GB2463247A

GB2463247A - Spinal palpation training mannequin

Info

Publication number: GB2463247A
Application number: GB0816118A
Authority: GB
Inventors: Katy Jane Roberts
Original assignee: Individual
Current assignee: Individual
Priority date: 2008-09-04
Filing date: 2008-09-04
Publication date: 2010-03-10
Also published as: GB0816118D0

Abstract

A spinal palpation training mannequin comprises a life-sized, anatomically accurate human body section 11 containing an anatomically accurate spine comprising vertebrae 13 capable of relative rotational and translational movement equivalent to that of human vertebrae. A sensor 30 associated with vertebrae 13 detects force applied during palpation and generates a force-dependent signal which is interpreted and displayed using a display 12 to indicate the strength of force applied to the vertebrae 13. Sensors 30 may be attached to each vertebra to detect the strength of force applied to each vertebra, the end-of-range movement of each vertebra, the direction of force applied to each vertebra, and/or the spinal level to which force is being applied. The display 12 may visually and/or audibly indicate the strength of force applied. The mannequin may include additional anatomically accurate skeletal elements, e.g. scapulae 14, ribs 15, pelvis 17 and/or hips. The spinal and skeletal elements may comprise polyurethane, metal or PVC, and the body section may comprise resilient material, e.g. latex or silicone rubber. The mannequin may include a head section 16, and resilient discs (26, fig. 2) may be located between the vertebrae which permit relative movement of the vertebrae when palpated.

Description

TRAINING MANNEQUIN

The present invention relates to a training mannequin, and in particular to an anatomically accurate training mannequin for practicing palpation of a spine.

For any healthcare practitioner involved with the treatment of backs, such as a physiotherapist, osteopath or chiropractor, palpation of a patient's spine is routinely used in the diagnosis and treatment of spinal dysfunction.

An initial spinal assessment involves taking a full subjective history of the patient, a physical observation, physiological range of movement measurements, special tests, reflexes and spinal palpation.

Palpation is used to gain valuable information; initially it is used, together with anatomical landmarks, to identify the position on the spine (or "spinal level") affected. Palpation is also used to detect any changes to intervertebral joint movement such as hyper-hypomobility (resistance felt) and end of range (or end-feel). Palpation can also help isolate the source of pain and establish the pain's characteristics.

Through practice and experience, a practitioner can establish the feel of normal joint movement and thereby identify abnormalities. Although any changes found may be asymptornatic, certain pathologies have specific characteristics that can assist when trying to form a differential diagnosis.

To palpate the spine, movement of each vertebra is assessed by applying force in the form of oscillatory postero-anterior (PA) movements on each of the spinous processes and also on the transverse processes (or along the articular pillar), whilst the patient lies in a prone position. Each of the vertebrae must be assessed in order to compare adjacent spinal levels and also the differences between left and right side.

To conduct palpations, the practitioner can either use their thumbs, or for the larger joints that require more force, the heel of one hand over the other, which is called the pisiform grip.

The amount and exact direction of force applied to each vertebra can be varied and this will provide different results, so it is important to ensure that the right amount of force is applied. If the force is too light, the end of range is unlikely to be felt or for the assessment to be effective. If too strong, the full range of movement cannot be appreciated and it is likely to elicit muscle spasm and pain with a resulting lack of trust between practitioner and the patient. Throughout the spine, the depth, curve and position of the joints vary and therefore the force of palpation needs to be adapted accordingly.

By altering the direction of the force applied, the exact point of contact of one vertebra on the other will vary. By applying force in a combined PA and medial direction on the transverse process, or PA cephalad direction on the spinous process, will produce a sliding movement at the apophyseal (facet) joint and can give a good indication of the quality of movement at this joint. The inclination or plane of the joint varies throughout the spine, so to effectively glide one vertebra over the other, the direction of the force applied needs to be altered accordingly.

Whilst palpating the spine in this way, the practitioner is noting any areas of pain or elicited muscle spasm, quality of movement, changes to resistance and position and feel of end-range. This information, together with the subjective history and other manual tests applied, help the practitioner to form an overall picture of the problems involved and make a differential diagnosis. A problem list and treatment plan can then be established.

Whilst treating the spine, palpation is also used in the above way to provide regular feedback to the practitioner in order to adapt or maintain the treatment applied.

A spinal dysfunction of mechanical origin often responds well to spinal mobilisations. This is a manual treatment applied to the patient lying in a prone position. Using their thumbs or pisiform grip, the practitioner applies a rhythmical force, in a PA direction, to the skin overlying the patient's spinous or transverse processes. The level of treatment applied is graded. These grades are defined according to the amplitude and amount of force applied by the practitioner. The treatment is thought to help mobilise the joints and soft tissue of the spine, thus reducing stiffness and pain.

One of the most popular treatment approach used is the Maitland concept whose grades are defined below: Grade I -small amplitude movement performed below resistance, used to treat highly irritable conditions; Grade II -large amplitude movement performed below resistance, at the midrange of joint play; Grade III -large amplitude movement performed within resistance, at the end of joint play; and Grade IV -small amplitude movement performed within resistance, at end of joint play, used to treat chronic conditions of low irritability.

Each grade is thought to affect different mechanoreceptors of the spine and therefore used for different conditions; it is for this reason that it is important to be able to alter amplitude and force accordingly.

Other manual treatments that are regularly used for the treatment of the spine have not been detailed here, but do require similar degrees of accuracy of palpation and touch. There are many other medical situations where accurate training of spinal palpation is important that have not been detailed here, such as for anaesthetists using spinal injections or epidurals, or surgeons in particular orthopaedic spinal surgeons.

It is widely accepted that there is poor reliability between practitioners when assessing both spinal level and range of joint movement, and the reason for this is thought to be due to a lack of a standardized educational training method. Currently, training consists of comparing a student's assessment with the tutor's judgement which is quite subjective. An alternative method used includes the use of so-called range of movement diagrams, which are thought to provide limited practical carryover.

By far the best way to learn palpation is through practice, yet it is not easy for a student practitioner to know whether they are applying the correct force, or applying it to the correct place or in the correct direction. There are also ethical questions as to whether a student should practice palpation on a human subject.

Therefore, a practical training model is required that can objectively improve the accuracy of the assessment and treatments of the spine.

According to the present invention there is provided a training mannequin on which a user practices spinal palpations comprising: -a life-sized and anatomically accurate human body section; -an anatomically accurate spine, comprising vertebrae, disposed within the body section, the vertebrae being capable of relative rotational and translational movement equivalent to that of human vertebrae; -at least one sensor associated with each vertebra that detect force applied thereto during palpation and which generate a force-dependent signal; and -means to interpret and display the signal from the force sensors to indicate the strength of force applied to the vertebrae.

Practitioners and students will primarily use the training mannequin so that they can develop consistent palpation skills.

The training mannequin must be anatomically accurate so that the body section and the spine have the same shape, feel, and proportions of a real spine within a patient's body. The mannequin may be of any size to equate to an adult or child, but the proportions must be accurate. To ensure that the mannequin feels as real as possible to the user, the body section preferably includes one or more of the following skeletal elements: scapulae, rib cage, pelvis, and hips. To further improve the feel and appearance of the mannequin, and because vertebrae extend up into the neck, it is also preferred that the body section of the mannequin further comprises a head.

The spine and other skeletal elements, if present, should have a full and realistic range of movements, feel identical to those on a real body, and be sturdy enough to withstand repeated force. Therefore it is preferred that the spine and skeletal elements are constructed from polyurethane, metal or PVC.

The vertebrae must be capable of the full range of rotational and translational movement of those of a human spine. Therefore it is preferable that resilient discs, which permit relative movement of the vertebrae when palpated, are located between the vertebrae. Alternatively the vertebrae can be separated by different means that permit this movement.

It is preferred that the body section is made from latex or silicone rubber, as this provides a similar feel and resistance to human skin and muscle.

The present invention is preferably arranged so that a practitioner or student can practice palpating the spine of the mannequin in exactly the same way as would be performed on a human patient. The sensors will therefore preferably enable detection of the strength of force being applied to the spine, the direction of force, the end-of-range movement for each vertebra and also identify the vertebra being palpated. Because each vertebra will preferably have independent movement, as per a human spine, a sensor is preferably attached to each vertebra.

A display console, which includes a processor, will preferably interpret and display the signal from the sensors. This console will relay to the user information relating to the various parameters detected by the sensors. The display console preferably includes a screen to display, in visual form, information to the user derived from the processed signal. Alternatively or additionally, the display console may further provide an audible signal deriving from the processed signal. The display console will preferably be remote from the body section, but could be placed within the body section, which could be provided with a screen or speaker from which feedback is provided to the user.

The processor preferably contains several training programmes. One example of training program is where a user is requested to apply a certain amount of force to a particular vertebra in order to detect end-of range movement. If the user applies the correct level of force on the correct vertebra, the display console will indicate this to them with a visual or audible signal. This enables the user to get a consistent feel for carrying out palpations.

So that it may be better understood, one embodiment of the present invention will now be described in detail with reference to the drawings wherein: Figure 1 shows a transparent side view of a mannequin according to the present invention and a display console device; and Figure 2 shows detail of the spine and sensors of the present invention.

Referring to both Figures there is shown a training mannequin for practicing spine palpation. The mannequin comprises a body section generally indicated 11 and a display console generally indicated 12. The body section is anatomically accurate in its proportions and is made of silicone rubber to emulate the feel of a human body, in particular the skin and soft tissue thereof.

Contained within the body section 11 are various anatomically accurate skeletal elements, including vertebrae 13, scapulae 14, ribs 15, a skull 16 and a pelvis 17. The vertebrae 13 are of varying shape and size, but are generally similar so for ease of reference they are assigned the same reference number. The skeletal elements are constructed from a suitably tough material such as polyurethane, PVC or metal. As well as providing support to the body section 11, the skeletal elements feel the same to a user when palpated through the body section 11 as human skeletal elements when a human's spine is palpated.

Figure 2 shows a series of vertebrae 13 from the spine of the present invention in more detail. Each vertebra 13 includes spinous processes 21, transverse processes 22, superior articular processes 23, interior articular processes 24, and vertebral bodies 25. Some of these regions of the vertebrae 13 will be felt during palpation. Between each vertebra 13 are resilient discs 26 which permit relative movement of the vertebrae. The discs 26 provide equivalent movement and resilience characteristics to those of intervertebral discs on humans.

Attached along the underside of the body 25 of each vertebra 13 is a senor 30, which detects force applied to the vertebrae 13 during palpation.

The sensors 30 are connected to the display console 12 via wire 31. The sensors 30 are capable of distinguishing different types of force. In particular the force sensors 30 will detect the strength of force being applied to the vertebrae 13, the direction of force applied to each vertebrae 13, and indicate the extent of movement of one vertebra 13 relative to another.

Within the display console 12 is a processor (not shown), LCD screen 32 and control buttons 33. The purpose of the display console 12 is to interpret the signal from the sensors 30 and relay to the user information that is useful when learning how to palpate a spine. In particular the display console 12 will indicate to a user on screen 32 the nature of the force applied to the spine of the mannequin, the direction of force being applied, the spinal level being palpated, and the end-of-range.

During use, a user will palpate the spine of the body section 11. To do this they will apply force to various parts of each vertebra 13 using known palpation techniques as previously described.

When force is applied to the vertebrae 13, the force is detected by the sensors 30, which generate a signal. The signal is sent to the display console 12 along wire 31, where it is analysed by the processor. The buttons 33 are used to control the display console 12, including selecting various training programs.

One example of training program is where a user is requested to apply a certain strength of force to a particular vertebra in order to detect end-of range. If the user applies the correct level of force on the correct vertebra, the display console will indicate this to them with a visual or audible signal.

The enables the user to get a consistent feel for carrying out palpations.

The processor could also contain a program that simulates certain pathologies such as damage to a patient's back, so a user can practise applying various forces to diagnose and treat such pathologies. In particular the processor can simulate the Maitland treatment programme for practice by the user.

The display console 12 will indicate to the user which vertebra 13 is being palpated to indicate the spinal level. Palpation of the vertebrae 13 moves one vertebra in relation to the adjacent vertebrae. From this movement, information about the spine can be obtained. When a user is attempting to identify the end-of range of a particular vertebra, the display console 12 will notify the user when the end of range has been achieved.

The user will be informed whether the force applied is sufficient and through repeated practice will be able to recognise the feel of accurate palpation.

Claims

CLAIMS1. A training mannequin on which a user practices spinal palpations comprising: -a life-sized and anatomically accurate human body section; -an anatomically accurate spine, comprising vertebrae, disposed within the body section, the vertebrae being capable of relative rotational and translational movement equivalent to that of human vertebrae; -sensors associated with each vertebra that detect force applied thereto during palpation and which generate a force-dependent signal; and -means to interpret and display the signal from the force sensors to indicate the strength of force applied to the vertebrae.
2. A training mannequin as claimed in claim 1, wherein one or more sensor is attached to each vertebra.
3. A training mannequin as claimed in claim 1 or claim 2, wherein the sensors detect the strength of force applied to each vertebra.
4. A training mannequin as claimed in any of the preceding claims, wherein the sensors detect the end-of range movement of each vertebra.
5. A training mannequin as claimed in any of the preceding claims, wherein the sensors detect the direction of force applied to each vertebra.
6. A training mannequin as claimed in any of the preceding claims, wherein the sensors detect the spinal level to which force is being applied.
7. A training mannequin as claimed in any of the preceding claims, further comprising a display console linked to the sensors, the display console including a processor, which interprets the signal from the sensors.
8. A training mannequin as claimed in claim 7, wherein the display console further includes a screen to display in visual form information to the user interpreted from the processed signal.
9. A training mannequin as claimed in claim 7 or claim 8, wherein the display console further provides an audible signal activated in response to the processed signal to inform the user.
10. A training mannequin as claimed in any of the preceding claims, wherein the body section further includes one or more of the following anatomically accurate skeletal elements: scapulae, rib cage, pelvis, and hips.
11. A training mannequin as claimed in any of the proceeding claims, wherein the spine and any additional skeletal elements are constructed from polyurethane, metal or PVC.
12. A training mannequin as claimed in any of the preceding claims, wherein the body section further comprises a head.
13. A training mannequin as claimed in any of the preceding claims, wherein the body section is made from a resilient material such as latex or silicone rubber.
14. A training mannequin as claimed in any of the preceding claims, wherein resilient discs are located between the vertebrae, which permit relative movement of the vertebrae when palpated.
15. A training mannequin as claimed in claim 1 and as substantially herein described with reference to and as illustrated in the accompanying drawings.