpip= 1 - Lfdip = 1 RETURN
UpperRight:
wrist(1) = 70 wrist(2) = 60 wrist(3) = 20 wrist(4) = 30 wstrot(1) = 0 wstro!(2) = O
IF Rwr$ = "N" THEN GOTO RElbow IF Rwr$ = "n" THEN GOTO RElbow IF Rwv<>1 THEN GOTO RWDig FORm=1 TO4 wrist(m) = 0 NEXT m wstrot(1) = 0 wstrot(2) = 0 GOTO RElbow RWDig:

1~29264 d=1 GOSUB RUlabel IF Rwv = 0 THEN GOTO RWFlexNorm PRINT "Digitize points (3) for fused right wrist "
PRINT "joint, angle of flexion now. . .' PRINT " "
GOSU8 RUdig d=2 GOSUB RUlabel PRINT "Digitize points (3) for fused right wrist "
PRINT 'loint, angle of extension now. . ."
PRINT " "
GOSUB RUdig GOTO RWRad RWFlexNorm:
d=1 GOSUB RUlabel PRINT "Digitize points (3) for the right wrist "
PRlNT"in flexion now . . ."
PRINT " "
GOSUB RUdig d=2 GOSUB RUlabel PRINT "Digitize points (3) for the right wrist "
PRINT "in extension now. . ."
PRINT " "
GOSUB RUdig RWRad:
d=3 GOSU8 RUlabei IF Rwv=0 THEN GOTO RWRadNorm PRINT "Digitize points (3) for fused right wrist "
PRINT "joint, angle of radial deviation now. . ."
PRINT " "
GOSUB RUdig d=4 GOSUB RUlabel PRINT "Digitize points (3) for fused right wrist "
PRINT "joint, angle of ulnar deviation now . . ."
PRINT " "
GOSU8 RUdig GOTO RWSup RWRadNorm:
d=3 GOSUB RUlabel PRINT Digitize points (3) for right wrist "
PRINT "joint in radial deviation now. . ."
PRINT " ~
GOSUB RWig d=4 GOSUB RUlabel PRINT "Digitize points (3) for right wrist "
PRINT "joint in ulnar deviation now. . . "
PRINT " "

/~

--" 1329264 GOSUB RUdig RWSup:
IF Rwv=0 THEN GOTO RWSupNorm wstrot(1) = 0 wstrot(2) = o GOTO RElbow RWSupNorm:
GOSUB RRotatwst RElbow:
elbow(1) = 150 elbow(2) = 0 IF Rel$ = "N" THEN GOTO RForearm IF Rel$ = "n" THEN GOTO RForearm IF Rev<>1 THEN GOTO REDig elbow(1) = o elbow(23 = 0 GOTO RForearm REDig:
d=5 GOSUB RUlabel IF Rev=0 THEN GOTO RENorm PRINT "Digitize points (3) for fused right elbow, "
PRINT "angle of flexion now . . ."
PRINT " "
GOSUB RUdig d=6 GOSUB RUlabel PRINT "Digitize points (3) for fused right elbow, "
. PRINT ~angle of extension now . . ."
` PRINT n n GOSUB RUdig GOTO RForearm RENorm:
d=5 GOSUB RUlabel PRINT "Digitize points (3) for right elbow "
PRINT "joint in flexion now . . . n PRINT
GOSUB RUdig d=6 GOSUB RUlabel PRINT "Digitize points (3) for right elbow "
PRINT ~joint in extension now . . . "
PRINT n n GOSUB RUdig RForearm:
arm(1) = 80 arm(2) = 80 IF Rfo$ = "N" THEN RETURN
IF Rfo$ = nn" THEN RETURN
IF Rfv=0 THEN GOSUB RFDig IF Rfv=0 THEN GOTO RFEnd - 132926~
arm(1) = o arm(2) = 0 RFEnd:
RETURN

UpperLeft:
Iwrist(1) = 70 Iwrist(2) = 60 Iwrist(3) = 20 Iwrist(4) = 30 Iwstrot(1 ) = 0 Iwstrot(2) = 0 IF Lwr$ = "N" THEN GOTO lelbow IF Lwr$ = "n" THEN GOTO lelbow IF Lwv<>1 THEN GOTO LWDig FOR m=1 TO 4 Iwrist(m) = 0 NEXT m Iwstrot(1) = 0 Iwstrot(2) = 0 GOTO lelbow LWDig:
d=1 , GOSUB LUlabel IF Lwv=0 THEN GOTO LWFlexNorm PRINT "Digitize points (3) for the fused left wrist"
PRINT "joint, angle of flexion now . . . "
PRINT " "
GOSU8 LUdig d=2 GOSUB LUlabel PRINT "Digitize points ~3) for the fused left wrist"
PRINT "joint, of extension now . . ."
PRINT ~ "
GOSUB LUdig GOTO LWRad LWFlexNorm:
d=1 GOSUB LUlabe~
PRINT "Digitize points (3) for left wrist "
PRINT "joint in flexion now . . . r PRINT " "
GOSUB LUdig d=2 GOSUB LUlabel PRINT "Digitize points (3) for left wrist "
PRINT "joint in extension now. . ."
PRINT " "
GOSUB LUdig LWRad:
d=3 GOSUB LUlabel IF Lwv=0 THEN GOTO LWRadNorm PRINT "Digitize points (3) for the fused left wrist"
PRINT ' joint, angle of radial deviation now. . ."
PRINT " "
GOSUB LUdig d=4 GOSUB LUlabel PRINT "Digitize points (3) for the fused left wrist "
PRINT "joint, angle of ulnar deviation now. . .
PRINT " "
GOSUB LUdig GOTOlwsup LWRadNorm:
d=3 GOSUB LUlabel PRINT "Digitize points (3) for the left wrist "
PRINT "joint in radial deviation now. . ."
PRINT ~
GOSUB LUdig d=4 GOSUB LUlabel PRINT "Digitize points (3) for the left wrist "
PRINT "joint in ulnar deviation now. . ."
PRINT " "
GOSUB LUdig Iwsup:
IF Rwv=0 THEN GOTO LWSupNorm Iwstrot(1) = 0 Iwstrot(2) = 0 GOTO lelbow - LWSupNorm:
GOSUB LRotatwst lelbow:
lelbow(1) = 150 lelbow(2) = 0 IF Lel$ = "N" THEN GOTO LForearm IF Lel$ = rn" THEN GOTO LForearm IF Lev<>1 THEN GOTO LEDig lelbow(1 )=0 lelbow(2)=o GOTO LForearm LEDig:
d=5 GOSUB LUlabel IF Lev=0 THEN GOTO LENorm PRINT "Digitize points (3) for the fused left elbow"
PRINT "joint, angle of flexion now . . ."
PRINT " "
GOSUB LUdig d=6 GOSUB LUlabel PRINT "Digitize points (3) for the fused left elbow "
PRINT "joint, angle of extension now. . ."
PRINT " "

132926~

GOSUB LUdig GOTO LForearm LENorm:
d=5 GOSUB LUlabel PRINT "Digitize points (3) for the left elbow "
PRINT "joint in flexion now . . ."
PRINT " "
GOSUB LUdig d=6 GOSUB LUlabel PRINT "Digitize points (3) for the left elbow "
PRINT "joint in extension now. . ."
PRINT " "
GOSUB LUdig LForearm:
larm(1) = 80 Iarm(2) = 80 IF Lfo$ = "N" THEN RETURN
IF Lfo$ = "n" THEN RETURN
IF Lfv=0 THEN GOSUB LFDig IF Lfv=0 THEN GOTO LFEnd larm(1) = 0 larm(2) = 0 LFEnd:
RETURN

FilllnRupper:
wrist(1) = 70 wrist(2) = 60 wrist(3) = 20 wrist(4) = 30 wstrot(1) = 0 wstrot(2) = 0 elbow(1) = 150 elbow(2) = 0 arm(1) = 80 arm(2) = 80 Rev=0 RfV=o Rwv=0 RETURN
FilllnLupper:
Iwrist(1 ) = 70 Iwrist(2) = 60 Iwrist(3) = 20 Iwrist(4) = 30 Iwstrot(1) = 0 Iwstrot(2) = 0 lelbow(1) = 150 lelbow(2) = 0 larm(1) = 80 /~

"` 132926~

larm(2) = 80 Lev=0 Lfv=O
Lwv=o RETURN

Rdig:
FOR i% = 1 TO 3 GOSUB ClearBuffer: BEEP
GOSUB TransmitRecordToHost WHILE LOC(1 ) <> Length%:WEND
Record$= INPUT$(Length%,1) sim$(i%) = MlD$(Record$,3,1) dig(i%,1 ) =VAL~MlD$(Record$,5,7)) dig(i%,2) =VAL(MlD$(Record$,1 2,7)) dig(i%,3) =VAL(MlD$(Record$,20,7)) IF i%=3 THEN GOSUB Rcalcangles IF i%=3 THEN RETURN
NEXT i%

Ldig:
FOR i% = 1 TO 3 GOSUB ClearBuffer: BEEP
GOSUB TransmitRecordToHost WHILE LOC(1 ) <> Length%:WEND
Record$= INPUT$(Length%,1) sim$(i%) = MlD$(Record$,3,1) dig(i%,1 ) =VAL(MlD$(Record$,5,7)) dig(i%,2) =VAL(MlD$(Record$,1 2,7)) dig(i%,3) =VAL(MlD$(Record$,20,7)) IF i%=3 THEN GOSUB Lcalcangles IF P/O=3 THEN RETURN
NEXT i%

RUdig:
FORi%=1 TO3 GOSUB ClearBuffer: BEEP
GOSUB TransmitRecordToHost WHILE LOC(1 ) <> Length%:WEND
Record$= INPUT$(Length%,1) sim$(i%) = MlD$(Record$,3,1) - dig(i%,1 ) =VAL(MlD$(Record$,5,7)) dig(i%,2) =VAL(MlD$(Record$,1 2,7)) dig(i%,3) =VAL(MlD$(Record$,20,7)) IF i%=3 THEN GOSUB Rwstangles IF i/O=3 THEN RETURN
NEXT i%
LUdig:
FOR i% = 1 TO 3 /0~

:

GOSUB ClearBuffer: BEEP
GOSUB TransmitRecordToHost WHILE LOC(1) <> Length%:WEND
Record$= INPUT$(Length%,1) sim$(i%) = MlD$(Record$,3,1) dig(i%,1 ) =VAL(MlD$(Record$,5,7)) dig(i%,2) =VAL(MlD$(Record$,1 2,7)) dig(i%,3) =VAL(MlD$(Record$,20,7)) IF i%=3 THEN GOSUB Lwstangles IF i%=3 THEN RETURN
NEXT i%
Rlabel:
IF d=1 THEN d$ = "Righl Thumb"
IF d=2 THEN d$ = "Right Index Finger"
IF d=3 THEN d$ = "Right Long Finger"
IF d=4 THEN d$ = "Right Ring Finger"
IF d=5 THEN d$ = "Right Fifth Finger"
RETURN
Llabel:
IF d=1 THEN d$ = "Left Thumb"
IF d=2 THEN d$ = "Left Index Finger"
IF dd THEN d$ = "Left Long Finger"
IF d=4 THEN d$ = "Left Ring Finger"
IF d=5 THEN d$= "Left Fifth Finger"
RETURN

RUlabel:
IF d=1 THEN d$ = nRight Wrist in flexion"
IF d=2 THEN d$ = "Right Wrist in extension"
IF d=3 THEN d$ = "Right Wrist radial deviation"
IF d=4 THEN d$ = "Right Wrist ulnar deviation"
IF d=5 THEN d$ = "Right Elbow in flexion"
IF d=6 THEN d$ = "Right Elbow in extension"
RETURN
LUlabel:
IF d=1 THEN d$ = "Left Wrist in flexion"
IF d=2 THEN d$ = "Left Wrist in extension"
IF d=3 THEN d$ = nLeft Wrist radial deviation"
IF d=4 THEN d$ = "Left Wrist ulnar deviation"
IF d=5 THEN d$ = "Left Elbow in flexion"
IF d=6 THEN d$ = nLeft Elbow in extension"
RETURN
ROtherLoop:
GOSUB RGetJnt IF de=0 THEN RETURN
GOSUB EGetArraylndex GOSUB Rdig GOTO ROtherLoop /0~

.

132~2~
LOtherLoop:
GOSUB LGetJnt IF de=0 THEN RETURN
GOSUB EGetArraylndex GOSUB Ldig GOTO LOtherLoop RFDig:
PRINT "Digitize points (2) for standard "
PRINT "right forearm position now. . ."
PRiNT "Place these points on the radius, "
PRINT "this will be the proximal position."
PRINT " ~' FOR i%= 1 TO 2 GOSUB ClearBuffer: BEEP
GOSUB TransmitRecordToHost WHILE LOC(1) <> Length%:WEND
Record$= INPUT$(Length%,1) sim$ti%) = MlD$(Record$,3,1) dig(i%,1 ) =VAL(MlD$(Record$,5,7)) dig(i%,2) =VAL(MlD$(Record$,1 2,7)) dig(i%,3) =VAL(MlD$(Record$,20,7)) stand(i%,1 ) = dig(i%,1 ) stand(i%,2) = dig(i%,2) stand(i%,3) = dig(i%,3) NEXT i/O
mdpnt(1,1 ) = (stand(1 ,1 )+stand(2,1))/2 mdpnt(1,2) = (stand(1,2)+stand(2,2))/2 mdpnt(1,3) = (stand(1,3)+stand(2,3))/2 .
PRINT "Digitize points (2) on radius of right"
PRINT "forearm supination position now. . ."
PRINT n n FOR i% = 1 TO 2 GOSUB ClearBuffer: BEEP
GOSUB TransmitRecordToHost WHILE LOC(1) <, Length%:WEND
Record$= INPUT$(Length%,1) sim$(i%) = MlD$(Record$,3,1) dig(i%,1 ) =VAL(MlD$(Record$,5,7)) dig(i%,2) =VAL(MlD$(Record$,1 2,7)) dig(i%,3) =VAL(MlD$(Record$,20,7)) sup(i%,1) = dig(i%,1) sup(i%,2) = dig(i%,2) sup(i%,3) = dig(i%,3) NEXT i%
mdpnt(2,1) = (sup(1,1)+sup(2,1))/2 mdpnt(2,2) = (sup(1,2)+sup(2,2))/2 mdpnt(2,3) = (sup(1,3)+sup(2,3))/2 PRINT UDigitize points (2) on radius of right "
/D~

132926~

PRlNT"forearm pronation position now. . ."
PRINT " "
FOR i% = 1 TO 2 GOSUB ClearBuffer: BEEP
GOSUB TransmitRecordToHost WHILE LOC(1 ) ~> Length%:WEND
Record$= INPUT$(Length%,1) sim$(i%)= MlD$(Record$,3,1) dig(i%,1 ) =VAL(MlD$(Record$,5,7)) dig(i%,2) =VAL(MlD$(Record$,1 2,7)) dig(i%,3) =VAL(MlD$(Reoord$,20,7)) pro(i%,1) = dig(i%,1) pro(i%,2) = dig(i%,2) pro(i%,3) = dig(i%,3) NEXT i%
mdpnt(3,1 ) = (pro(1,1 )+pro(2,1))/2 mdpnt(3,2) = (pro(1,2)+pro(2,2))12 mdpnt(3,3) = (pro(1 ,3)+pro(2,3))/2 transl(1,1 ) = mdpnt(1,1 )-mdpnt(2,1 ) transl(1,2) = mdpnt(1,2)-mdpnt(2,2) transl(1,3) = mdpnt(1,3)-mdpnt(2,3) transl(2,1 ) = mdpnt(1,1 )-mdpn~(3,1 ) transl(2,2) = mdpnt(1,2)-mdpnt(3,2) transl(2,3) = mdpnt(1,3)-mdpnt(3,3) FORk=1 TO3 sup(1,k) = sup(1,k)+transl(1,k) sup(2,k) = sup(2,k)+transl(1,k) pro(1,k) = pro(1,k)+transl(2,k) pro(2,k) = pro(2,k)+transl(2,k) NEXTk xa=stand(1,1 )-mdpnt(1,1 ) ya=stand(1 ,2)-mdpnt(1 ,2) za=stand(1 ,3)-mdpnt(1 ,3) xb=sup(1,1)-mdpnt(1,1) yb=sup(1 ,2)-mdpnt(1 ,2) - zb=sup(1,3)-mdpnt(1,3) la=SQR(xa'xa+ya^ya+za-za) Ib=SQR(xb~xb+yb^yb+zb-zb) sm=xa^xb+ya^yb+za^zb x=sm/(la^lb) IF x=1 THEN x=1.00001 theta=(-ATN(xlSQR(1 -x^x))+1 .570796) alpha=theta^180/3.1 41 5 PRiNT " "
PRINT "Right Forearm supination angle = "alpha; "degrees"
PRINT n ~
arm(1) = alpha xa=stand(1,1 )-mdpnt(1,1 ) ya=stand(1 ,2)-mdpnt(1 ,2) /0~

za=stand(1 ,3)-mdpnt(1 ,3) xb=pro(1,1 )-mdpnt(1,1 ) yb=pro(1 ,2)-mdpnt(1 ,2) zb=pro(1 ,3)-mdpnt(1 ,3) la=SQR(xa'xa+ya~ya+za~za) Ib=SQR(xb~xb+yb~yb+zb-zb) sm=xa~xb+ya^yb+za~zb x=sm/(la~lb) IF x=1 THEN x=1.00001 theta=(-ATN(x/SQR(1-x x))+1.570796) alpha=theta~180/3.1 41 5 PRINT " "
PRlNT"Right Forearm pronation angle = ~'alpha; "degrees"
PRINT " "
arm(2) = alpha R~TURN
LFDig:
PRINT "Digitize points (2) for standard "
PRINT "left forearm position now. . ."
PRINT "Place these points on the radius, "
PRINT "this will be the proximal position."
PRINT " "
FOR i% = 1 TO 2 GOSUB ClearBuffer: BEEP
GOSUB TransmitRecordToHost WHILE LOC(1) <> Length%:WEND
Record$= INPUT$(Length%,1) sirn$(i%) = MlD$(Record$,3,1) dig(i%,1 ) =VAL(MlD$(Record$,5,7)) dig(i%,2) =VAL(MlD$(Record$,1 2,7)) dig(i%,3) =VAL(MlD$(Record$,20,7)) Istand(i%,1) = dig(i%,1) Istand(i%,2) = dig(i%,2) Istand(i%,3) = dig(i%,3) NEXT i%
Imdpnt(1,1) = (Istand(1,1)+Istand(2,1))/2 Imdpnt(1,2) = (Istand(1,2)+1stand(2,2))/2 Imdpnt(1,3) = (Istand(1,3)~1stand(2,3))/2 PRINT "Digitize points (2) on radius of left "
PRINT "forearm supination position now. . ."
PRINT " "
FOR i% = 1 TO 2 GOSUB ClearBuffer: BEEP
GOSUB TransmitRecordToHost WHILE LOC(1) <, Length%:WEND
Record$= INPUT$(Length%,1) - sim$(i%) = MlD$(Record$,3,1) dig(i%,1 ) =VAL(MlD$(Record$,5,7)) dig(i%,2) =VAL(MlD$(Record$,1 2,7)) dig(i%,3) =VAL(MlD$(Record$,20,7)) Isup(i%,1 ) = dig(i%,1 ) /0~

Isup(i%,2) = dig(i%,2) Isup(i%,3) = dig(i%,3) NEXT i%
Imdpnt(2,1) = (Isup(1,1)+1sup(2,1))/2 Imdpnt(2,2) = (Isup(1,2)+1sup(2,2))/2 Imdpnt(2,3) = (Isup(1 ,3)+1sup(2,3))12 PRINT "Digitize points (2) on radius of left "
PRlNT"forearm pronation position now. . ."
PRINT " "
FOR i/O = 1 TO 2 GOSUB ClearBuffer: BEEP
GOSUB TransmitRecordToHost WHILE LOC(1) <> Length%:WEND
Record$= INPUT$(Length%,1) sim$(i%) = MlD$(Record$,3,1) dig(i%,1 ) =VAL(MlD$(Record$,5,7)) dig(i%,2) =VAL(MlD$(Record$,1 2,7)) dig(i%,3) =VAL(MlD$(Record$,20,7)) Ipro(i%,1 ) = dig(i%,1 ) Ipro(i%,2) = dig(i%,2) Ipro(i%,3) = dig(i%,3) NEXT i%
Imdpnt(3,1) = (Ipro(1,1)+1pro(2,1))/2 Imdpnt(3,2) = (Ipro(1,2)+1pro(2,2))/2 Imdpnt(3,3) = (Ipro(1,3)+1pro(2,3))/2 Itransl(1,1 ) = Imdpnt(1,1 )-Imdpnt(2,1 ) Itransl(1,2) = Imdpnt(1,2)-lmdpnt(2,2) Itransl(1,3) = Imdpnt(1 ,3)-lmdpnt(2,3) . Itransl(2,1 ) = Imdpnt(1,1 )-Imdpnt(3,1 ) Itransl(2,2) = Imdpnt(1,2)-lmdpnt(3,2) Itransl(2,3) = Imdpnt(1,3)-lmdpnt(3,3) FORk=1 TO3 Isup(1,k) = Isup(1,k)+1transl(1,k) Isup(2,k) = Isup(2,k)+1transl(1,k) Ipro(1,k) = Ipro(1,k)+1transl(2,k) Ipro(2,k) = Ipro(2,k)+1transl(2,k) NEXT k xa=lstand(1 ,1)-lmdpnt(1 ,1) ya=lstand(1 ,2)-lmdpnt(1 ,2) za=lstand(1 ,3)-lmdpnt(1 ,3) xb=lsup(1,1 )-Imdpnt(1,1 ) yb=lsup(1 ,2)-lmdpnt(1 ,2) zb=lsup(1 ,3)-lmdpnt(1 ,3) la=SQR(xa^xa+ya~ya+za^za) Ib=SQR (xb~xb+yb^yb+zb~zb) sm=xa~xb+ya~yb+za~zb x=sm/(la~lb) IF x=1 THEN x=1.00001 theta=(-ATN(x/SQR(1 -x~x))+1 .570796) //~

132926~

alpha=~heta^ 180/3 .1415 PRINT " "
PRINT Left Forearm supination angle = "alpha; "degrees"
PRINT " "
larm(1) = alpha xa=lstand(1,1 )-Imdpnt(1,1 ) ya=lstand(1 ,2)-lmdpnt(1 ,2) za=lstand(1 ,3)-lmdpnt(1 ,3) xb=lpro(1,1 )-Imdpnt(1,1 ) yb=lpro(1 ,2)-lmdpnt(1 ,2) zb=lpro(1 ,3)-lmdpnt(1 ,3) la=SQR(xa~xa+ya~ya+za^za) Ib=SQR(xb~xb+yb^yb+zb-zb) sm=xa^xb+ya^yb+za^zb x=sm/(la-lb) IF x=1 THEN x=1.00001 theta=(-ATN(x/SQR(1 -x^x))+1 .570796) alpha=theta~180/3.1 41 5 PRINT " "
PRINT "Left Forearm pronation angle = "alpha; "degrees"
PRINT " "
larm(2) = alpha RETURN

- RRotatwst:
PRINT "Digitize points (2) for standard "
PRINT "distal right wrist position now. . . "
PRINT Place these points on the second "
PRINT "and fifth metacarpals.
;I PRlNTn"
FOR i% = 1 TO 2 GOSUB ClearBuffer: BEEP
GOSUB TransmitRecordToHost WHILE LOC(1) c, Length%:WEND
Record$= INPUT$(Length%,1) sim$(i%) = MlD$(Record$,3,1) dig(i%,1 ) =VAL(MlD$(Record$,5,7)) dig(i%,2) =VAL(MlD$(Record$,1 2,7)) dig(i%,3) =VAL(MlD$(Record$,20,7)) wstand(i%,1 ) = dig(i%,1 ) wstand(i%,2) = dig(i%,2) wstand(i%,3) = dig(i%,3) NEXT i%
wmdpnt(1,1) = (wstand(1,1)+wstand(2,1))/2 wmdpnt(1,2) = (wstand(1,2)+wstand(2,2))/2 wmdpnt(1,3) = (wstand(1,3)+wstand(2,3))/2 PRINT "Digitize points (2) for distal right "
PRINT wrist supination position now. . ."

/// -1~29264 PRINT "Place these points on the second "
PRINT "and fifth metacarpals. "
PRINT n 1~
FOR i% = 1 TO 2 GOSUB ClearBuffer: BEEP
GOSUB TransmitRecordToHost WHILE LOC(1) <, Length%:WEND
Record$= INPUT$(Length%,1) sim$(i%) = MlD$(Record$,3,1) dig(i%,1 ) =VAL(MlD$(Record$,5,7)) dig(i%,2) =VAL(MlD$(Record$,1 2,7)) dig(i%,3) =VAL(MlD$(Record$,20,7)) wsup(i%,1 ) = dig(i%,1 ) wsup(i%,2) = dig(i%,2) wsup(i%,3) = dig(i%,3) NEXT i%
wmdpnt(2,1) = (wsup(1,1)+wsup(2,1))/2 wmdpnt(2,2) = (wsup(1,2)+wsup(2,2))/2 wmdpnt(2,3) = (wsup(1,3)+wsup(2,3))/2 PRINT "Digitize points (2) for distal right "
PRINT "wrist pronation position now. . ."
PRINT "Place lhese points on the second "
PRINT "and fifth metacarpals. "
PRINT " "
FOR i% = 1 TO 2 - GOSUB ClearBuffer: BEEP
GOSUB TransmitRecordToHost WHILE LOC(1 ) <> Length%:WEND
Record$= INPUT$(Length%,1) sim$(i%) = MlD$(Pecord$,3,1) dig(i% 1) =VAL(MlD$(Record$ 5,7)) dig(i% 2) =VAL(MlD$(Record$ 12,7)) dig(i%,3) =VAL(MlD$(Record$,20,7)) wpro(i%,1) = dig(i%,1) wpro(i%,2) = dig(i%,2) wpro(i%,3) = dig(i%,3) NEXT i%
wmdpnt(3,1 ) = (wpro(1,1 )+wpro(2,1))/2 wmdpnt(3,2) = (wpro(1,2)+wpro(2,2))/2 wmdpnt(3,3) = (wpro(1,3)+wpro(2,3))/2 wtransl(1,1 ) = wmdpnt(1,1 )-wmdpnt(2,1 ) wtransl(1,2) = wmdpnt(1,2)-wmdpnt(2,2) wtransl(1,3) = wmdpnt(1,3)-wmdpnt(2,3) wtransl(2,1) = wmdpnt(1,1)-wmdpnt(3,1) wtransl(2,2) = wmdpnt(1,2)-wmdpnt(3,2) wtransl(2,3) = wmdpnt(1,3)-wmdpnt(3,3) FORk= 1 TO3 wsup(1,k) = wsup(1,k)+wtransl(1,k) wsup(2,k) = wsup(2,k)+wtransl(1,k) wpro(1,k) = wpro(1,k)+wtransl(2,k) //~7 132926~
wpro(2,k) = wpro(2,k)+wtransl(2,k) NEXTk xa=wstand(1,1)-wmdpnt(1,1) ya=wstand(1,2)-wmdpnt(1,2) za=wstand(1,3)-wmdpnt(1,3) xb=wsup(1,1)-wmdpnt(1,1) yb=wsup(1,2)-wmdpnt(1,2) zb=wsup(1,3)-wmdpnt(1,3) la=SQR(xa^xa+ya^ya+za-za) Ib=SQR(xb^xb+yb^yb+zb'zb) sm=xa^xb+ya'yb+za^zb x=sm/(la-lb) IF x=1 THEN x=1.00001 theta=(-ATN(x/SQR(1 -x^x))+1.570796) alpha=theta^180/3.1415 PRINT n ~
PRINT "Right Distal Wrist Supination Angle = "alpha; "degrees"
PRINT " "
wstrot(1) = alpha xa=wstand(1,1)-wmdpnt(1,1) ya=wstand(1,2)-wmdpnt(1,2) za=wstand(1,3)-wmdpnt(1,3) xb=wpro(1,1)-wmdpnt(1,1) yb=wpro(1,2)-wmdpnt(1,2) zb=wpro(1,3)-wmdpnt(1,3) la=SQR(xa^xa+ya^ya+za-za) Ib=SQR(xb^xb+yb-yb+zb~zb) sm=xa^xb+ya^yb+za^zb x=sm/(la^lb) IF x=1 THEN x=1.00001 theta=(-ATN(x/SQR(1 -x^x))+1.570796) alpha=theta^180/3.1415 PRINT " "
PRINT " Right Distal Wrist Pronation Angle = "alpha; "degrees"
PRINT " "
wstrot(2) = alpha RETURN
LRotatwst:
PRINT "Digitize points (2) for standard distal "
PRINT "left wrist position now. . ."
PRINT "Place ~hese points on the second"
PRINT "and fifth metacarpals."
PRINT " "
FOR i% = 1 TO 2 GOSUB ClearBuffer: BEEP
GOSUB TransmitRecordToHost WHILE LOC(1) <> Length%:WEND
Record$= INPUT$(Length%,1) sim$(i%)= MlD$(Record$,3,1) dig(i%,1) =VAL(MlD$(Record$,5,7)) dig(i%,2) =VAL(MlD$(Record$,1 2,7)) dig(i%,3) =VAL(MlD$(Record$,20,7)) Iwstand(i%,1) = dig(i%,1) Iwstand(i%,2) = dig(i%,2) Iwstand(i%,3) = dig(i%,3) NEXT i%
Iwmdpnt(1 ,1 ) = (Iwstand(1 ,1 )+Iwstand(2,1))/2 Iwmdpnt(1,2) = (Iwstand(1,2)+1wstand(2,2))/2 Iwmdpnt(1,3) = (Iwstand(1,3)+1wstand(2,3))/2 PRINT "Digitize points (2) for distal left "
PRINT "wrist supination position now. . ."
PRINT "Place these points on the second"
PRINT "and fifth metacarpals."
PRINT ~ n FOR i% = 1 TO 2 GOSUB ClearBuffer: BEEP
GOSUB TransmitRecordToHost WHILE LOC(1) <> Length%:WEND
Record$ = INPUT$(Length%,1) sim$(i%)= MlD$(Record$,3,1) dig(i%,1 ) =VAL(MlD$(Record$,5,7)) dig(i%,2) =VAL(MlD$(Record$,1 2,7)) dig(i%,3) =VAL(MlD$(Record$,20,7)) Iwsup(i%,1) = dig(i%,1) Iwsup(i%,2) = dig(i%,2) Iwsup(i%,3) = dig(i%,3) NEXT i%
Iwmdpnt(2,1) = (Iwsup(1,1)+1wsup(2,1))/2 Iwmdpnt(2,2) = (Iwsup(1,2)+1wsup(2,2))/2 Iwmdpnt(2,3) = (Iwsup(1,3)+1wsup(2,3))/2 PRINT "Digitize points (2) for distal left "
PRINT "wrist pronation position now. . .
PRINT NPlace these points on the second"
' PRINT "and fifth metacarpals."
PRINT " "
FOR i% = 1 TO 2 GOSUB ClearBuffer: BEEP
GOSUB TransmitRecordToHost WHILE LOC(1) <> Length%:WEND
Record$= INPUT$(Length%,1) sim$(i%) = MlD$(Record$,3,1) dig(i%,1 ) =VAL(MlD$(Record$,5,7)) dig(i%,2) =VAL(MlD$(Record$,1 2,7)) dig(i%,3) =VAL(MlD$(Record$,20,7)) Iwpro(i%,1 ) = dig(i%,1 ) Iwpro(i%,2) = dig(i%,2) Iwpro(i%,3) = dig(i%.3) NEXT i%
Iwmdpnt(3, 1 ) = (Iwpro(1 ,1 )+Iwpro(2, 1))/2 Iwmdpnt(3,2) = (Iwpro(1,2)+1wpro(2,2))/2 Iwmdpnt(3,3) = (Iwpro(1,3)+1wpro(2,3))/2 Iwtransl(1,1) = Iwmdpnt(1,1)-lwmdpnt(2,1) Iwtransl(1,2) = Iwmdpnt(1,2)-lwmdpnt(2,2) Iwtransl(1,3) = Iwmdpnt(1,3)-lwmdpnt(2,3) Iwtransl(2,1) = Iwmdpnt(1,1)-Iwmdpnt(3,1) Iwtransl(2,2) = Iwmdpnt(1,2)-lwmdpnt(3,2) Iwtransl(2,3) = Iwmdpnt(1,3)-lwmdpnt(3,3) FOR k = 1 TO 3 Iwsup(1,k) = Iwsup(1,k)+1wtransl(1,k) Iwsup(2,k) = Iwsup(2,k)+1wtransl(1,k) Iwpro(1,k) = Iwpro(1,k)+1wtransl(2,k) Iwpro(2,k) = Iwpro(2,k)+1wtransl(2,k) NEXT k xa=lwstand(1,1)-Iwmdpnt(1,1) ya=lwsland(1,2)-lwmdpnt(1,2) za=lwstand(1,3)-lwmdpnt(1,3) xb=lwsup(1,1)-Iwmdpnt(1,1) yb=lwsup(1,2)-lwmdpnt(1,2) zb=lwsup(1,3)-lwmdpnt(1,3) la=SQR(xa^xa+ya'ya+za za) Ib=SQR(xb^xb+yb-yb+zb^zb) sm=xa'xb+ya-yb+za^zb x=sm/(la-lb) IF x=1 THEN x=1.00001 theta=(-ATN(xlSQR(1 -x^x))+1.570796) ' alpha=theta^ 180/3.1415 PRINT n ~
PRINT "Left Dislal Wrist Supination Angle = "alpha; "degrees"
PRINT " "
Iwstrot(1) = alpha xa=lwstand(1,1)-Iwmdpnt(1,1) ya=lwstand(1,2)-lwmdpnt(1,2) za=lwstand(1,3)-lwmdpnt(1,3) xb=lwpro(1,1)-Iwmdpnt(1,1) yb=lwpro(1,2)-lwmdpnt(1,2) zb=lwpro(1,3)-lwmdpnt(1,3) la=SQR(xa'xa+ya'ya+za'za) Ib=SQR(xb'xb+yb'yb+zb'zb) sm=xa^xb+ya^yb+za^zb x=sm/(la~lb) IF x=1 THEN x=1.00001 theta=(-ATN(x/SQR(1 -x^x))+1.570796) alpha=lheta~180/3.1415 PRINT " "
PRINT " Left Distal Wrist Pronation Angle = "alpha; "degrees"
PRINT n ~
Iwstrot(2) = alpha RETURN

~/~

Report:
filename$ = N$
OPEN filename$ FOR OUTPUT AS #3 PRINT #3 N$
PRINT #3 Rimp PRINT #3, ext(1) PRINT #3, flex(1) PRINT #3, Ripip PRINT #3, ext(2) - PRINT #3, flex(2) PRINT #3, Ridip PRINT #3, ext(3) I PRINT #3, flex~3) PRINT #3,Rlmp PRINT #3, ext(4) PRINT #3,flex(4) PRINT #3,Rlpip PRINT #3,ext(5) PRINT #3, flex(5) PRINT #3,Rldip PRINT #3, ext(6) PRINT #~,flex(6) PRINT #3,Rrmp PRINT #3,ext(7) PRINT #3,flex(7) :, PRINT #3,Rrpip PRINT #3,ext(8) PRINT #3,flex(8) :.~ PRINT #3,Rrdip PRINT #3,ext(9) ~ PRINT #3,flex(9) ? PRINT #3,Rfmp PRINT #3,ext(10) PRINT #3,flex(10) PRINT #3,Rfpip PRINT #3,ext(11) PRINT #3,flex(11) PRINT #3,Rfdip PRINT #3,ext(12) PRINT #3,flex(12) PRINT #3,Rtmp PRINT #3,ext(13) PRINT #3,flex(13) PRINT #3,Rtip PRINT #3,ext(14) PRINT #3,flex(14) PRINT #3,Rwv PRINT #3,wrist(2) PRINT #3,wrist(1) PRINT #3 wrist(3) PRINT #3 wrist(4) PRINT #3,wstrot(1) //~

- 13292~4 PRINT #3,ws~rot(2) PRINT #3,Rfv PRINT #3,arm(1) PRINT #3,arm(2) PRINT #3,Rev PRINT #3,elbow(2) PRINT #3,elbow(1) NOW OUTPUT FOR LEFT EXTREMITY
PRINT #3,Limp PRINT #3,1ext(1) PRINT #3,1flex(1) PRINT #3,Lipip PRINT #3,1exl(2) PRINT #3,1flex(2) PRINT #3,Lidip PRINT #3,1ex~(3) PRINT #3,1flex(3) PRINT #3,Llmp PRINT #3,1exl(4) PRINT #3,1flex(4) PRINT #3,Llpip PRINT #3,1ex~(5) PRINT #3,1flex(5) PRINT #3,Lldip PRINT #3,1ext(6) PRINT #3,1flex(6) - PRINT #3,Lrmp PRINT #3,1ext(7) PRINT #3,1flex(7) , PRINT #3,Lrpip PRINT #3,1ext(8) PRINT #3,1flex(8) PRINT #3,Lrdip PRINT #3,1ext(9) PRINT #3,1flex(9) PRINT #3,Lfmp PRINT #3,lext(10) PRINT #3,1flex(10) PRINT #3,Lfpip PRINT #3,1ext(11) PRINT #3,1flex(11) PRINT #3,Lfdip PRINT #3,1ext(12) PRINT #3,1flex(12) PRINT #3,Ltmp PRINT #3,1ext(13) PRINT #3,1flex(13) PRINT #3,Ltip PRINT #3,1ext(14) : PRINT #3,1flex(14) PRINT #3,Lwv PRINT #3,1wrist(2) PRINT #3,1wrist(1) PRINT #3,1wrist(3) :

_ -132926~

PRINT #3,1wrist(4~
PRINT #3,1wstrot(1) PRINT #3,1wstrot(2) PRINT #3,L~v PRINT #3,1arm(1) PRINT #3,1arm(2) PRINT #3,Lev PRINT #3,1elbow(2) PRINT #3,1elbow(1)CLOSE #3 RETURN

Rwstangles:
xa=dig(1,1 )-dig(2,1 ) ya=dig(1 ,2)-dig(2 ,2) za=dig(1 ,3)-dig(2,3) xb=dig(3,1 )-dig(2,1 ) yb=dig(3,2)-dig(2,2) zb=dig(3,3)-dig(2,3) : la=SQR(xa~xa+ya~ya+za^za) Ib=SQR(xb^xb+yb^yb+zb^zb) sm=xa~xb+ya~yb+za^zb x=sm/(la~lb) IF x=1 THEN x=1.00001 theta=(-ATN(x/SQR(1 -x^x))+1 .570796) alpha=1 80-theta~180/3.141 5 PRINT " "
PRINT d$;" = "alpha; "degrees"
PRINT" "
IF d = 1 THEN wrist(1) = alpha IF d = 2 THEN wrist(2) = alpha IF d = 3 THEN wrist(3) = alpha IF d = 4 THEN wrist(4) = alpha IF d = 5 THEN elbow(1) = alpha IF d = 6 THEN elbow(2) = alpha RETURN

Lwstangles:
xa=dig(1,1 )-dig(2,1 ) ya=dig(1 ,2)-dig(2,2) za=dig(1 ,3)-dig(2,3) xb=dig(3,1)-dig(2,1) yb=dig(3,2)-dig(2,2) zb=dig(3 ,3)-dig (2 ,3) la=SQR (xa^xa+ya^ya+za^za) Ib=SQR(xb~xb+yb~yb+zb^zb) /~
/

1~2~26~

sm=xa~xb+ya~yb+za~zb x=sm/(la~lb) IF x=1 THEN x=1.00001 theta=(-ATN(x/SQR(1 -x~x))+1 .570796) alpha=1 80-theta~180/3.141 5 PRINT " "
PRINT d$;" = "alpha; "degrees"
PRINT ~ u IF d = 1 THEN Iwrist(1) = alpha IF d = 2 THEN Iwris~(2) = alpha IF d = 3 THEN Iwrist(3) = alpha IF d = 4 THEN Iwrist(4) = alpha IF d = 5 THEN lelbow(1) = alpha IF d = 6 THEN lelbow(2) = alpha RETURN
Rcalc:
FOR i% = 1 TO 2 IF i% = 1 THEN a$ = "PIP"
IF i% = 2 THEN a$ = ~DIP~
IF d=1 THEN IF i%=1 THEN a$ = "MP"
IF d=1 THEN IF i% = 2 THEN a$ = "IP"
IF i% = 1 THEN j$ = "p"
IF i% = 2 THEN j$ = "d"
IF d=1 THEN IF i%=1 THEN j$ = "m"
IF d=1 THEN IF i% = 2 THEN j$ = "i"
GOSU8 GetArraylndex FOR j% = 1 TO 3 FORk%=1 TO3 dig(j%,k%) = d(j%~i%-1 ,k%) NEXT k%
NEXT j%
GOSUB Rcalcangles NEXT i%
RETURN

Lcalc:
FOR i%= 1 TO 2 IF i% = 1 THEN a$ = "PIP"
IF i% = 2 THEN a$ = "DIP"
IF d=1 THEN IF i%=1 THEN a$ = UMP"
IF d=1 THEN IF i% = 2 THEN a$ = ~IP"
IF i% = 1 THEN j$ = "p"
IF i% = 2 THEN j$ = "d"
IF d=1 THEN IF i%=1 THEN j$ = "m"
IF d=1 THEN IF i% = 2 THEN j$ = "i"
GOSUB GetArraylndex FOR j% = 1 TO 3 FOR k% = 1 TO 3 diga%,k%) = d(j%+i%-1,k%) NEXT k%
NEXT j%

//~

GOSUB Lcalcangles NEXT i%
RETURN

Rcalcangles:
xa = dig(1,1)-dig(2,1) ya = dig(1,2)-dig(2,2) za = dig(1,3)-dig(2,3) xb = dig(3,1)-dig(2,1) yb = dig(3,2)-dig(2,2) zb = dig(3,3)-dig(2,3) la=SQ R(xa~xa+ya~ya+za'za) Ib=SQR(xb^xb+yb^yb+zb^zb) sm=xa^xb+ya^yb+za^zb x=sm/(la^lb) IF x=1 THEN x=1.00001 theta=(-ATN(x/SQR(1 -x^x))+1.570796) alpha=180-theta^180/3.1415 PRINT " "
PRINT d$;" ' ;a$;" ";e$;" = ";alpha;" degrees"
PRINT " "
IF f$ ="f" THEN flex(ndx)=alpha IF f$ = "e" THEN ext(ndx)=alpha RETURN

Lcalcangles' xa= dig(1,1)-dig(2,1) ya = dig(1,2)-dig(2,2) za = dig(1,3)-dig(2,3) xb = dig(3,1)-dig(2,1) yb = dig(3,2)-dig(2,2) zb = dig(3,3)-dig(2,3) la=SQR(xa-xa+ya^ya+za^za) Ib=SQR(xb^xb+yb^yb+zb^zb) sm=xa^xb+ya^yb+za^zb x=sm/(la^lb) IF x=1 THEN x=1.00001 theta=(-ATN(x/SQR(1-x'x))+1.570796) alpha=180-theta^180/3.1415 , PRlNT n "
PRINT d$;" ";a$;" ";e$;" = ";alpha;" degrees"
PRINT ~ "
IF f$ ="f" THEN Iflex(ndx)=alpha IF f$ = "e" THEN lext(ndx)=alpha RETURN

ClearBuffer:
Dummy$= INPUT$(LOC(1), 1) RETURN
SetPointDigitizerMode:

/o2C) - ,' ... . ~: . -~ , PRINT #1 ,"tYt"
RETURN
SetNonContinMode PRINT #1,"c"
RETURN

InitArray:
FOR i=1 TO 4 wrist(i) = 0 Iwrist(i) = o NEXT i FOR i=1 TO 2 elbow(i) = o lelbow(i) = 0 a-m(i) = 0 larm(i) = o wstrot(i) = 0 Iwstrot(i) = 0 N EXT i FOR i=1 TO 2 FORj= 1 TO3 stand(i,j) = 0 Istand(i,j) = 0 wstand(i,j)= 0 Iwstand(i,j) = 0 sup(i,j) = o Isup(i,j) = o wsup(i,j) = 0 Iwsupti,j) = O
pro(i,j) = o Ipro(iJ) = 0 wpro(i,j) = 0 Iwpro(i,j) = 0 mdpnt(i,j) = 0 Imdpnt(i,j) = 0 wmdpnt(i,;) = 0 Iwmdpnt(i,j) = 0 transl(i,j) = o Itransl(i,j) = 0 wtransl(iJ) = 0 Iw~ransl(i,j) = 0 NEXT j NEXT i FORi= 1 TO3 mdpnt(3,i) = 0 Imdpnt(3,i) = 0 wmdpnt(3,i) = 0 NEXTWjmdpnt(3,i) = O
FOR i = 1 TO 14 flex(i) = 0 Iflex(i) = 0 /~/

.

ext(i) = 0 lext(i) = 0 NEXT i RETURN

TransmitRecordToHost:
PRINT "Strike Return key when ready...";
INPUT ch$
PRINT #1,"P";
RETURN
Ena~leCartesianDataRecord:
PRINT #1,"02"
RETURN
HandleMenu:
MENU OFF
ON MENU(0) GOSUB FileMan MENU ON
RETURN
GetArraylndex:
IF d=1 THEN IF j$ = nm" THEN ndx = 13 IF d=1 THEN IFj$ = "i" THEN ndx = 14 IF d=2 THEN IFj$ = ~mH THEN ndx = 1 IF d=2 THEN IFj$ = "p" THEN ndx = 2 IF d=2 THEN IFj$ = nd" THEN ndx = 3 IF d=3 THEN IFj$ = "m" THEN ndx = 4 IF d=3 THEN IFj$ = p" THEN ndx = 5 IF d=3 THEN IFj$ = Ud" THEN ndx = 6 IF d=4 THEN IFj$ = "m" THEN ndx = 7 IF d=4 THEN IFj$ = np~ THEN ndx = 8 IF d=4 THEN IF j$ = nd" THEN ndx = 9 IF d=5 THEN IF j$ = nm" THEN ndx = 10 IF d=5 THEN IF j$ = "p-- THEN ndx = 11 IF d=5 THEN IF j$ = "d" THEN ndx = 12 IF d=1 THEN IFj$ = nM" THEN ndx = 13 IF d=1 THEN IFj$ = nl~ THEN ndx = 14 IF d=2 THEN IF j$ = nM" THEN ndx = 1 IF d=2 THEN IFj$ = npu THEN ndx = 2 IF d=2 THEN IFj$ = "D" THEN ndx = 3 IF d=3 THEN IFj$ = "M" THEN ndx = 4 IF d=3 THEN IFj$ = ~P" THEN ndx = 5 IF d=3 THEN IFj$ = "D" THEN ndx = 6 IF d=4 THEN IFj$ = "M" THEN ndx = 7 IF d=4 THEN IFj$ = "P" THEN ndx = 8 IF d=4 THEN IFj$ = "D" THEN ndx = 9 IF d=5 THEN IF j$ = "M" THEN ndx = 10 IF d=5 THEN IF j$ = "P" THEN ndx = 11 IF d=5 THEN IFj$ = "D" THEN ndx = 12 RETURN

/~

-` 1329264 EGetArraylndex:
IF de=1 THEN IF j$ = "m" THEN ndx = 13 IF de=1 THEN IFj$ = "i" THEN ndx = 14 IF de=2 THEN IF j$ = "m" THEN ndx = 1 IF de=2 THEN IFj$ = ..pU THEN ndx = 2 IF de=2 THEN IF j$ = "d" THEN ndx = 3 IF de=3 THEN IF j$ = Um" THEN ndx = 4 IF de=3 THEN IFj$ = "p" THEN ndx = 5 IF de=3 THEN IF j$ = "d" THEN ndx = 6 IF de=4 THEN IF j$ = "m" THEN ndx = 7 IF de=4 THEN IFj$ = "p-- THEN ndx = 8 IF de=4 THEN IF j$ = "d" THEN ndx = 9 IF de=5 THEN IF j$ = "m" THEN ndx = 10 IF de=5 THEN IFj$ = "p" THEN ndx = 11 IF de=5 THEN IF j$ = "d" THEN ndx = 12 IF de=1 THEN IFj$ = "M" THEN ndx = 13 IF de=1 THEN IFj$ = "1" THEN ndx = 1 IF de=2 THEN IF j$ = "M" THEN ndx = 1 IF de=2 THEN IFj$ = "P" THEN ndx = 2 IF de=2 THEN IF j$ = "D" THEN ndx = 3 IF de=3 THEN IFj$ = "M" THEN ndx = 4 IF de=3 THEN IFj$ = Np~ THEN ndx = 5 IF de=3 THEN IF j$ = "D" THEN ndx = 6 IF de=4 THEN IF j$ = "M" THEN ndx = 7 IF de=4 THEN IF j$ = "P" THEN ndx = 8 IF de=4 THEN IF j$ = "D" THEN ndx = 9 IF de=5 THEN IF j$ = "M" THEN ndx = 10 IF de=5 THEN IF j$ = "P~ THEN ndx = 11 IF de=5 THEN IF j$ = UD" THEN ndx = 12 RETURN

GetlD:
PRlNT"Patient's nameU;
INPUT N$
PRINT "Today's date:n;
INPUT t$
PRINT Operator number:n;
INPUT o$
PRINT n n RETURN
RGetJnt:
PRINT UWhich digit (1-5, or 0 when finished)";
INPUT de PRINT u n IF NOT(de=0 OR de=1 OR de=2 OR de=3 OR de=4 OR de=5) THEN GOTO RGetJnt IF de=0 THEN RETURN
IF de=1 THEN d$ = "Right Thumb"
IF de=2 THEN d$ = "Right Index Finger"
IF de=3 THEN d$ = "Right Long Finger"
IF de=4 THEN d$ = "Right Ring Finger"
/~?3 l32~2e4 IF de=5 THEN d$ = "Right Fifth Finger"
check43:
PRINT "Which joint [ M)P, P)IP, D)IP, I)P ] ";
INPUT j$
PRINT " "
IF NOT(j$="M" OR j$="m" OR j$="P" OR j$="p" OR j$="D" OR j$="d" OR j$="l" OR
j$="i") THEN GOTO check43 IF de=1 THEN IF j$ = "P" THEN GOTO RJointError IF de=1 THEN IF j$ = up-~ THEN GOTO RJointError IF de=1 THEN IF j$ = "D" THEN GOTO RJointError IF de=1 THEN IF j$ = "d" THEN GOTO RJointError IF de=2 THEN IF j$ = ~I" THEN GOTO RJointError IF de=2 THEN IF j$ = "i" THEN GOTO RJointError IF de=3 THEN IF j$ = "I" THEN GOTO RJointError IF de=3 THEN IF j$ = n;~ THEN GOTO RJointError IF de=4 THEN IF j$ = "I" THEN GOTO RJointError IF de=4 THEN IF j$ = "i" THEN GOTO RJointError IF de=5 THEN IF j$ = "I" THEN GOTO RJointError IF de=5 THEN IF j$ = "i" THEN GOTO RJointError IF j$ = "m" THEN a$ = "MP"
IF j$ = "M" THEN a$ = "MP"
IF j$ = "p" THEN a$ = "PIP"
IF j$ = "P" THEN a$ = "PIP"
IF j$ = "d" THEN a$ = "DIP"
IF j$ ="D" THEN a$ = "DIP"
IF j$ = "i" THEN a$ = "IP"
IF j$ = nl" THEN a$ =UIP"
IF y$ = "Y" THEN GOTO continue IF y$="y" THEN GOTO continue - check44:
PRINT UF)lexion or E)xtension u;
INPUT f$
PRINT ~ "
IF f$ = "F" THEN f$ = "f"
IF f$ = "E" THEN f$ = "e"
IF NOT(f$="r OR f$=~e") THEN GOTO check44 IF f$ = "r THEN e$ = "Flexion~
IF f$ = ~e" THEN e$ = ~ExtensionU
continue. PRINT UYou may digitize the points (3) for the joint now..."
RETURN
RJointError:
PRINT ~Wrong joint. Try again."
PRINT " "
GOTO RGetJnt LGetJnt:
PRINT UWhich dlgit (1-5, or 0 when finished)";
INPUT de PRINT u u IF NOT(de=0 OR de=1 OR de=2 OR de=3 OR de=4 OR de=5) THEN GOTO LGetJnt -IF de=0 THEN RETURN
IF de=1 THEN d$ = "Left Thumb"
IF de=2 THEN d$ = "Left Index Finger"
IF de=3 THEN d$ = "Left Long Finger"
IF de=4 THEN d$ = ~Left Rin~ Finger~
IF de=5 THEN d$ = "Left Fifth Finger"
check45:
PRINT ~Which joint I M)P, P)IP, D)IP, I)P ] ~;
INPUT j$
PRINT ~
IF NOT(j$="M" OR j$="m" OR j$="P" OR j$="p" OR j$=~D~ OR j$=~d~ OR j$="l" OR
j$="i") THEN GOTO check45 IF de=1 THEN IF j$ = "P" THEN GOTO LJointError IF de=1 THEN IF j$ = "p" THEN GOTO WointError IF de=1 THEN IF j$ = "D" THEN GOTO WointError IF de=1 THEN IF j$ = ~d~' THEN GOTO WointError IF de=2 THEN IF j$ = "I" THEN GOTO LJointError IF de=2 THEN IF j$ = i" THEN GOTO WointError IF de=3 THEN IF j$ = "I" THEN GOTO WointError IF de=3 THEN IF j$ = "i" THEN GOTO LJointError IF de=4 THEN IF j$ = "I" THEN GOTO Woin~Error IF de=4 THEN IF j$ = "i" THEN GOTO LJointError IF de=5 THEN IF j$ = Ul" THEN GOTO WointError IF de=S THEN IF j$ = "i" THEN GOTO WointError IF j$ = "m" THEN a$ = "MP"
. IF j$ = "M" THEN a$ = "MP"
IF j$ = Hp~ THEN a$ = "PIP"
IF j$ = np~ THEN a$ = "PIP"
IF j$ = "dN THEN a$ = "DIP"
IF j$ =nD" THEN a$ = "DIP"
IF j$ = "i" THEN a$ = "IP"
IF j$ = "I" THEN a$ ="IP"
IF y$ = uy.. THEN GOTO Lcontinue IF y$ = ny" THEN GOTO Lcon~inue check46:
PRINT UF)lexion or E)xtension ";
INPUT f$
PRINT n U
IF f$ = "F" THEN f$ = "f"
IF f$ = UEU THEN f$ = "e"
IF NOTlf$="f" OR f$=Ue") THEN GOTO check46 IF f$ = "f" THEN e$ = "Flexion"
IF f$ = "e" THEN e$ = "Extension"
Lcontinue: PRINT "You may digitize the points (3) for the joint now..."
PRINT ~ u RETURN
WointError:
PRINT "Wrong joint. Try Again."
PRINT ~ u GOTO LGetJnt /~

t32~2~4 .

FileMan:
Ou~putOption% = MENU(1) IF OutputOption%=5 THEN MENU RESET
RETURN
Init:
DIM sim$(300), dig(300, 3) WINDOW 1, "xy", (70,30)-(370,330),2 MENU 1,0,1," Output to... "
MENU 1,1,1,"Disk (Data)"
MENU 1,2,1,nPrinter"
MENU 1,3,1,"Disk and Screen"
MENU 1,4,1,"Printer and Screen"
MENU 1,5,1 ,"Quit"
DiskOutput%= 1 LprOutput% = 2 DiskScreenOutput% = 3 LprScreenOutput% = 4 Length% = 47 Screenxy%= 1 Screenxz% = 2 ScreenOption%= Screenxy%
OPEN"COM1:9600,N,8,1" AS 1 LEN=4000 OutputOption%= 2 OldKey$ = "~"
Station:
GOSUB ClearBuffer GOSUB SetPointDigitizerMode GOSUB EnableCartesianDataRecord GOSUB SetNonContinMode GOSUB ClearBu~fer ON MENU GOSUB HandleMenu MENU ON
RETURN

., /

. , . ' EXHIBIT C

Left Fifth Finger Fifth Finger Range of Motion Left Hand Extension Proximal Joint (MP) 0 MiddleJoint (PIP) 0 Distal Joint (DIP) 0 Flexion Proximal Joint (MP) 76.4083 : Middle Joint (PIP) 98.142 :- Distal Joint (DIP) 79.8322 ~npairment Proximal Joint (MP) 6 Middle Joint (PIP) 0 Distal Joint (DIP) 0 , Total Range of Motion Impairment 6 Sensory Examination of Left Fifth Finger '~' Radial Aspect Ulnar Aspect Static Two Point 8 10 Discrimination (mm) :
Moving Two Point 8 10 Discrimination (mm) Fifth Finger Sensory Impairment 16 Left Fifth Finger Amputation Level Scar: Painful scars at PIP joint /o?7 . .

.

~ 3292S~

Surgery and Rehabilitation of the Hand Division of Plastic Surge~y Washington University School of Medicine 4949 Barnes Hospital Plaza Suite 17424 St Louis, Missouri 63110 (314) 362-7388 Surgeons Paul M. Weeks, M.D.
Jeffrey L. Marsh, MD.
V. Leroy Young, M.D.
Richard W. Clement, M.D.
Samuel E. Logan, M.D., Ph.D.
Thomas A. Mustoe, M.D.
Bruce A. Kraemer, M.D.

Patient Name: John Jones State: MO
Injured Hand: Left Dominant Hand: Right Date of Injury: 12/15/87 Pertinent Past History:

Present Complaints:

Pain Numbness in the fingers Physical Examination Settings 1 2 3 4 5 Average Gross Grip: Rightl9 21 20 18 19 19.4 (kg) Left 15 16 14 15 16 15.2 Attempts 1 2 3 Average 1~

.
`, Pinch: Right 8 7 8 7.6666666 (lbs) Left 6 5 3 4.6666666 Circumferential Measurements of the Forearm (cm):
Right: 15 Left: 14 Left Thumb ,.
Thumb Range of Motion (Degrees) Right Left Extension Proximal Joint (MP) 0 0 Distal Joint (IP) 0 0 Flexion Proximal Joint (MP) 60 62.878 Distal Joint (IP) 80 78.465 Abduction ,~
Opposition (Limitation Measured in mm) ~npairment Proximal Joint (MP) 0 0 Distal Joint (IP) 0 0 Abduction Opposition Total Range of Motion ~npairment 0 0 Sensory Examination of Left Thumb Radial Aspect Ulnar Aspect Static Two Point 2 3 Mscrimination (mm) /~

.. . . .
, ,.,, ~ ~ ' .

1329~6~
Moving Two Point 2 2 Discrimination (mm) Left Thumb Sensory Impairment 0 Left Thumb Amputation Level Scar:

Left Index Finger ~dex Finger Range of Motion Left Hand Extension Proximal Joint (MP) 0 Middle Joint (PIP) 74.9B348 Distal Joint (DIP) 0 Flexion Proximal Joint (MP) 90.969 Middle Joint (PIP) 105.120 Distal Joint (DIP) 76.4878 ~npairment -Proximal Joint (MP) 0 Middle Joint (PIP) 42 Distal Joint (DIP) 0 Total Range of Motion ~npairment 42 Sensory Examination of Left Index Finger Radial Aspect Ulnar Aspect Static Two Point 8 10 Discrimination (mm) Moving Two Point 8 10 3~) .

~329264 Discrimination (mm) Index Finger Sensory Impairment 14 Left Index Finger Amputation Level Scar: Painful scars at PIP joint Left Long Finger Long Finger Range of Motion Left Hand Extension Proximal Joint (MP) 0 Middle Joint (PIP) 56.02673 Distal Joint (DIP) 0 Flexion Proximal Joint (MP) 89.692 Middle Joint (PIP) 99.1150 Distal Joint (DIP) 82.6688 Impairment Proximal Joint (MP) 0 Midclle Joint (PIP) 36 Distal Joint (DIP) 0 Total Range of Motion Impairment 36 Sensory Examination of Left Long Finger Radial Aspect Ulnar Aspect Static Two Point 8 10 Discrimination (mm) Moving Two Point 8 10 l3/
.~ .

1329~64 Discrimination (mrn) Long Finger Sensory Impairment 14 Left Long Finger Amputation Level Scar: Painful scars at PIP joint Left Ring Finger Ring Finger Range of Motion Left Hand Extension Proximal Joint (MP) O
Middle Joint (PIP) O
Distal Joint (DIP) O
Flexion Proximal Joint (MP) 78.7611 Middle Joint (PIP) 96.7121 Distal Joint (DIP) 82.162 Impairment Proximal Joint (MP) 6 Middle Joint (PIP) O
Distal Joint (DIP) O

Total Range of Motion lmpairment 6 Sensory Examination Of Left Ring Finger Radial Aspect Ulnar Aspect Static Two Point 8 10 Discrimination (mm) Moving Two Point 8 10 Discrimination (mm) l3 ~ .
,, . :
' .: ' 132926~

Ring Finger Sensory Impairment 14 Left Ring Finger Amputation Level Scar: Painful scars at PIP joint Left Upper Extremity ActiveRange of Motion Right Left Shoulder Extension Flexion ~npairment Abduction Irnpairrnent External Rotation Internal Rotation Impairment Total Range of Motion ~npairrnent Scar:

Elbow Right Left Extension 0 4.75416 Flexion 150 147.148 ~npairrnent O O

S~
l33 Forearm Right Left Supination 80 71.4845 Pronation 80 92.3969 Impairment 0 2 Scar:

Wrist Right Left Extension 60 42.2641 Flexion 70 59.5285 Impairment 0 5 Radial Deviation 20 16.5560 Ulnar Deviation 30 29.7474 Impairment 0 0 Supination 0 83.7111 Pronation 0 82.238 Total Wrist Range of Motion Impairment Scar:
Left Hand Impai~nent Summary Range of Mo~don Impairment of the Left Hand Impairment of the Digit Impairment of the Hand Thumb 0 Index 42 11 3S~

' ' .

. ~ , 132~26~
Long 36 7 Ring 6 Fifth 6 0 Total Range of Motion Impairment of the Hand 19 Sensory ~npairment of the Left Hand Thumb 0 Index 14 Long 14 Ring 14 Fifth 16 Left Hand Sensory Impairment 8.6 ~npairment of the Left Hand Thumb 0 ~dex 50.12 Long 44.96 Ring 19.16 Fif~ 2 1.04 Left Hand Impairrnent 23.036 13292~
Left Upper Extremity Impairment Summary Impairment of the Left Hand Thumb 0 Index 50.12 Long 44.96 Ring 19.16 Fifth 2 1.04 Left Hand Impairment 23.036 Impairment of the Left Upper Extremity .-;
Hand 2 1 Wrist 5 Elbow 0 Forearm 2 Shoulder Irnpairment of the Left Upper Extremity 24.95 Right Thumb Thumb Range of Motion (Degrees) Right Left Extension Proximal Joint (MP) 0 0 l3~

~g2~

Distal Joint (IP) 0 0 Flexion Proximal Joint (MP) 60 62.878 Distal Joint (IP) 80 78.465 Abduction Opposition (~imitation Measured in mm) Impairment Proximal Joint (MP) 0 0 Distal Joint (IP) 0 0 Abduction Opposition Total Range of Motion Impairment 0 0 Sensory Examination of Right Thumb Radial Aspect Ulnar Aspect Static Two Point Discrimination (mm) Moving Two Point Discrimination (mm) Right Thumb Sensory Impairment Right thumb Amputation Level Scar:

Right Index Finger Index Finger Range of Motion Right Hand 1~1 1329~6~

Extension Proximal Joint (MP) O
Middle Joint (PIP) O
Mstal Joint (DIP) O
Flexion Proximal Joint (MP) 90 Middle Joint (PIP) 100 Distal Joint (DIP) 70 Impairment Proximal Joint (MP) O
Middle Joint (PIP) O
Distal Joint (DIP) O

Total Range of Motion Impairment O

Sensory Examination of Right Index Finger Radial Aspect Ulnar Aspect Static Two Point Discrimination (mm) Moving Two Point Discrimination (mm) Index Finger Sensory Impairment Right Index Finger Amputation Level Right Long Finger Long Finger Range of Motion Right Hand Extension Proximal Joint (MP) O

132~2~4 Middle Joint (PIP) O
Distal Joint (DIP) O
Flexion Proximal Joint (MP) 90 Middle Joint (PIP) 100 Distal Joint (DIP) 70 Impairment Proximal Joint (MP) O
Middle Joint (PIP) O
Distal Joint (DIP) O

Total Range of Motion Impairment O

Sensory Examination of Right Long Finger Radial Aspect Ulnar Aspect Static Two Point Discrimination (mm) Moving Two Point Discrimination (mm) Long Finger Sensory Impairment Right Long Finger Amputation Level Scar:

Right Ring Finger Ring Finger Range of Motion Right Hand Extension Proximal Joint (MP) O
Middle Joint (PIP) O

/3~

132~26~
Distal Joint (DIP) O
Flexion Proximal Joint (MP) 90 Middle Joint (PIP) 100 Distal Joint (DIP) 70 Impairment Proximal Joint (MP) O
Middle Joint (PIP) O
Distal Joint (DIP) O

Total Range of Motion Impairment O

Sensory Examination of Right Ring Finger Radial Aspect Ulnar Aspect Static Two Point Discrimination (mm) Moving Two Point Discrimination (mm) Ring Finger Sensory Impairment Right Ring Finger Amputation Level Scar:

Right Fifth Finger Fifth Finger Range of Motion Right Hand Extension Proximal Joint (MP) O
Middle Joint (PIP) O
Distal Joint (DIP) O
/~

....

... ~ .

132926~
Flexion Proximal Joint (MP) 90 Middle Joint (PIP) 100 Distal Joint (DIP) 70 Impairment Proximal Joint (MP) O
Middle Joint (PIP) O
Distal Joint (DIP) O

Total Range of Motion ~npairment O

Sensory Examination of Right Fifth Finger Radial Aspect Ulnar Aspect Static Two Point Discrimination (mm) Moving Two Point Discrimination (mm) Fifth Finger Sensory Impairment Right Fifth Finger Amputation Level Scar:

Right Upper Extremity Active Range of Motion Right Left Shoulder Extension Flexion Impairment /~1 1 32~

Abduction Impairment External Rotation Internal Rotation ~npairment Total Range of Motion Impairment Scar:

Elbow Right Left Extension 0 4.75416 Flexion 150 147.148 Impairment 0 0 Scar:

Forearm Right Left Supination 80 71.4845 Pronation 80 92.3969 Impairment 0 2 Scar:

Wrist Right Left Extension 60 42.2641 Flexion 70 59.5285 ~npairment 0 5 Radial Deviation 20 16.5560 Ulnar Deviation 30 29.7474 / ~

, ~ ~

; ~' , , 132~2~
Impairment O O

Supination 0 83.7111 Pronation 0 82.238 ~npairment Total Wrist Range of Motion Impairment Scar:

Right Hand Impairment Summary Range of Motion Impairment of the Right Hand Impairment of the Digit Impairment of the Hand Thumb O O

Index O O

Long O O

Ring O O

Fifth O

Total Range of Motion Impairment of the Hand O

Sensory Impairment of the Right Hand Thumb Index Long 1~3 ~3~

Ring Fifth Right Hand Sensory Impairment Impairment of the Right Hand Thumb O
Index O
Long O
Ring O
Fifth O
Right Hand Impairment O
Right Upper Extremi~ lmpairment Summary ~npairment of the Right Hand Thumb O
~dex o Long O
Ring o Fifth O

Right Hand Impairment O

,, ., , :
. , .. - ' ~ .' , .
~, ., 132~26~

~npairment of the Right Upper Extremity Hand O

Wrist O

Elbow O

Forearm O

Shoulder Impairment of the Right Upper Extremity O

~npression:

Patient has an average response to the therapy after such an extensive injury.

l~S

, ~, MILLIKEN HAND CENTER FINAL EVALUATION

Physician: Brown Therapist: Smith Date of Evaluation: 12/30/87 Patient Name: John Jones Age: 25 State: MO
X-rays: Barnes Hospital, St. Louis, MO
Injured Hand: Left Dominent Hand: Right Date of Injury: 12/lS/87 Type of Injury: Four fingers of left hand are cut severly Treatment: Surgery Physical therapy Pertinent Past History:
1. None

2. Previously injured hand without residual impairment

- 3. Previously injured hand with residual impairment

4. Acquired disease which contributes to impairment of hand

5. Previous injury to uninjured hand with residual impairment None /~
, .

.

132926~
Present Complaints:

1. Sensitivity of Cold 2. Numbness 3. Awkward Use of Hand 4. Unable to Make a Tight Fist 5. Decreased Hand Strength . 6. Unable toStraighten Fingers 7. Drops Objects from Hand 8. Appearance 9. Lack of Coordination 10. Tenderness or Pain Upon Strenuous Use of Hand 1 1. Other:
Numbness in fingers Pain PHYSICAL EXAMINATION
Circumferential Measurements of the Forearm (cm):
Right: 15 Left: 14 Settings: 1 2 3 4 5 Average Gross Grip:Right l9 21 20 18 19 19.4 Left 15 16 14 15 16 15.2 Attempts: 1 2 3 Average Pinch: Right 8 7 8 7.666 /~

, . .:

13292B~

Left 6 5 3 4.666 Patient Name: John Jones Date of Evaluation: 12/30/87 Injured Hand: Left Therapist: Smith LEFT THUMB
Thumb Physical Characteristics 0=Joint Mobile 1=Amputation 2=Joint Fused Right Thumb Proximal Joint (MP) 0 Right Thumb Distal Joint (IP) 0 Left Thumb Proximal Joint (MP) 0 Left Thumb Distal Joint (IP) 0 Scar:

THUMB RANGE OF MOTION Right Left Extension Proximal Joint (MP) 0 0 Distal Joint (IP) 0 0 Flexion Proximal Joint (MP) 60 62.8781 Distal Joint (IP) 80 78.4658 Abduction /~

132~26~
Opposition (Limitation Measured in mm) Impairment Proximal Joint (MP) 55 O
DistalJoint (IP) O O
Abduction Opposition Total Range of Motion Impairment 55 0 Sensory Examination of Left Thumb Sensorv Modalitv Radial Aspect Ulnar Aspect Pinprick intact to 2 Level Indicated cm cm Static Two Point 2 3 Discrimination (mm) Moving Two Point 2 2 Discrimination (mm) Left Thumb Sensory ImpaiIment O

Left Thumb Amputation Level 1. Through Distal Phalanx a. Less ~an 50%
b. Greater tha'n 50%
2. Through Interphalangeal Joint 3. Through Proximal Phalanx /~

132~ 4 4. Through Metacarpal LEFT INDEX FINGER
Left Index Finger Physical Characteristics 0=Joint Mobile 1=Amputation 2=Joint Fused Index Finger Proximal Joint (MP) 0 Index Finger Middle Joint (PIP) 0 Index Finger Distal Joint (DIP) 0 Scar: Painful scar at PIP joint :;
Index Finger ~ange of Motion _ _ Left Hand . Extension Proximal Joint (MP) 0 Middle Joint (PIP~ 74.9834 :: Distal Joint (DIP) 0 ; Flexion Proximal Joint (MP) 90.969 Middle Joint (PIP) 105.120 Distal Joint (DIP) 76.4878 Impairment Proximal Joint (MP) 0 Middle Joint (PIP) 42 Distal Joint (DIP) 0 /SD

~3~64 Total Range of Motion Impairment 42 Sensory Examination of Left Index Finger Sen$orv Modalitv R~l Aspect Ulnar Aspec~
Pinprick Intact to 6 4 Level Indicated cm cm Static Two Point 8 10 Discrimination (mm) Moving Two Point 8 10 Discrimination (mm) Index Finger Sensory Impairment 14 Left Index Finger Amputation Level 1. Through Distal Phalanx a. Less than 50%
b. Greater ~an 50 2. Through Distal Joint 3. Between Proximal Joint (MP) and Dist~l Joint (DIP) 4. Through Metacarpal LEFT LONG FINGER
Left Long Finger Physical Characteristics 0=Joint Mobile 1=Amputation /S/

1~2~26~

2=Joint Fused Long Finger Proximal Joint (MP) 0 Long Finger Middle Joint (PIP) 0 Long Finger Distal Joint (DIP) 0 Scar: Painful scar at PIP joint Long Fing~r Range of Motion _ Left Hand Extension Proximal Joint (MP) 0 Middle Joint (PIP) 56.0267 Distal Joint (DIP) 0 Flexion Proximal Joint (MP) 89.692 : Middle Joint (PIP) 99.11S0 Distal Joint (MP~ 82.6688 Impairment Proximal Joint (MP) 0 Middle Joint (PIP) 36 Distal Joint (DIP) 0 Total Range of Motion Impairment 36 Sensory Examination of Left Lo~g Finger Sensory Mod~litv Radial Asl;~ect Ulnar Asl;?ec~
PinprickIntact to 5 6 Level Indicated cm cm lS~

132~264 Static Two Point 8 10 Discrimination (mm) Moving Two Point 8 10 Discrimination (mm) Long Finger Sensory Impairment 14 Left Long Finger Amputation Level 1. Through Distal Phalanx a. Less ~an 50%
b. Greater than 50%
2. Through Distal Joint 3. Between Pro~nal Joint (MP) and Distal Joint (DIP) 4. Through Metacarpal LEFT RING FINGER
Left Ring Finger Physical Characteristics O=Joint Mobile 1=Amputation 2=Joint Fused Ring Finger Proximal Joint (MP) O
Ring Finger Middle Joint (PIP) O
Ring Finger Distal Joint (DIP) O

/~3 ~32`~6~

Scar: Painful scar at PIP joint Ring Finger R~nge of Motion Left Hand Extension Proximal Joint (MP) O
Middle Joint (PIP) O
Distal Joint (DIP) O
Flexion Proximal Joint (MP) 78.7611 Middle Joint (PIP) 96.7121 Distal Joint (DIP) 82.1629 Impai~nent Proximal Joint (MP) 6 Middle Joint (PIP) O
Distal Joint (DIP) O
Total Range of Motion Impairment 6 Sensory Examination of Left Ring Finger Sensorv Modalitv Radial Asl?ectUlnar Asl~ect Pinprick Intact to - 4 5 Level Indicated cm cm Static Two Point 8 10 Discrimination (mm) Moving Two Point 8 10 Discnmination (mm) 132~26~
Ring Finger Sensory Impai~nent 14 Left Ring Finger Amputation Level 1. Through Distal Phalanx a. Less than 50%
b. Greater than 50%
2. Through Distal Joint 3. Between Pro~nal Joint (MP) and Distal Joint (DIP) 4. Through Metacarpal "
LEFT FIFTH FINGER
Left Fifth Finger Physical Characteristics O=Joint Mobile 1=Amputation 2=Joint Fused Fifth Finger Proximal Joint (MP) O
;: Fifth Finger Middle Joint (PIP) O
Fifth Finger Distal Joint (DIP) O

Scar: Painful scar at PIP joint Fifth Finger Range of Motion Left Hand Extension Pro~mal Joint (MP) O
Middle Joint (PIP) O

/SS' , . .. . .

Distal Joint (DIP) 0 Flexion Proximal Joint (MP) 76.4083 Middle Joint (PIP) 98.142 Distal Joint (DIP) 79.8322 Impairment Pro~mal Joint (MP) 6 Middle Joint (PIP) 0 Distal Joint (DIP) 0 Total Range of Motion Impairment 6 Sensorv Examination of Left Fifth Finger Sensorv Modalitv __ _ Radial Asl?ect Ulnar Aspect PinprickIntact to 3 4 Level Indicated cm cm Static Two Point 8 10 Discrimination (mm) Moving Two Point 8 10 Discrimination (mm) Fifth Finger Sensory Impairment 16 Left Fifth Finger Aml~utation Level 1. Through Distal Phalanx a. Less ~an 50%
b. Greater than 50%

/5'~

13292~4 2. Through Distal Joint 3. Between Proximal Joint (MP) and Distal Joint (DIP) 4. Through Metacarpal LEFT HAND IMPAIRMENT SUMMARY
Range of Motion Impairment of the Left Hand Impairment of the Digit Impairment of the Hand Thumb O O
Index 42 11 Long 36 7 Ring 6 Fifth 6 0 Total Range of Motion Impairment of the Hand 19 ;
Sensory Impairment of the Left Hand Thumb O
Index 14 Long 14 Ring 14 Fifth 16 Total Ha~d Sensory Impairment 8.6 Impairment of the Left Hand T~umb O
/~

132926~
Index 50.12 Long 44.96 Ring 19.16 Fifth 2 1.04 Left Hand Impairment 23.036 LEFT UPPER EXTREMITY IMPAIRMENT SUMMARY
Impai~nent of the Left Hand Hand 2 1 Wrist 5 Elbow 0 Foreann 2 Shoulder Impairment of the Left Upper Extremity 26.451 UPPER EXTREMITY
Active Range of Motion Right Left Shoulder Physical Characteristics (0--Joint Module, l=Amputation, 2=Joint Fused) Extension Flexion Impairment Abduction Impairment External Rotation Internal Rotation Impairrnent Total R~nge of Motion Impairment Right:
Scar:

Right:
Comments:

Left:
Scar:

Left:
Comments:

Elbow Right Left Physical Charactenstics O O
Physical Characteristics (O=Joint Module, 1=Amputation, 2=Joint Fused) Extension 0 4.75416 Flexion 150 147.148 ~npairment O O

Right:
Scar:
/5~

132926~

Right:
Comments:

.
Left:
Scar:

Left:
Comments:
UPPER EXTREMITY
Active Range of Motion Forearm Right Left Physical Characteristics 0 0 Physical Characteristics (0=Joint Module, l=Amputation, 2=Joint Fused) Supination 80 71.4845 Pronation 80 92.39691 Impairment 0 2 Right:
Scar:

Right:
Comments:

Left:

-_ _ ., -13~9~
Scar:

Left:
- Comments:
~' Wrist Right Left Physical Characteristics 0 0 Physical Characteristics (0=Joint Module, l=Amputation,2=Joint Fused~
Extension 60 42.2641 Flexion 70 59.5285 Impairment - O 5 Radial Deviation 20 16.5560 Ulnar Deviation 30 29.7474 Impairment 0 0 Supination 0 83.7111 Pronation 0 82.238 ~npairment Total Wrist Range of Motion Impairment Right:
Scar:

Right: -Comments:
/~/

.. . . . . .

, ..

13292~

Left:
Scar:
.
Left:
' Comments:
' RIGHT THUMB
Thumb Physical Characte~stics 0=Joint Mobile l=Amputation 2=Joint Fused Right Thurnb Pro~dmal Joint (MP) 0 Right Thumb Distal Joint (IP) 0 Left Thumb Pro~nal Joint (MP) 0 Left Thumb I)istal Joint (lP) 0 Scar:

THUMB RANGE OF MOTION Right Left Extension Proximal Joint (MP) 0 0 Distal Joint (IP) 0 0 Flexion Pro~mal Joint (MP) 60 62.8781 Dist~l Joint (IP) 80 78.4658 Abduction "

Opposition (Limitation Measured in mm) Impairment Proximal Joint (MP) 55 0 Distal Joint (IP) 0 0 Abduction Opposition Total Range of Motion Impairment 55 0 , .
Sensory Examination of Right Thumb Sensorv Modalitv. . _~ect UlnarAsl~ect Pinprick intact to LevelIndicated cm cm Static Two Point Disc~iminatlon (mm) Moving Two Point Discrimination (mm) Right Thumb Sensory Impairment Right Thumb Amputation Level 1. Through Distal Phalanx a. Less than 50%
b. Greater than 50%
2. Through Interphalangeal Joint 3. Through Proximal Phalanx 132926~
4. Through Metacarpal RIGHT INDEX FINGER
Right Index Finger Physical Characterists O=Joint Mobile l=Amputation 2=Joint Fused Index Finger Proximal Joint (MP) O
Index Finger Middle Joint (PIP) O
Index Finger Distal Joint (DIP) O
.
Scar: Painful scar at PIP joint Indçx, Finger R~g~f Motion ,,_ Right Hand Extension Proximal Joint (MP) O
Middle Joint (PIP) O
Distal Joint (DIP) O
Flexion Proximal Joint (MP) 90 Middle Joint (PIP) 100 Distal Joint (DIP) 70 ~npai~nent Proximal Joint (MP) O
Middle Joint (PIP) O
Distal Joint (DIP) O

/65~

13292~
Total Range of Motion Impairment O
Sensory Examination of Left Index Finger Sensorv Modalitv Radial Aspect Ulnar As~ect Pinprick Intact to Level Indicated cm cm Static Two Point Discrimination (mm) Moving Two Point Discrimination (mm) Index Finger Sensory Impairment Right Index Finger Amputation Level 1. Through Distal Phalanx a. Less than 50%
b. Greater than 50%
2. Through Mstal Joint 3. Between Proximal Joint (MP) and Distal Joint (DIP) 4. Through Metacarpal RIGHT LONG FINGER
Right Long Finger Physical Characteristics 0=Joint Mobile l=Amputation 132~264 2=Joint Fused Long Finger Proximal Joint (MP) O
Long Finger Middle Joint (PIP) O
Long Finger Distal Joint (DIP) O

Scar: Painful scar at PIP joint Long Fi~çr Range of Motio~ _ Right Hand Extension Proximal Joint (MP) O
Middle Joint (PIP) O
Distal Joint (DIP) O
Flexion Proximal Joint (MP) 90 Middle Joint (PIP) 100 Distal Joint (DIP) 70 Impairment Proximal Joint (MP) O
Middle Joint (PIP) O
Distal Joint (DIP) O
Total Range of Motion Impairment O
Sensory Examination of Right Long Finger Sensorv Modalitv Radial Aspect Ulnar Aspect Pinprick Intact to Level Indicated cm cm /CC

Sta~c Two Point 13 2 ~ 2 6 4 Discrimination (mm) Moving Two Point Discrimination (mm) Long Finger Sensory Impairment Right Long Finger Am~uta~ion Level 1. Through Distal Phalanx a. Less than 50%
b. Greater than 50%
2. Through Distal Joint 3. Between Proximal Joint (MP) and Distal Joint (DIP) 4. Through Metacalpal RIGHT RING FINGER
Right Ring Finger Physical Characteristics O=Joint Mobile l=Amputation 2=Joint Fused Ring Finger Proximal Joint (MP) O
Ring Finger Middle Joint (PIP) O
Ring Finger Distal Joint (DIP) O

/6,7 132926~
Scar: Painful scar at PIP joint Ring Finger Range of Motion Right Hand Extension Proximal Joint (MP) O
Middle Joint (PIP) O
Distal Joint (DIP) O
Flexion Proximal Joint (MP) 90 Middle Joint (PIP) 100 Distal Joint (DIP) 70 Impairment Proximal Joint (MP) O
Middle Joint (PIP) O
Distal Joint (DIP) O
Total Range of Motion Impairment Sensory Examination of Right Ring Finger Sensorv Modalitv Radial Aspect Ulnar Aspect : Pinprick Intact to Levelkldicated cm cm .~
Static Two Point Discrimination (mm) Moving Two Point Discrimination (mm) /G

~3292691 Ring Finger Sensory Impairment Right Ring Finger Amputation Level 1. Through Distal Phalanx a. Less ~an 50%
b. Greater than 50%
2. Through Distal Joint 3. Be~veen Pro~mal Joint (MP) and Distal Joint (DIP) 4. Through Metacarpal RIGHT FIFTH FINGER
Right Fifth Finger Physical Characteristics O=Joint Mobile l=Amputation 2=Joint Fused Fifth Finger Proximal Joint (MP) O
Fifth Finger Middle Joint (PIP) O
Fifth Finger Mstal Joint (DIP) O

Scar: Painful scar at PIP joint Fifth Finger Range of Motion Left Hand Extension Pro~nal Joint (MP) O
Middle Joint (PIP) O
Distal Joint (DIP) O

. , ~3~9264 Flexion Proximal Joint (MP) 99 Middle Joint (PIP) 100 Distal Joint (DIP) 70 Impairment Proximal Joint (MP) O
Middle Joint (PIP) O
Distal Joint (DIP) O
Total Range of Motion Impai~nent O
Sensory Examination of Right Fifth Finger Sensorv Modalitv _ Radial Asl?ect Ulnar Aspect Pinprick Intact to Level Indicated cm cm Static Two Point Discrimination (mm) Moving Two Point Discrimination (mm) Fifth Finger Sensory Impairment Right Fifth Finger Amputati~n Level 1. Through Mstal Phalanx a. Less than 50%
b. Greater than 50%
2. Through Distal Joint ,.~ . ~

. ' . ." .

1329~6~
3. Between Proximal Joint (MP) and Distal Joint (DIP) 4. Through Metacarpal RIGHT HAND IMPAIRMENT SUMMARY
Range of Motion Impairment of the Right Hand Impai~nent of the DigitImpai~nent of the Hand Thumb 55 22 Index O O
Long O
Ring O O
Fifth O

Total Range of Motion Impairment of the Hand 22 Sensory Impairment of the Right Hand Thumb Index Long Ring Fifth Total Hand Sensory Impairment Tmpairment of the Right Hand Thumb 55 Index O / 7/

Long 0 Ring 0 Fifth 0 Right Hand Impairment 22 .
RIGHT UPPER EXTREMITY IMPAIRMENT SUMMARY
Impairment of the Right Hand Hand 20 Wrist 0 Elbow 0 Forearm 0 Shoulder Impairment of the Left Upper Extremity 20 Name: John Jones Sex: M
Birthdate: 4/6/62 Age: 25 Home Address: 1012 W. Maple St. Louis State: MO
Zip: 63121 Home Telepjhone: (314) 123-4567 WorkTelepphone: (314) 234-5678 Refer~ng Physician: Bolen, St. Louis, MO
First HRC Exam: .
Injured Extremity: Left /7~

.
,~, .

132~26~
Dominant Extremity: Right Insurance Coverage: Blue Cross Occupation: Carpenter Employer: SMC Co.

RTW:

Date of Injury: 12/15/87 Injury Mechanism: four fingers of left hand severly cut PMH:
Treatment: surgery physical therapy , ~73 . ~ ~ ` . ,, i32!~26~

Name: John Jones Date of Evaluation: 12/30/87 Therapist: Smith Injured Hand: Left Functional Evaluation Index Long Ring Fifth Right Hand Key Pinch (Digit): Y Y Y Y

Pulp/Pulp Pinch: Y Y Y Y

Palmar Flexion (mm) Fingertip to DPC 3 3 3 3 Fingertip to Palm 3 3 3 3 Left Hand Key Pinch (Digit): Y N N Y

Pulp/Pulp Pinch: N N N N

Palmar Flexion (mm) Fingertip to DPC 5 4 5 3 Fingertip to Palm 4 3 5 5 Strength Evaluation Settings 1 2 3 4 5 Average Gross Grip: Right 19 21 20 18 19 19.4 Left 15 16 14 15 16 15.2 Attempts 1 2 3 Average Pinch: Right 8 7 8 7.6666666 Left 6 5 3 4.6666666 /7~

132g~64 Pick Up Pencil Y
Sign Name Y
Ha~ner a Nail Y
Button a Button Y
Open and Close Safe[y Pin Y
Use Empty Drinking Glass Y

Dexterity Testing Pegs (seconds) Right 20 Left 30 Pins and Collars (seconds) Right 5 Left 7 Observations:

Painful stiffness in injured fingers Painful scars at PIP joint of injured fingers Symptoms Numbness in injured fingers Pain in injured fingers Tenderness in injured fingers Swelling none / 7~

. ~ .

Burning and Tingling in injured fingers Patient Name: John Jones Injured Hand: Left Therapist: Smith Date of Evaluation: 12/30/87 Circumference Measurements Tool Used: number three RightHand (mm) MPP PIP MMP DIP

~dexFinger 6 5 4 3 Long Finger 5.5 5 4 3.5 Ring Finger 5 4.5 4 3 Fifth Finger 4 3.1 3 2.9 Thumb MPP IP MDP

9.5 9 DWC (cm) 10 DPC (cm) 12 10cm Distal Epicondyle (cm)15 Other Left Hand (mm) MPP PIP MMP DIP

Index Finger 5.5 5 4 3 ~32~2~4 Long Finger 5 4.5 4 3.5 Ring Finger 4.8 3.2 3 2.9 Fifth Finger 4 3 2.9 2.5 . Thumb MMP IP MDP
:' 9 8.7 8.5 DWC (cm) 10 DPC (cm) 11 10cm Distal Epicondyle (cm)14 Other Patient Name: John Jones Injured Hand: Left Therapist: Smith Date of Evaluation: 12/30/87 ., Sensory Examination of Left Hand Sensory Battery Done (Y/N): Y Date: 12/20/87 Muscle Exam Done (Y/N): N Date:

Pinprick (Zone) Left Thumb Radial 2 cm Ulnar 1 cm Left Index Finger / 7 ~7 :

.

13292g4 Radial 6 cm Ulnar 4 cm Left Long Finger Radial 5 cm Ulnar 6 cm Left Ring Finger Radial 4 cm Ulnar 5 cm Left Fifth Finger Radial 3 cm Ulnar 4 cm Two Point Discrimination (mm) Static Moving Left Thumb Radial 2 2 Ulnar 3 2 Left Index Finger Radial 8 8 U~ 10 10 Left Long Finger Raclial 8 8 Ulnar 10 10 ~7~

.

~i Left Ring Finger Radial 8 8 Ulnar 10 10 Left Fifth Finger Radial 8 8 Ulnar 10 10 Patient Name: John Jones Injured Hand: Left Therapist: Smith Date of Evaluation: 12/30/87 Sensory Impai~nent of Left Hand Left Thumb 0 Left Index 14 Left Long 14 Left Ring 14 Left Fifth 16 Total Sensory Impairment of the Left Hand: 8.6 Patient Name: John Jones Injured Hand: Left Therapist: Smith Date of Evaluation: 12/30/87 / ~ ~

, . , - . :

~' .

Physical Characteristics of Left Upper Extremity O = Joint Mobile 1 = Amputation 2 = Joint Fused Thumb Right Thumb Pro~mal Joint (MP) O
Right Thumb Distal Joint (IP) O
Left Thumb Proximal Joint (MP) O
Left Thumb Distal Joint (IP) O

Left Index Finger Index Finger Proximal Joint (MP) O
Index Finger Middle Joint (PIP) O
Index Finger Distal Joint (DIP) O

Left Long Finger Long Finger Proximal Joint (MP) O
Long Finger Middle Joint (PIP) O
Long Finger Distal Joint (DIP) O

Left Ring Finger Ring Finger Proximal Joint (MP) O
Ring Finger Middle Joint (PIP) O
Ring Finger Distal Joint (DIP) O

Left Fifth Finger Fifth Finger Proximal Joint (MP) O
Fifth Finger Middle Joint (PIP) O
/~D

: :

Fifth Finger Distal Join~ (DIP) 0 Patient Name: John Jones Injured Hand: Left Therapist: Smith Date of Evaluation: 12/30/87 Joint Range of Motion of the Left Hand Left Index Finger Active Passive MP Extension 0 Flexion 90.969 Impairment 0 PIP Extension 74.9834 Flexion 105.120 Impairment 42 DIP Extension 0 Flexion 76.4878 ~npairment 0 Total Index Finger RDM Impairment 42 Left Long Finger Active Passive MP Extension 0 Flexion 89.692 Impairment 0 PIP Extension 56.0267 Flexion 99.1150 Impairment 36 /~/

, .

. ~

DIP Extension 0 Flexion 82.6688 Impairment 0 Left Long Finger RDM Impairment 36 Left Ring Finger Active Passive MP Extension 0 Flexion 78.761 1 ~npairment 6 PIP Extension 0 Flexion 96.7121 Impairment 6 DIP Extension 0 Flexion 82.1629 ~npairment 0 Total Ring Finger RDM Impairment 6 Patient Name: John Jones ~jured Hand: Left Therapist: Smith Date of Evaluation: 12/30/87 Joint Range of Motion of the Left Hand Left Fifth Finger Active Passive MP Extension 0 Flexion 76.4083 Irnpairment 6 .

, ~
. ..
.
~: , 132~2~4 PIP Extension 0 Flexion 98.142 Impairment 20 DIP Extension 0 Flexion 79.83224 Impairment Total Fifth Finger RDM Impairment 24.8 Right Thumb Active Passive MP Extension 0 Flexion 60 Impairment 0 IP Extension 0 Flexion 80 Impairment 0 , Abduction Impairment Opposition Impairment Total Right Thumb RDM Impairment 0 Left Thumb Active Passive MP Extension 0 Flexion 62.8781 Impairment 0 IP Extension 0 Flexion 78.4658 / ~3 .

, 132926~
Impairment 0 Abduction Irnpairment Opposition Impairment Total Left Thumb RDM ~npairment Patient Name: John Jones Injured Hand: Left Therapist: Smith Dave of Evaluation: 12/30/87 Joint Range of Motion of the Left Upper Extremity Left Wrist Active Passive Extension 42.2641 Flexion 59.5285 ~npairment 5 Radial Deviation 16.5560 Ulnar Deviation 29.7474 Impairment 0 Supination 83.7111 Pronation 82.238 Impairment Total Wrist Impairment S

Left Forearm Active Passive Supination 7 1.4845 Pronation 92.3969 Total Forearm Impairment 2 Patient Name: John Jones Injured Hand: Left Therapist: Smith Date of Evaluation: 12/30/87 Joint Range of Motion of Left Upper Extremity LeftElbow Active Passive Extension 4.75416 Flexion 147.148 Total Elbow Impai~nent 0 LeftShoulder Active Passive Extension Flexion Impairment Abduction ~npairment ~ternal Rotation External Rotation Impairment Total Shoulder Impairment Left Hand Impairment Summary ., ,~ .

,~ , .

Range of Motion Impairment of the Left Hand Impairment of the Digit Impairment of the Hand Thumb 0 Index 42 11 Long 36 7 Ring 6 Fifth 24.8 Total Range of Motion Impairment of the Hand 20 Sensory Impairment of the Left Hand Thumb 0 Index 14 Long 14 Ring 14 Fifth 16 Total Hand Sensory Impairment 8.6 Impairment of the Left Hand Thumb 0 Index 50.12 /

.
~,~

, 132g264 Long 44.96 Ring 19.16 Fifth 36.832 LeftHandImpairment 24.6152 Left Upper Extremity Impai~nent Sumrnary :
- Impairment of the Left Hand ~ .
Thumb 0 ` Index 50.12 ':
Long 44.96 Ring 0 Fifth 36.832 ` LeftHandImpa~rment 24.6152 ' lmpairment of the Left Upper Extremity : ;-,- -~ Hand 22 . ,.
Wrist 5 '`
Elbow 0 Forearm 2 Shoulder , , "
.~ ....... , . -.~ . . . .

.

Impairment of the Left Upper Extremity 27.382 Patient Name: John Jones Injured Hand: Left Therapist: Smith Date of Evaluation: 12/30/87 .~, Sensory Examination of Right Hand SensoryBatteryDone(Y/N): N Date: 12/15/87 Muscle Exam Done (Y/N): N Date:

Pinprick (Zone) Right Thumb Radial cm Ulnar cm Right Index Finger Radial cm Ulnar cm Right Long Finger Radial cm Ulnar cm Right Ring Finger Radial cm Ulnar cm /~

Right Fifth Finger 1 3 2 9 2 6 ~

Radial cm Ulnar cm Two Point Discrimination (mm) Static Moving Right Thumb Radial Ulnar Right Index Finger Radial Ulnar Right Long Finger Radial Ulnar Right Ring Finger Radial Ulnar Right Fifth Finger Radial Ulnar Patient Name: John Jones Injured Hand: Left ,~

", .

Therapist: Smith Date of Evaluation: 12/30/87 Sensory Impairment of Right Hand Right Thumb 0 Right Index 0 Right Long 0 Right Ring 0 Right Fifth 0 Total Sensory Impairment of the Right Hand: 0 Patient Name: John Jones Injured Hand: Left Therapist: Smith Date of Evaluation: 12/30/87 , .
Physical Characteristics of Right Upper Extremity ~ /
0 = Joint Mobile 1 = Amputation 2 = Joint Fused Thumb Right Thumb Proximal Joint (MP) 0 Right Thumb Distal Joint (IP) 0 Left Thumb Proximal Joint (MP) 0 Left Thumb Distal Joint (IP) 0 :^
/~0 132926~
Right Index Finger Index Finger Proximal Joint (MP) 0 Index Finger Middle Joint (PIP) 0 Index Finger Distal Joint (DIP) 0 Right Long Finger Long Finger Proximal Joint (MP) 0 Long Finger Middle Joint (PIP) 0 Long Finger Distal Joint (DIP) 0 Right Ring Finger Ring Finger Proximal Joint (MP) 0 Ring Finger Middle Joint (PIP) 0 Ring Finger Distal Joint (DIP) 0 Right Fifth Finger Fifth Finger Proximal Joint (MP) 0 Fifth Finger Middle Joint (PIP) 0 Fifth Finger Distal Joint (DIP) 0 Patient Name: John Jones Injured Hand: Left Therapist: Smith Date of Evaluation: 12/30/87 Joint Range of Motion of the Right Hand Right Index Finger Active Passive MP Extension 0 Flexion 90 Irnpairment O

PIP Extension O
Flexion 100 Irnpairment O

DIP Extension O
Flexion 70 Impairment O

Total Index Finger RDM Impairment O

Right Long Finger Active Passive MP Extension O
Flexion 90 ~npairment O

PIP Extension O
Flexion 100 Impairment O

MP Extension O
Flexion 70 ~npairment O

Total Long Finger RDM ~npairment O

Right Ring Finger Active Passive MP Extension O
Flexion 90 ~npairment O

PIP Extension O
Flexion 100 / 902 ,~.. .. , ~., ~

,. . . .

132~264 Impairment 0 DIP Extension 0 Flexion 70 ~npairment 0 Total Ring Finger RDM Impairment 0 Patient Name: John Jones Injured Hand: Left Therapist: Smith Date of Evaluation: 12/30/87 Joint Range of Motion of the Right Hand RightFifth Finger Active Passive MP Extension 0 Flexion 90 -~. Impairment 0 ~.
PIP Extension 0 . ., Flexion 100 Impairment 0 DIP Extension 0 Flexion 70 ~npairment 0 Total Fifth Finger RDM Impairment 0 Right Thumb Active Passive MP Extension 0 Flexion 60 ~3 Impairment 0 IP Extension 0 Flexion 80 Impairment 0 Abduction Impairment Opposition Impairment Total Right Thumb RDM Impairment 0 Left Thumb Active Passive MP Extension 0 Flexion 62.87~1 Impairment 0 IP Extension 0 Flexion 78.4658 ~npairment 0 Abduction ~npairment . .
Opposition Impairment Total Left Thumb RDM Impairment 0 Patient Name: John Jones Injured Hand: Left Therapist: Smith / ~y~

Date of Evaluation: 12/30/87 Joint Range of Motion of the Right Upper Extremity Right Wrist Active Passive Extension 60 Flexion 70 Impairment 0 Radial Deviation 20 Ulnar Deviation 30 Impairment 0 Supination 0 Pronation 80 lrnpairment . .
~ Total Wrist Impairment 0 , Right Forearm Active Passive ' Supination 80 Pronation 80 ., Total Forearm Impairment 0 Patient Name: John Jones Injured Hand: Left Therapist: Smith Date of Evaluation: 12/30/87 Joint Range of Motion of Right Upper Extremity Right Elbow Active Passive 132926~

Extension 0 Flexion 150 Total Elbow Impairment 0 Right Shoulder Active Passive Extension Flexion Impairment Abduction Irnpairment Internal Rotation External Rotation ~npairment Total Shoulder ~npairment Right Hand Impairment Summary Range of Motion Impairment of the Right Hand Impairment of the Digit Irnpairment of the Hand Thumb 0 0 ~dex 0 0 Long 0 0 Ring O O

Fifth 0 1 3 2 ~

Total Range of Motion Impairment of the Hand O
Sensory Impairment of the Right Hand Thumb O
Index O
Long O
Ring O
Fifth O
Total Hand Sensory Impairment O
Impairment of the Right Hand Thumb O
Index O
Long O
Ring O
Fifth O
Right Hand Impairment O
Right Upper Extremity Impairment Summary Impairment of the Right Hand Thumb O /~7 Index O
Long O
Ring O
Fifth O

. .
Right Hand Impairment O

Impairment of the Right Upper Extremity Hand O
. 1 Wrist O
. .
, Elbow O

Forearm O

Shoulder ~npairment of the Right Upper Extremi~ O
~' I q~

.
~ : :
.~ . -

Claims (15)

What is claimed is:

1. A clinical range of motion and disability evaluation device for measuring the range of flexion and extension of a patient's hand comprising a computer means, means directly connected to the computer means for a skilled human operator such as a rehabilitative or physical therapist or physician to selectively measure and input various physical locations of the articulated segments which comprise the fingers of the hand, a common reference point, the measuring and input means including means to locate points proximate the various joints of fingers on the hand with respect to said common reference point in a fully three-dimensional Cartesian coordinate form, said measurements being taken with the fingers of the hand in both a flexed and extended orientation, and the computer means having means to determine the degree of disability from said measured locations according to recognized standard criteria, the disability determining means thereby having means to calculate the angles of maximum flexion and extension for each finger from points that locate the absolute position of maximal and distal segments at each and every joint articulation in the fingers of the hands.

2. The device of claim 1 wherein said measurement and input means includes means for a therapist to select an anatomic locus for measurement with his hands and enter data corresponding to the dimension with some body part other than his hands, thereby leaving his hands free to move rapidly from one dimension to another during the course of the evaluation.

3. The device of claim 1 wherein the measuring and input means includes a pointer or manual stylus assembly for a therapist or other expert human to bring into physical contact with a pre-determined anatomic locus on the hand, and means for the therapist to actuate the measuring and input means and thereby cause a measurement to be taken.

4. The device of claim 1 wherein the disability determining means includes means to calculate maximum and minimum angles of flexion and extension of the fingers and thereby determine the range of motion possible.

5. The device of claim 1 further comprising means for the therapist to enter data into the computer means corresponding to the measurement of other physiological parameters of the hand.

6. The device of claim 5 further comprising a dynamometer, a pinch gauge, and means interconnecting same to the computer means so that data generated by same is directly entered into the computer means.

7. A device to perform the clinical evaluation of the range of motion of a patient's hands, said device comprising a computer means, a pointer means, a reference, means directly connected to the computer means to generate data corresponding to the position of the pointer means in three dimensional space with respect to the reference, and means for a therapist to cause data generated by the position means to be stored in the computer means so that a therapist can enter data into the computer means corresponding to the maximum flexion and extension of the patient's hands, said computer having means to calculate and communicate the range of motion.

8. The device of claim 7 further comprising means for a therapist to enter data into the computer means corresponding to the measured sensitivity of the patient's hands, the computer means having means to calculate and communicate the degree of disability of the patient's hands.

9. The device of claim 8 further comprising means to generate data corresponding to the gripping strength of the patient's hands, and means to communicate said data to the computer means.

10. The device of claim 8 further comprising means to generate data corresponding to the pinch strength of the patient's hands, and means to communicate said data to the computer means.

11. The device of claim 7 further comprising a work station for containing said device, the work station having a working surface on which the patient's hands are placed for the clinical evaluation, the reference being mounted substantially adjacent to the working surface, and the work station having a shield to minimize electromagnetic interference.

12. The device of claim 7 further comprising means to measure the range of motion of the wrist from measurements taken at the radius and ulna as the wrist is moved from a neutral position to each of a maximum supination position and a maximum pronation position.

13. A clinical range of motion and disability evaluation device comprising a work station having a work surface, a personal computer, a three-dimensional six degree of freedom position locator and wand directly connected to the personal computer, said three-dimensional position locator including a common reference mounted to the work station substantially adjacent the working surface and having means to generate data corresponding to the position of the wand with respect to said reference, a second means connected to the personal computer to control the entry of data from the three-dimensional position locator to the computer wherein a therapist may selectively orient the wand at a plurality of points across a patient's hand and input data corresponding to the position of the joints while the hand is in a state of maximum flexion and extension, and the computer having means to calculate the angles of maximum extension and flexion and a degree of disability therefrom.

14. The device of claim 13 further comprising an electromagnetic shield mounted in the work station and spaced apart from the working surface to shield the common reference from electromagnetic interference.

15. The device of claim 13 further comprising a dynamometer and pinch gauge connected directly to the personal computer to permit data entry into the computer corresponding to the grip strength and pinch strength of a patient's hand.