U.S. patent application number 11/198399 was filed with the patent office on 2006-03-23 for isometric system, method and apparatus.
Invention is credited to Thomas L. Harris, Michael A. Smyser, Ronald L. Wiley.
Application Number | 20060064042 11/198399 |
Document ID | / |
Family ID | 32092408 |
Filed Date | 2006-03-23 |
United States Patent
Application |
20060064042 |
Kind Code |
A1 |
Smyser; Michael A. ; et
al. |
March 23, 2006 |
Isometric system, method and apparatus
Abstract
System, method and apparatus for carrying out isometric
exercises for either diagnostic purposes or therapeutic purposes.
When employed in a diagnostic mode, the instrument is programmed to
carry out standardized diagnostic regimens and during such regimens
provides both visual and aural cues, carries out mathematical
computations of force values and provides recordation of diagnostic
data in archival memory. When employed in a therapeutic mode the
apparatus may only be programmed within mandated therapeutic
parameter limitations. During therapeutic trials, the user is
visually and aurally cued throughout the test sequence and the
therapeutic data evolved during the regimen is recorded and
recoverable from archival memory.
Inventors: |
Smyser; Michael A.; (Galena,
OH) ; Wiley; Ronald L.; (Oxford, OH) ; Harris;
Thomas L.; (Powell, OH) |
Correspondence
Address: |
EPSTEIN BECKER & GREEN, P.C.
1227 25TH STREET, N.W. 7TH FLOOR
WASHINGTON
DC
20037
US
|
Family ID: |
32092408 |
Appl. No.: |
11/198399 |
Filed: |
August 8, 2005 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10268363 |
Oct 10, 2002 |
6962569 |
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11198399 |
Aug 8, 2005 |
|
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60330265 |
Oct 18, 2001 |
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Current U.S.
Class: |
600/595 ;
73/379.01 |
Current CPC
Class: |
A61B 5/225 20130101;
A63B 2225/20 20130101; A63B 24/00 20130101; A63B 2220/53 20130101;
G16H 20/30 20180101; A63B 21/0023 20130101; A61B 5/6825 20130101;
A61B 2560/0406 20130101 |
Class at
Publication: |
600/595 ;
073/379.01 |
International
Class: |
A61B 5/103 20060101
A61B005/103; A61B 5/117 20060101 A61B005/117; A61B 5/22 20060101
A61B005/22; G01L 3/24 20060101 G01L003/24; A63B 21/00 20060101
A63B021/00 |
Claims
1-77. (canceled)
78. Apparatus for carrying out a protocol-based isometric exercise
regimen, comprising: a rigid housing having a hand grasping portion
with first and second base grip components having respective
outwardly disposed first and second elongate grasping surfaces,
said first and second grip surfaces being spaced apart a first
predetermined widthwise extend and said first base grip having a
first base connector assembly adjacent the said first grip surface
thereof, said housing having an interacting portion fixed to and
extending from said hand grasping portion; an elongate rigid thrust
plate positioned within said housing hand grasping portion in force
transfer relationship with said first and second base grip
components; a load cell assembly coupled in stress transfer
relationship with said thrust plate and having a force output
signal in response to stress imposed from said first and second
base grip components; a control circuit within said housing
responsive to said force output signal to provide an evaluation
output; a readout assembly mounted at said housing interaction
portion, responsive to said evaluation output to provide a
perceptible output corresponding therewith; and a first auxiliary
grip component having a first auxiliary grasping surface and a
first auxiliary connector assembly adjacent said first auxiliary
grasping surface removably connectable with said first base
connector assembly, when said first auxiliary connector assembly is
connected with said first base connector assembly said first
auxiliary grasping surface being spaced from said second base grip
second grasping surface a second predetermined widthwise extent
greater than said first predetermined widthwise extent.
79. The apparatus of claim 78 in which: said second base grip
component includes a second base connector assembly adjacent the
said second elongate grasping surface thereof; and aid first
auxiliary grip component first auxiliary connector assembly is
removably connectable with said second base connector assembly,
when said first auxiliary connector assembly is connected with said
second base connector assembly said first auxiliary grasping
surface being spaced from said first base grip first grasping
surface said second predetermined widthwise extent.
80. The apparatus of claim 78 in which: said first auxiliary grip
component is generally semi-cylindrical in shape, and said first
auxiliary grasping surface is of an undulatory finger grasping
configuration.
81. The apparatus of claim 78 in which: said second base grip
component includes a second base connector assembly adjacent the
said second elongate grasping surface thereof; and further
comprising a second auxiliary grip component having a second
auxiliary grasping surface and a second auxiliary connector
assembly adjacent said second auxiliary grasping surface removably
connectable with said first base connector assembly as said second
base connector assembly, when said second auxiliary connector
assembly is connected with said first or second base connector
assembly said second auxiliary grasping surface being spaced from
respective said second or first grip surface said second
predetermined widthwise extent.
82. The apparatus of claim 81 in which: said second auxiliary grip
component is generally semi-cylindrical in shape, and said second
auxiliary grasping surface is generally of concave curvature
effective to engage the palm of the hand.
83. The apparatus of claim 78 in which: said second base grip
component includes a second base connector assembly adjacent the
said second elongate grasping surface thereof; further comprising a
second auxiliary grip component having a second auxiliary grasping
surface and a second auxiliary connector assembly adjacent said
second auxiliary grasping surface removably connectable with said
first base connector assembly; said first auxiliary grip component
first auxiliary connector assembly is removably connectable with
said second base connector assembly; and when said first auxiliary
connector assembly is connected with said second base connector
assembly and said second auxiliary connector assembly is connected
with said first base connector assembly, said second auxiliary
grasping surface is spaced from said first auxiliary grasping
surface a third predetermined widthwise extent greater than said
second predetermined widthwise extent.
84. The apparatus of claim 78 in which: said readout assembly is
mounted at said housing interaction portion in an angular
orientation effective to be observed only from an eye station
having a line of sight confronting said first base grip
component.
85. A system for carrying out an isometric exercise regimen by a
user, comprising: a hand grip assembly including a load cell
component responsive to compressive squeezing force applied by a
hand of said user to derive a load value output corresponding with
the value of said force; a display, responsive to a visual input
signal to provide a visually perceptible display output; first and
second control members hand actuable to provide respective first
and second control conditions; a controller including a processor
and memory operatively associated therewith; and said processor
being responsive to said first control condition to conditionally
enter a diagnostic grip test mode providing a said visual input
signal deriving a first prompt at said display to actuate said
first control member to enter said diagnostic grip test mode, is
responsive to said second control condition to v conditionally
enter a therapy mode, and is then responsive to said first control
f condition to provide a said visual input signal deriving a second
prompt at said display to actuate said first control member to
enter said therapy mode.
86. The system of claim 85 in which: said processor is responsive
in the presence of said first prompt to said first control
condition to derive a said visual input signal providing a third
prompt to said user at said display to actuate said first control
member to enter a maximum grip test therapy mode.
87. The system of claim 85 in which: said processor is responsive
in the presence of said first prompt to said second control
condition to derive a said visual input signal providing a fourth
prompt at said display to actuate said first control member to
enter a rapid exchange diagnostic mode.
88. The system of claim 85 in which: said processor is responsive
in the presence said second prompt to said first control condition
to derive a said visual input signal providing a fifth prompt at
said display to actuate said first control member to enter a fixed
exercise therapy mode.
89. The system of claim 85 in which: said processor is responsive
in the presence of said second prompt to said second control
condition to derive a said visual input signal providing a sixth
prompt at said display to actuate said first control member to
enter a stepped exercise therapy mode.
90-93. (canceled)
94. A method for carrying out an isometric exercising by a user,
comprising the steps of: identifying a muscle group of said user
for isometrically exercising; measuring the maximum isometric
strength capability value of said identified muscle group;
identifying a protocol matrix of factors; nominating values to said
factors; initiating and monitoring an exercise protocol based upon
a said factor, applied to said measured maximum strength to derive
a target force value and a factor representing a hold interval for
said target force; annunciating an alarm when said target force
value is exceeded by said user during said exercise; compiling
exercise data from said exercise protocol; and archiving said
exercise data.
95. The method of claim 94 further comprising the step: providing
compliance scores during said exercise protocol.
96. The method of claim 94 in which: said muscle group is
identified from the group comprising: jaw muscles, neck muscles,
shoulder muscles, upper arm muscles, lower arm muscles, hand
muscles, finger muscles, diaphragm muscles, abdominal muscles,
lower back muscles, upper leg muscles, lower leg muscles, ankle
muscles, foot muscles, and toe muscles.
97. The method of claim 94 further comprising the step of:
establishing a goal strength of measuring the maximum strength of
an unimpaired muscle group contralateral to said identified muscle
group.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of U.S. application Ser.
No. 10/268,363 filed Oct. 10, 2002, which claims priority of U.S.
Provisional Application No. 60/330,265 filed Oct. 18, 2001.
STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH
[0002] The use of isometric as compared to rhythmic exercise in the
general field of athletic strength development, as well as a
therapy for strength recovery has been the subject of somewhat
controversial discourse over the past decades. In general, such
exercise has been considered to promote, for example, coronary risk
factors. See generally:
[0003] (1) Vecht R J, Graham G W S, Server P S. "Plasma
Noradrenaline Concentrations During Isometric Exercise." Brit Heart
J. 1978; 40:1216-20.
[0004] (2) Chrysant S G. "Hemodynamic Effects of Isometric Exercise
in Normotensive Hypertensive Subjects": Hypertension. Angiology
1978:29(5):379-85.
[0005] However, as such attitudes persisted, some investigators
commenced to observe contradictions to these generally accepted
beliefs. See for, example, the following publications:
[0006] (3) Buck, et al., "Isometric Occupational Exercise and the
Incidence of Hypertension", J. Occup. Med., 27:370-372, 1985.
[0007] (4) Choquette, et al., "Blood Pressure Reduction in
`Borderline` Hypertensivies Following Physical Training" Can. Med.
Assoc. J. 1108:699-703, 1973.
[0008] (5) Clark, et al., "the Duration of Sustained Contractions
of the Human Forearm of Different Muscle Temperatures", J.
Physiol., 143:454-473, 1958.
[0009] (6) Gliders, et al., "Endurance Training and Blood Pressure
in Normotensive and Hypertensive Adults", Med. Sci. Sports Exerc.
21:629-636, 1989.
[0010] (7) Hagberg, et al., "Effect of Weight Training on Blood
Pressure and Hemodynamics in Hypertensive Adolescents", J. Pediatr.
1104:147-151, 1984.
[0011] (8) Harris, et al., "Physiological Response to Circuit
Weight Training in Borderline Hypertensive Subjects", Med. Sci.
Sports Exerc., 19:246-252, 1987.
[0012] (9) Hurley, et al., "Resistive Training Can Induce Coronary
Risk Factors Without Altering VO.sub.2 max or Percent Body Fat"
Med. Sci. Sports Exerc. 20:150-154, 1988.
[0013] (10) Hypertension Detection and Follow-Up Program
Cooperative Group, "The Effect of Treatment on Mortality in `Mild`
Hypertension", N. Engl. J. Med., 307:976-980, 1982.
[0014] (11) Kiveloff, et al., "Brief Maximal Isometric Exercise in
Hypertension", J. Am. Geriatr. Socl, 9:1006-1012, 1971.
[0015] (12) Merideth et al., "Exercise Training Lowers Resting
Renal but not Cardiac Sympathetic Activity in Humans",
Hypertension, 18:575-582, 1991.
[0016] (13) Seals and Hagberg, "The Effect of Exercise Training on
Human Hypertension: A Review", Med. Sci. Sports Exerc., 16:207-215,
1984.
[0017] (14) Hanson P, Nagle F. "Isometric Exercise: Cardiovascular
Responses in Normal and Cardiac Populations." Cardiology Clinics
1987; 5(2):157-70.
[0018] Such speculation on the part of these early observers was
confirmed by Wiley in the 1990s, as described in U.S. Pat. No.
5,398,696 entitled "Isometric Exercise Method for Lowering Resting
Blood Pressure and Grip Dynamometer Useful Therefore", issued Mar.
21, 1995 and as described in the following publication:
[0019] (15) Wiley, et al., "Isometric Exercise Training Lowers
Resting Blood Pressure", Med. Sci. Sports Exerc. 29:749-754,
1992.
[0020] With the approach or protocol developed by Wiley, the
isometric regimen is closely controlled both in terms of exerted
force and in the timing of trials or exertions.
[0021] In contrast, earlier subjects or trainees undergoing
isometric exercise stressed the involved musculature to their full
or maximum capability (publication
[0022] (11)) or at some submaximal force as long as it could be
sustained, in either case only terminating with the onset of
unendurable fatigue. Such approaches often have incurred somewhat
deleterious results as evidenced by the injuries sustained in
consequence of improper weightlifting procedures. Weightlifting
procedures or endeavors exhibit a significant isometric factor. See
generally:
[0023] (16) Lind A R. "Cardiovascular Responses to Static Exercise"
(Isometrics, Anyone?) Circulation 1970; 41(2): 173-176.
[0024] (17) Mitchell J H, Wildenthal K. "Static (Isometric)
Exercise and the Heart: Physiological and Clinical Considerations".
Ann Rev Med 1974; 25:369-81.
[0025] The diagnosis of patient hand-arm strength using
isometric-based testing has been employed by physiologists,
physical therapists and medical personnel for over three decades.
These procedures function to evaluate hand-arm trauma or
dysfunction and involve the patient use of a handgrip-based
dynamometer. The dynamometer is grasped by the patient and squeezed
to a maximum capability under the verbal instruction of an
attending therapist or diagnostician. The hand dynamometer most
widely used for these evaluations incorporates a grip serving to
apply force through closed circuit hydraulics to a force readout
provided by an analog meter facing outwardly so as to be
practitioner readable. Adjustment of the size of the grip of the
dynamometer is provided by inward or outward positioning of a
forwardly disposed grip component. The dynamometers currently are
marketed under the trade designation: "Jamar Hydraulic Hand
Dynamometer" by Sammons Preston of Bolingbrook, Ill. An extended
history of use of these dynamometers has resulted in what may be
deemed a "standardization" of testing protocols. For instance,
three of the above-noted grip length adjustments are employed in a
standardized approach and verbal instructions on the part of the
testing attendant, as well as the treatment of force data read from
the analog meter are now matters of accepted protocol. In the
latter regard, multiple maximum strength values are recorded,
whereupon average strengths, standard deviations and coefficients
of variation are computed by the practitioner. In one test, the
instrument is alternately passed between the patient's right and
left hands to derive a maximum strength output reading each 1.5
seconds or 2.5 seconds. Reading and hand recording strength values
for such protocols has remained problematic. The protocols, for
example, have been the subject of recommendations by the American
Society of Hand Therapist (ASHT) and have been discussed in a
variety of publications including the following:
[0026] (18) Mathiowetz V., Federman S., Wiemer D. "Grip and Pinch
Strength: Norms for 6 to 19 Year Olds." The American Journal of
Occupational Therapy 40:705-11, 1986.
[0027] (19) Mathiowetz V., Donohoe L., Renells C. "Effect of Elbow
Position on Grip and Key Pinch Strength." The Journal of Hand
Surgery 10A:694-7, 1985.
[0028] (20) Mathiowetz V., Dove M., Kashman N., Rogers S., Volland
G., Weber K. "Grip and Pinch Strength: Normative Data for Adults."
Arch Phys Med Rehabilitation 66:69-72, 1985.
[0029] (21) Mathiowetz V., Volland G., Kashman N., "Reliability and
Validity of Grip and Pinch Strength Evaluations." The Journal of
Hand Surgery 9A:22-6, 1984.
[0030] In about 1998, the above-noted Wiley protocols as described
in connection with publication (12) above were incorporated in a
compact, lightweight isometric device. Described in detail in U.S.
Pat. No. 5,904,639 entitled "Apparatus, System, and Method for
Carrying Out Protocol-Based Isometric Exercise Regimens" by Smyser,
et al., the hand-held dynamometer has a hand grip which
incorporates a load cell assembly. Extending from the hand grip is
a liquid crystal display and two user actuated control switches or
switch buttons. The display is mounted in sloping fashion with
respect to the grip such that the user can observe important visual
cues or prompts while carrying out a controlled exercise regimen
specifically structured in terms of force values and timing in
accordance with the Wiley protocols. This device is therapeutic as
opposed to diagnostic in nature and is microprocessor driven with
archival memory. External communication with the battery powered
instrument is made available through a communications port such
that the device may be configured by programming and, additional
data, such as blood pressure values and the like may be inserted
into its memory from an external device. Visual and audible cueing
not only guides the user through a multi-step protocol but also
aids the user in maintaining pre-computed target level grip
compression levels.
[0031] Of course, it will be beneficial to incorporate improved
diagnostic features for hand-arm evaluation techniques with
therapist or practitioner designed therapeutic protocols
specifically tailored to the condition of a given patient and which
provide a control over such therapies clearly establishing such
therapies as beneficial to strength development and recovery.
BRIEF SUMMARY OF THE INVENTION
[0032] The present invention is addressed to a system method and
apparatus for carrying out a controlled isometric regimen by a
user. Being microprocessor driven, the instrument is programmed to
carry out established diagnostic as well as newly developed
grip-based isometric regimens. When carrying out diagnostic
procedures, the attending diagnostician may elect either a maximum
grip test or a rapid exchange testing procedure. When employed for
carrying out a diagnostic maximum grip test, the diagnostician
selects configuration parameters and the instrument provides both
visual and audible prompts and cues throughout the procedure.
Maximum grip forces for each of the sequence of trials of this
procedure are selected typically by the diagnostician and when so
selected are recorded in instrument memory along with calendar
data, and processor computed values for average grip force,
standard deviation of the force values throughout a sequence of
tests and corresponding coefficients of variation. At the
termination of the diagnostic procedure, memory recorded test data
are displayable to the diagnostician and may be downloaded through
a communications port to a computer facility.
[0033] When utilized in a rapid exchange test mode, the attending
diagnostician again programs the instrument with elected but
standardized test parameters. At the commencement of and during the
ensuing multi-trial test procedure, the patient may be provided
with aural cues and, at the election of the diagnostician with
visual cues. Grip force values for each trial are recorded in
memory. As before, the instrument processor accesses that memory
retained data and computes average grip force values, corresponding
standard deviation for those force values and coefficient of
variation, the values of which also are recorded in memory. At the
termination of the multi-trial test regimen, the diagnostician is
provided a successive display of the force values and associated
computed information recorded in instrument memory.
[0034] For each of the diagnostic procedures, the widthwise extent
of the instrument grip may be both varied in standard 1/2 inch
increments from a minimum width. The grip is further configured
such that the visually perceptible readout of the instrument may be
viewed only by the diagnostician where deemed appropriate.
[0035] An important aspect of the therapeutic method associated
with the instrument of the invention resides in the limiting of
user performance to carry out the regimen of trials. In this
regard, the instrument is programmed to perform only within
predetermined and mandated test limits. Two therapeutic methods are
described, a fixed therapy and a stepped therapy. Each therapeutic
regimen is based upon an initial evaluation of the maximum gripping
force capability of the user. Under that limitation, target load
factors, hold on target load intervals, intervening rest intervals
and trial repetition numbers may be elected only from
pre-established and mandated memory retained ranges. The program
also nominates rest intervals and hold on target intervals in
correspondence with user elected target force factors. Thus,
valuable strength recovery and development may be achieved but only
within safe limits.
[0036] During each of the above therapeutic regimens, an audible
warning is elicited whenever the user grip force value exceeds a
computed upper limit. During each timed interval wherein the user
is prompted to grip at a target force value computed with respect
to the pre-tested maximum grip force, a dynamic bar graph and
center point display is provided as a visual cue related to desired
grip performance. Additionally, a rapid succession of score values
are computed and the average thereof recorded at the end of each
trial of a given regimen. These scores permit a therapist to access
the quality of the performance of the user. In general, trial data
is recorded in conjunction with calendar data and, as before, may
be downloaded to a computer facility from an instrument contained
communications port.
[0037] Other objects of the invention will, in part, be obvious and
will, in part, appear hereinafter.
[0038] The invention, accordingly, comprises the method, system and
apparatus possessing the construction, combination of elements,
arrangement of parts and steps which are exemplified in the
following detailed description.
[0039] For a fuller understanding of the nature and objects of the
invention, reference should be made to the following detailed
description taken in connection with the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
[0040] FIG. 1 is a perspective view of apparatus according to the
invention showing its orientation with respect to a users hand
wherein its display is viewable by such user;
[0041] FIG. 2 is a perspective view of the apparatus of FIG. 1
showing the orientation of the apparatus with respect to the users
hand wherein the display thereof is not visually accessible to the
user;
[0042] FIG. 3 is an exploded perspective view of the apparatus of
FIG. 1;
[0043] FIG. 4 is a side sectional view of the apparatus of FIG.
1;
[0044] FIG. 5 is a side view of the apparatus of FIG. 1 showing a
minimum grip width configuration;
[0045] FIG. 6 is a side view of the apparatus of FIG. 1 showing an
orientation for user viewing of its display and a grip widthwise
extent 1/2 inch greater than the grip orientation of FIG. 5;
[0046] FIG. 7 is a side view of the instrument of FIG. 1 showing an
orientation for user viewing of its display and illustrating a grip
widthwise extent of maximum value;
[0047] FIG. 8 is a side view of the instrument of FIG. 1 showing an
orientation for diagnostic viewing and a grip widthwise extent
corresponding with that of FIG. 6;
[0048] FIG. 9 is a side view of instrument of FIG. 1 showing a
display orientation for viewing of a display by a diagnostician and
having a grip widthwise extent corresponding with that of FIG.
7;
[0049] FIG. 10 is a block diagrammatic drawing of the circuit
employed with the apparatus of FIG. 1;
[0050] FIG. 11 is a flow chart describing the start up components
of the program of the instrument of FIG. 1 as well as a
configuration routine;
[0051] FIGS. 12A and 12B combine as labeled thereon to provide a
flow chart of a maximum grip test diagnostic procedure;
[0052] FIG. 13 is a flow chart illustrating a rapid exchange
diagnostic procedure;
[0053] FIGS. 14A-14C combine as labeled thereon to illustrate a
flow chart describing a therapeutic fixed exercise regimen carried
out by the instrument of FIG. 1;
[0054] FIG. 15 is a flow chart demonstrating the technique by which
a score value is developed by the apparatus of the invention;
[0055] FIGS. 16A-16E are a sequence of displays provided by the
instrument of the invention showing a publication of score, a
dynamic bar graph with center pointer and a time remaining cue;
[0056] FIGS. 17A-17C combine as labeled thereon to illustrate a
flow chart of a step therapeutic exercise which may be carried out
with the instrument of the invention;
[0057] FIG. 18 is a flow chart showing an intentional power off
sequence; and
[0058] FIG. 19 is a flow chart describing the applicability of the
use of isometric exercise in conjunction with safe muscle
strengthening and therapy protocols for a broad range of muscle
groups.
DETAILED DESCRIPTION OF THE INVENTION
[0059] Isometric exercise apparatus under which the methodology of
the invention may be carried out is lightweight, portable, battery
powered and sufficiently rugged to withstand the compressive
pressures which it necessarily endures during use. The instrument
is programmable such that it may be utilized by a therapeutic
practitioner for diagnostic purposes employing established grip
test modalities. Strength measurements carried out during these
modes are compiled in memory and the practitioner is afforded
calculated values for average grip force, standard deviation and
coefficient of variation with respect to grip force trials.
Furthermore, individual strength measurements compiled in these
averages, whether taken rapidly or slowly, are stored in memory and
may be reviewed by the therapist.
[0060] Additionally, the instrument is employable as a therapeutic
device. First a protocol is nominated by prescribing nominal
parameters of the effort. Each isometric regimen is controlled
initially by requiring that a maximum grip strength be established
for each individual patient or user. Then, the practitioner may
elect parameters of grip force and timing under mandated memory
contained parameter limits. Accordingly, the user will be unable to
carry out strength enhancement therapies which would otherwise
constitute an excessive grip force regimen. For carrying out the
noted diagnostic procedures as well as therapy activities, the grip
widthwise extent is variable from 17/8 inches to 27/8 inches, such
variation being adjustable in 1/2 inch increments. This is in
keeping with standardized diagnostic practices. Further with
respect to diagnostic procedures, the display or readout of the
instrument can be adjusted with respect to the grip structuring
such that only the practitioner or therapist may observe the data
which is being developed during a diagnostic protocol.
[0061] Looking to FIG. 1, the instrument or apparatus is
represented generally at 10 as having a housing identified
generally at 12. Housing 12 is formed of acrylonitrile butadiene
styrene (ABS) and, thus, is resistant to impact phenomena and the
like. FIG. 1 shows that the housing 12 includes a hand grasping
portion 14 and an integrally formed interacting portion 16.
Interacting portion 16 supports a readout assembly 18 which is
configured as an elongate liquid crystal display (LCD).
Additionally located at the interacting portion are two finger
actuable switches represented generally at 20. Of these switches,
switch 22 is designated as a "menu" switch, while switch 24 is
designated as a "select" switch. Note that the readout assembly 18
is angularly oriented with respect to the grip axis 26 of the
apparatus 10. With this configuration, the user may observe prompts
and cues appearing at the readout 18 as represented by the symbolic
user eye station 28 and line of sight represented symbolically at
arrow 30. In this regard, note that the hand 32 of the user is
grasping the hand grasping portion 14. For the arrangement shown,
the hand grasping portion 14 is represented as exhibiting its
largest widthwise extent, i.e., 27/8 inches. To gain this larger
widthwise extent, auxiliary grip components 34 and 36 are employed
in conjunction with the hand grasping portion 14. These auxiliary
grip components will be seen to be removable as well as universally
positionable so as to provide the noted widthwise adjustments in
1/2 inch increments.
[0062] Referring to FIG. 2, the instrument 10 is shown as it is
employed for diagnostic activities. For this purpose, the auxiliary
grip components 34 and 36 as seen in FIG. 1 have been reversed in
their orientation at hand grasping portion 14. Note, additionally,
that the symbolic eye station at 38 is now that of the
diagnostician with a line of sight as represented symbolically at
arrow 40 addressing the readout 18 (not shown). Note that the line
of sight 40 is directed toward the auxiliary grip component 36 and
the data readout for diagnostic purposes is not visually available
to the user whose hand is represented at 32. Seen additionally in
FIG. 2 is a serial communications port 40 and a battery compartment
access cover 42. This serial port offers, for diagnostic purposes,
the instantaneous transfer of real-time data to remote monitoring
and data archiving equipment.
[0063] Looking to FIG. 3, an exploded perspective view of the
apparatus 10 is provided. In the figure, the grasping portion 14 is
seen to be comprised of two mirror image sides 52 and 54.
Integrally molded with the sides 52 and 54 are the two housing
components of the interactive portion 16 as shown respectively at
56 and 58. Plastic inserts or plugs are shown at 60 and 62 which
are insertable within respective screw cavities 64 and 66.
Extending from grasping portion side 54 is an integrally molded
screw receiving post 68. In similar fashion, screw receiving post
70 is integrally formed with and extends from component 58.
Additionally, a screw receiving post 72 extends from component 58.
Post 72 receives a screw inserted through a battery cavity 74
inwardly disposed from cover 42. Post 72 additionally functions to
contribute to the support of a printed circuit board 76 by virtue
of its insertion through an aperture 78 formed therein. Note that
the printed circuit carrying board 76 also supports communications
port 40. In this regard, the port 40 extends into a rectangular
opening 80 formed within interactive portion 58 of housing 12.
Further extending inwardly from component 52 are two force plate
support plates 53 and 55
[0064] Disposed centrally within the cavity defined by gripping
portion sides 52 and 54 is a steel thrust plate 82 having a
thickness and rigidity elected to withstand compressive gripping
forces which may range, for example, up to about 205 pounds. Plate
82 is configured with two holes 81 and 83 which are used to
restrain the plate from disengaging from the assembly when fitted
over respective posts 53 and 55. Elongate side 84 of thrust plate
82 is configured for insertion within an elongate groove 86 of a
base grip component 88. Grip component 88 is formed of a rigid
plastic and includes an outwardly disposed base grasping surface 90
upwardly located in adjacency with the grasping surface 90 is one
component of a base connector assembly represented generally at 92
and which is seen to be integrally molded with the grip component
88 and incorporates a slot or opening 94 in conjunction with a tab
receiving trough 96. A tab component (not shown) of the base
connector assembly feature of the base grip component 88 will be
seen to extend from the end thereof opposite connector assembly
component 92.
[0065] Two oppositely disposed edge extensions 98 and 100 of the
thrust plate 82 are configured for operative association with a
load cell assembly represented generally at 102. Load cell assembly
102 includes an elongate steel base 104 incorporating two slots for
receiving extensions 98 and 100, one such slot being revealed at
106. Connection between the base 104 and thrust plate 82 is
provided by pins (not shown) which extend through mated bores 108
and 110 and 112 and 114. The load cell assembly 102 further
includes an elongate outer force component 116. Two field
plate-form load cells 118 and 120 are mounted from load cell mount
structures shown, respectively at 122 and 124 formed within base
104. Such mounting is in cantilever fashion, the load cell 118
being attached to mount 122 by a screw and mounting plate assembly
126. Similarly, load cell 120 is attached in cantilever fashion to
mount structure 124 by a screw and mounting plate assembly 128.
Outer force component 116 is seen to have a centrally disposed
rectangular post portion 130 which is attached by a connector plate
assembly to the mutually inwardly extending ends of the load cells
118 and 120. The attachment plate assembly for this union is seen
in general at 132. Assembly 132 is seen to be formed of two plate
components 132a and 132b coupled, in turn, to load cells 120 and
118. Screws are use to effect the attachment.
[0066] The base grip component positioned oppositely of base grip
component 88 is shown at 134. In similar fashion as component 88,
the base grip component 134 is configured with a base connector
assembly having one component at 136 which incorporates a slot and
trough (not shown) in similar fashion as described at 92 in
connection with component 88. A tab protrusion of generally
cylindrical configuration shown at 138 is disposed oppositely from
connector assembly component 136. The rigid plastic base component
134 is attached to elongate outer force component 116 of the load
cell assembly 102. This attachment is provided by the insertion and
crimping of two posts 134a and 134b (FIG. 4) within respective
holes 117 and 119 formed within force component 116. A slot in
component 1134 is provided to positively locate it onto the outer
profile of component 116. In general, posts 134a and 134b (FIG. 4)
are inserted through holes 117 and 119 and then melted with a hot
iron to mechanically secure the two pieces 134 and 116 together as
one sub-assembly. With the arrangement shown, gripping compressive
force is asserted from the base component 188 through the thrust
plate 82 into the load cell assembly 102. This force is
counteracted by gripping force asserted from base gripping
component 134.
[0067] Auxiliary grip component 34 is shown in the figure in spaced
adjacency with respect to the base grip component 134. Auxiliary
component 34 is configured with an outwardly disposed auxiliary
grasping surface of generally half cylindrical cross section with a
grasping surface profile curved concavely outwardly, for example,
at region 140. This curvature is provided for enhancing grip
contact with the palm of the user hand and for applying force
centrally to the load cell assembly. Component 34 is formed with an
auxiliary connector assembly which includes a flexible engaging tab
150 configured for insertion within the connector component 136 of
base grip component 134. Connection at the opposite end is provided
by a curved slot (not shown) which receives the tab protrusion 138
of base grip component 134. The connector assemblies are universal
such that each of the auxiliary grip components may be mounted upon
either of the base grip components 88 or 134. In this regard, not
that a similar flexible engaging tab 152 is positioned upwardly
upon auxiliary grip component 36. Similarly, the component 36 is
configured having a curved slot 154 at its opposite end which
receives tabs, for example, as at 138. The mounting of either
auxiliary grip component 36 or 34 will increase the widthwise
extent of the grip by one half inch. Accordingly, with both
auxiliary grip components installed, the widthwise extent of the
grip is increased to 27/8 inches.
[0068] Interacting region 16 also includes a top cover 156. Formed,
as the other components, of ABS plastic, the cover 156 includes a
rectangular bezel opening 158 within which the LCD 18 is
positioned. Integrally formed with top cover 156 is a downwardly
depending switch cover 160 through which two rectangular openings
162 and 164 are provided. The switching function 20 is mounted upon
a separate circuit board 166 which is seen to carry two push
actuated switches as earlier described at 22 and 24 and identified
by the same numeration in the instant figure. Located over the
switches 22 and 24 is a flexible polymeric cover 168 formed of a
flexible polymeric material such as Santoprene, a thermoplastic
elastomer marketed by General Polymers of Charlotte, N.C. Circuit
board 166 is supported between two slots formed in the interior of
side components 56 and 58, one of these slots is seen at 170. The
LCD 18 is mounted upon a circuit board 172 supported in turn, from
interactive components 56 and 58. A bus-type wiring harness
electrically associates the switching function 20, LCD 18, load
cell assembly 102, the battery within compartment 74 and the
circuitry carried by circuit board 76.
[0069] A sectional view of the instrument 10 is provided at FIG. 4.
In the figure, base grip component 88 is shown in conjunction with
base connector assembly component 92. In that regard, the slot 94
again is revealed as well as the tab receiving trough 96. At the
opposite end, the base connector assembly includes an outwardly
extending arcuate tab 174. Auxiliary gripping component 36 is shown
coupled to the base grip 88. Note that the auxiliary component 36
has a grasping surface 176, the profile of which is undulatory to
provide a finger grasping configuration. This undulatory profile
further functions to provide a finger grasping configuration which
centers the gripping force on handle 88. The lower portion of the
base grip component 88 is seen to be formed having an outwardly
extending arcuate tab 174 which slideably nests within the
corresponding arcuate slot 154 in auxiliary grip 36. The connector
assembly for base grip component 134 is identical. In this regard,
the component 134 includes an arcuate outwardly extending tab 138
and a slotted receiver 136 structured identically as that described
at 92. Auxiliary grip component 34 is connected to base grip
component 134 by sliding a protruding tab or tongue 138 into
arcuate slot 178. Additionally, the flexible engaging tab 150 is
shown extending through a slot in connector component 136.
[0070] FIGS. 5-7 illustrate variations of grip widthwise extent
available for utilization of instrument 10 in conjunction with
therapeutic protocols. In general, for such therapeutic protocols,
the readout assembly 18 is arranged to face the eye station of the
user. In FIG. 5, no auxiliary grip components are mounted upon
either base grip component 88 or base grip component 134.
Accordingly, the widthwise extent of the grip is 17/8 inch. Looking
to FIG. 6, the palm engaging auxiliary grip component 34 is shown
mounted over base grip component 134. This increases the widthwise
extent of the grip for therapeutic applications to 23/8 inches.
FIG. 7 illustrates the utilization of both auxiliary grip
components 34 and 36 to provide a grip widthwise extent of 27/8
inches. As before, the auxiliary grip components are arranged such
that the user may observe readout 18.
[0071] FIGS. 8 and 9 illustrate grip arrangements particularly
suited for diagnostic purposes wherein the diagnostician has
exclusive access visual to the readout assembly 18. In FIG. 8, base
grip component 134 is combined with auxiliary grip component 34 to
provide a widthwise grip extent of 23/8 inches. Removal of the
auxiliary grip component 34 returns the grip widthwise extent to
17/8 inches.
[0072] In FIG. 9, both auxiliary grip components 34 and 36 are
employed to provide a maximum widthwise grip extent of 27/8 inches.
It may be observed in FIGS. 8 and 9 that the positioning of the
auxiliary grips is reversed in the sense of the grip configuration
shown in FIGS. 5-7.
[0073] Turning to FIG. 10, a block diagrammatic representation of
the controller components of instrument 10 is revealed. In general,
the instrument 10 is microprocessor driven, for example, employing
a type 8051 microprocessor as represented at block 180. The
controller is powered by a standard 9 volt battery. That voltage
then is regulated to 5 volts for use by the circuit components. A
power supply to the strain gauge implemented load cells 118 and 120
is dropped by a resistor such that the maximum current applied is
limited to 50 milliamps. Such power supply is represented in the
figure at block 182 which, in turn, is seen to be associated with
microprocessor 180 via line 184 and with switch 24 via lines 186
and 188. Note that switches 22 and 24 respectively are labeled
"menu" and "select". Switch 24 serves the additional function of an
on switch or enablement switch. Power also is seen to be supplied
to the communications connector 40 as represented at line 190.
Communications connector 40, in turn, is seen coupled to a
communications driver 192 as represented at line 194. Driver 192
associated with the microprocessor 180 as represented at line 196.
The microprocessor 180 also provides control over an annunciator or
buzzer as represented at block 198 and line 200. Similarly, control
to the liquid crystal display (LCD) 18 from microprocessor 180 is
represented at line 202. A real-time clock is provided with the
controller circuit as represented at block 204. Time and date data
from that clock are used in conjunction with the monitoring and
memory features of the instrument 10 such that important data,
including date and time of a given trial regimen can be retained in
memory and downloaded via the communications port 40 when called
for. The association of the real-time clock function 204 and
microprocessor 180 is represented at line 206. Archival memory as
well as temporary memory are provided with the controller. Archival
memory may be provided, for example, as an electrically erasable
programmable read only memory (EE PROM), an 8 kilobyte device which
requires no power to sustain its memory retention, i.e., it is
non-volatile. The archival memory is represented at block 208 and
its association with the microprocessor 180 is represented at line
210.
[0074] Load cells 118 and 120 are represented with that numeration
in FIG. 10. These load cells are each configured as a four
resistance balance bridge-type load cell. The outputs of load cells
118 and 120 are directed to an amplification function as
represented by respective lines 212 and 214 extending to amplifier
block 216. The output of amplifier 216 is represented at line 218
extending to an analog-to-digital converter function represented at
block 220. Correspondingly, output of the converter function 220 is
directed to the microprocessor 180 as represented at line 222.
Microprocessor 180 converts the signal to a force value in pounds
or kilograms which is displayed in the LCD 18. The menu switch 22
is shown associated with microprocessor 180 via line 224, while the
select switch 24 is associated with that processing function as
represented at line 188.
[0075] Each of the instruments 10 is calibrated using nineteen
combinations of six standard weights. A best fit is determined and
the instrument is called upon to have a root mean square error
(RMS) of 0.1 pounds or less to pass calibration requirements. Once
the calibration constants has been determined, the system is loaded
with two redundant copies of the calibration constants. The zero
point of the load cell is monitored at all times during the use of
the instrument 10. If a drift is found, then a warning is shown at
the LCD display 18. If any lead wire to the load cell becomes
disconnected, then the built-in monitoring detects this occurrence,
shows an error message, and disables further use of instrument 10
until the power is reset. These features insure that the force
reading shown is accurate and true. Absolute values of the outputs
of load cells 118 and 120 are summed to provide a force output
signal. In general, the load measurement accuracy of instrument 10
is better than 0.1 pound or 0.1% of applied force whichever is
greater.
[0076] In the discourse to follow, the sequences of the program
protocol carried out by instrument 10 are represented in flow chart
fashion. In general, these flow charts commence with a
configuration sequence if desired and then look to two diagnostic
protocols followed by two therapeutic protocols.
[0077] Turning to FIG. 11, the procedure seen to commence as
represented at block 230 with the selection of the grip widthwise
extent. In general, that grip width is elected to accommodate
variations in user hand sizes. The program then continues as
represented at line 232 and block 234 wherein, where appropriate,
one or two auxiliary grip components as at 34 and 36 are installed
in an orientation providing for user viewing of display 18 as
illustrated in connection with FIG. 1, or in an arrangement for
therapeutic practitioner viewing to the exclusion of the user as
described in connection with FIG. 2. The program then continues as
represented at line 236 and block 238 providing for the enablement
of instrument 10 by actuation of select switch 24. Upon such
actuation, as represented at line 240 and block 242 a start-up
message is provided at display assembly 18 for an interval of two
seconds. Then, as represented at line 244 and block 246 a prompt is
displayed at readout 18 identifying a default configuration wherein
pounds as opposed to kilograms are elected; an audible tone is
enabled, and for a diagnostic test referred to as "rapid exchange"
wherein instrument 10 is passed from one hand of the user to the
other and then back for a number of exchanges, the user providing a
grip force trial at each exchange. The rapid exchange default
values are ten exchanges with 1.5 seconds available for user
griping or squeezing. Following the publication of the screen as
represented at block 246, should the user not actuate either the
switches 22 or 24, then as represented at line 248 and block 250
the instrument 10 will turn off or power down at the end of a five
minute interval. This feature is always active, i.e., turning off
five minutes after a last switch actuation.
[0078] With the publication of the screen as represented at block
246, then as represented at line 252 and block 254 the practitioner
or user is called upon to determine whether to enter a
configuration sequence or to progress to a diagnostic grip test. To
enter the latter diagnostic grip test sequence, as represented at
line 256 and block 258 by pressing switch 24 display 18 will prompt
the user to press the select switch 24 to commence a diagnostic
grip test sequence. Where the select switch 24 is actuated, then
the program enters the diagnostic grip test sequence as represented
at line 260 and node A.
[0079] Where a determination on the part of the practitioner or
user is made to enter a configuration sequence, then as represented
at line 262 and block 264 the configuration sequence is entered by
actuating switch 22. As represented at line 266 and block 268 the
initial configuration looks to units. Recall from block 246 that
the instrument 10 defaults to a units evaluated in pounds. As
represented at line 270 and block 272 by actuating select switch 24
the units parameter can be converted to kilograms instead of
pounds. The program then continues upon depressing or actuating
menu switch 22 as represented at either lines 274 or 276 leading to
block 278. As represented at block 278, the user then is given the
opportunity to delete the audible tone. In this regard, by
actuating select switch 24, as represented at line 280 and block
282, the tone is deleted, display 18 showing the term "tone" in
connection with the letter N.
[0080] The configuration sequence then continues as represented at
either lines 283 or 284 with the actuation of menu switch 22. This
actuation of switch 22 provides for the establishing of a rapid
exchange diagnostic test cycle time change. As set forth at block
286 the default cycle time is 1.5 seconds. However, by actuation of
select switch 24, as represented at line 288 and block 290 the
operator may change the cycle time to 2.5 seconds. The program then
continues by actuating the menu switch 22 as represented at either
of lines 292 or 294. These lines lead to the configuration
alteration represented at block 296. Recall from block 246 that the
default number of exchanges for the rapid exchange diagnostic
procedure is 10. However, as represented at line 298 and block 300
the operator may change the number of exchanges from 10 to 20 by
actuation of select switch 24. The program then returns to line 244
by actuation of the menu switch 22 as represented at lines 302 and
304. As described in connection with block 258, line 260 and node
A, the operator may elect to proceed with a diagnostic grip
test.
[0081] Referring to FIG. 12A, node A reappears in conjunction with
line 306 extending to the query posed at block 308 wherein a
determination is made as to whether or not to enter a diagnostic
grip test mode. Where the operator determines that the diagnostic
grip test mode should be entered, then as represented at line 310
and block 312, the grip test mode is entered by actuating select
switch 24. The operator is then prompted at display 18 to actuate
select switch 24 to enter a max test mode. Accordingly, with the
actuation of switch 24, as represented at line 314 and block 316
the maximum diagnostic grip test mode is entered. On the other
hand, as represented at line 318 and node B by actuating the menu
switch 22, the practitioner may cause instrument 10 to enter a
rapid exchange sequence.
[0082] Returning to block 316, the maximum strength grip test can
be carried out with 10 maximum squeezing force trials. At the
conclusion of a given number of such trials, the practitioner
actuates select switch 24, whereupon computations are carried out.
Accordingly, as represented at line 320 and block 322 the user is
prompted with the message "squeeze hard!!!" at the readout 18. The
program will elect the highest force applied during such squeezing
activity, whereupon the user releases the grip force as represented
at line 324 and block 326. Then instrument 10 will publish the
maximum force applied by the user as represented at line 328 and
block 330, a first maximum grip evaluation being shown as an
example as 64.4 pounds. Block 330 also indicates that the user is
prompted to either actuate the select switch 24 to accept the
published maximum squeeze evaluation as set forth at block 330 or
to squeeze the grip 14 again. Such squeezing again will provide a
substitute maximum grip force evaluation. Then, as represented at
line 332 and block 334 the query is posed as to whether the select
switch 24 has been actuated. In the event that it has not, then the
program loops as represented at line 336 extending to line 320,
whereupon a maximum grip effort again is undertaken. Where the
operator elects the maximum first trial grip force evaluation, then
as represented at line 338 and block 340, the program will compute
an average of force values, standard deviation and coefficient
variation, albeit it for one trial at this juncture in the
procedure.
[0083] The program then continues as represented at line 342 and
block 344 to display computed values which, as noted above, for the
first trial are irrelevant. However, as the number of trials
increases, those computed values gain significance. Next, as
represented at line 346 and block 348 the program commences to
carry out a next maximum grip test by providing a prompt at readout
18 which advises the user to "squeeze hard!!!" and indicates that
this is a second trial as represented by the terms: "MAX 2".
Following a squeezing of the grip region 14, as represented at line
350 and block 352 the user releases the grip force and, as
represented at line 354 and block 356 the maximum force asserted by
the user is published, for example, showing 60 pounds for a "MAX 2"
trial. This prompt further advises the user to actuate select
switch 24 to elect the published grip force value or to squeeze
again to carry out a next trial. The program then continues as
represented at line 360 and block 362 to determine whether or not
select switch 24 had been actuated. In the event that it had not
been actuated then the program loops as represented at lines 364
and 346 whereupon the user again may carry out the second maximum
grip trial. Where switch 24 has been actuated, then as represented
at line 366 and block 368, the program carries out a computation of
the average of the maximum forces asserted and computes standard
deviation and coefficient of variation which are submitted to
memory. The program then continues as represented at line 370 and
block 372 whereupon the values computed in connection with block
368 are published at display 18. The above maximum grip test trials
may be reiterated for 10 trials. Accordingly, as represented at
line 374 and block 376 the maximum test trials are reiterated for a
total of N tests (10 maximum) and the computed values of average
force, standard deviation and coefficient of variation are both
submitted to memory and published at display 18. As represented at
line 378 and block 380 the user may restart this max test sequence
following the Nth trial by actuating select switch 24, whereupon
the program returns as represented at line 382 to line 310 (FIG.
12A). Returning to block 380, by actuating menu switch 22, as
represented at line 384 and block 386, a subsequent actuation of
select switch 24 will return the program to a previous menu. As
represented at line 388 and block 390 by again actuating menu
switch 22, as represented at line 392 the program reverts to node B
as described in conjunction with FIG. 12A. By again actuating
select switch 24, as represented at line 394 the program returns to
entry into the maximum grip diagnostic test, line 394 extending to
line 314 seen in FIG. 12A. This circular logic is made available at
a variety of locations within the program.
[0084] Returning to FIG. 12A, where the query posed at block 308
results in a negative determination that the maximum grip test
diagnostic mode is not to be entered, then, by actuation of menu
switch 22, as represented at line 396 and block 398 a determination
is made as to whether to exit a diagnostic mode and enter a therapy
based mode. Where a therapy mode is not elected, then as
represented at line 400 and block 402 a previous menu may be
elected by actuating the select switch 24 as represented at line
404 and node D. By actuating menu switch 22, then as represented at
line 406, the program loops to line 306 and the query posed at
block 308. Where a therapy mode is elected by the user, then as
represented at line 408, the program diverts to a therapy mode of
performance as represented at line 408 and node E.
[0085] Looking back to the query posed at block 334, where the menu
switch 22 is actuated as opposed to electing a maximum grip value,
then as represented at line 410 and block 412 the program will
reconfigure for restarting the grip test mode. Once at this point
in the program as represented at block 412, by again actuating
select switch 24, the program reverts, as represented at line 414
to line 320 to carry out another maximum grip trial. On the other
hand, where menu switch 22 is actuated, as represented at line 416
and block 418 an indication will be given to the operator that to
elect a previous menu, select switch 24 is to be actuated. As
represented at line 419, the program then reverts to node C. Node C
again appears in FIG. 12A in conjunction with line 420 extending to
line 310. Where menu switch 22 is again actuated, the program
reverts to block 412 as represented at line 422.
[0086] Looking again to FIG. 12B and the query posed at block 362,
where the second maximum grip test is not selected but menu switch
22 is actuated, then as represented at line 424 and block 426 the
program enters a mode for restarting the maximum grip test. By
again actuating menu switch 22, as represented at line 428 and
block 430 the user is prompted to enter the previous menu position
in the program by actuating the select switch 24. Accordingly, by
actuating switch 24 as represented at line 432, the program reverts
to node C. Returning to block 426, where the select switch 24 is
actuated, then the program loops as represented at line 434, to
line 346 to again undertake the second of the maximum grip tests.
By actuating menu switch 22 from the program location of block 430,
as represented at line 436 the program reverts to its position at
block 426.
[0087] The diagnostic performance mode of the instrument 10 also
provides for the carrying out of a rapid exchange (RE) test. With
the rapid exchange test, the user may grip instrument 10 in the
manner shown in FIG. 2 such that the therapist or practitioner may
observe readout 18 to the exclusion of the user or patient. With
the rapid exchange, a maximum grip force is exerted by the user or
patient in exchanging between the right and left hands under a
controlled exchange timed cycle which will have been elected, for
example, in connection with the configuration mode described in
connection with FIG. 11. It may be recalled that the number of
exchanges may also be elected by the diagnostician as 10 or 20
efforts or trials. The rapid exchange mode of performance is
elected as represented at block 312 and line 318 extending to node
B described in connection with FIG. 12A. Node B reappears in FIG.
13 in association with line 440 and block 442. Referring to that
figure, block 442 is seen to provide for a prompt to the
practitioner to actuate select switch 24 to enter the rapid
exchange mode. Upon actuating switch 24, as represented at line 444
and block 446 a prompt is provided at readout assembly 18 advising
the user to squeeze the grip 14 with the right hand to start the
rapid exchange sequence. As represented at line 448 and block 450
the program awaits the presence of a right hand squeezing force.
Until that squeezing force is asserted, the program dwells as
represented at loop 452 extending to line 444. Where a squeezing
force is detected, then as represented at line 454 and block 456
the program commences to time out the succession of periods or
time-hacks allocated for this cycle of the rapid exchange
diagnostic procedure. That time interval may have been elected in
the configuration mode as described in conjunction with blocks 286
and 290 (FIG. 11). For example, the cycle time, T.sub.r has a
default value of 1.5 seconds or the last value selected.
[0088] As represented at line 458 and block 460 the user will have
squeezed the grip region 14 and the maximum hand force value
evolved will be submitted to memory. Then as represented at line
462 and block 464 a determination is made as to whether the menu
switch 22 has been actuated. In the event that it has not, as
represented at line 466 and block 468 the program determines
whether the Nth, i.e., 10.sup.th or 20.sup.th trial has been
completed. In the event that it has not, then as represented at
line 470 and block 472 the rapid exchange test has not been
completed and an audible tone cue (time hack) is provided
indicating that the instrument should be switched to the opposite
hand. A short dwell occurs as represented at line 474 and block 476
wherein the instrument determines whether or not a squeeze force
has been asserted. In the event that it has not, then the program
loops as represented at line 478. Where the user has imparted a
squeezing force to the instrument, the program continues or loops
as represented at line 480 extending to line 458 leading to a next
trial in an alternate hand.
[0089] Returning to block 464 where menu switch 22 is actuated in
the course of carrying out rapid exchange trials, an affirmative
determination will be made with respect to the query posed at that
block. Accordingly, as represented at line 482 and block 484 the
user is prompted to restart the rapid exchange test by actuating
select switch 24. Where select switch 24 is actuated, then as
represented at line 486 the program reverts to line 444 and block
446. On the other hand, where menu switch 22 is actuated, then as
represented at line 488 and block 490 the user is prompted to
revert to the previous menu by actuating select switch 24. Where
select switch 24 is so actuated, then the program reverts to node C
as represented at line 492. Note, additionally, that if menu switch
22 is actuated in conjunction with the prompt provided at block
442, then as represented at line 494 the program reverts to line
488. Returning to block 490, where menu switch 22 is actuated then
as represented at line 496 and block 498 the program computes and
displays the overall average of the maximum trial values, standard
deviation and coefficient of variation for the N trials. That data
is submitted to memory. Should menu switch 22 be actuated at this
juncture, then as represented at lines 500 and 482, the program
returns to block 484. Where the select switch 24 is actuated,
however, as represented at line 502 and block 504 the maximum force
value for trial N and the average SD and CD for all trials is
displayed. On the other hand, where the menu switch 22 is actuated,
then as represented at lines 506 and 482, the program reverts to
block 484.
[0090] Where the select switch 24 is actuated repetitively, then as
represented at line 508 and block 510 the succession of trials 1
through N is displayed. Additionally, the unchanging average for
all those trials is displayed for convenience. Further, a query is
posed as to whether the Nth trial has been displayed. Where it has
not, then the display program loops as represented at line 512
extending to line 502. On the other hand, where the Nth trial has
been displayed, then as represented at line 514, the program loops
to line 502 to repeat the succession of displays.
[0091] It may be recalled that in conjunction with block 398 in
FIG. 12A, a therapy mode may be entered by actuation of select
switch 24 as discussed in connection with line 408 and node E. Node
E reappears in FIG. 14A in conjunction with line 520 and block 522.
Block 522 indicates that the readout 18 will publish information
that a grip therapy is available by actuation of select switch 24.
It may be recalled that the parameters of time and force are
somewhat pre-established under the regimen of the instant program.
In this regard, it is important that the isometric grip exercise be
constrained within predefined force and time interval of holding
and resting limits. These parameters are nominated in the program
and while some variations are permitted, those variations are
retained within physiologically determined limit values. Of
importance of the grip therapy at hand, it may be observed that it
is predicated upon the patient or users actual and unique the
maximum gripping force which initially is evaluated and then
treated by a preordained but still electable target valuation. In
general, the prompt and cues provided at display 18 are made
available to the patient or user by a handle configuration as
described in conjunction with FIG. 1. Looking to FIG. 14A, block
522 provides for a display at readout 18 indicating that a grip
therapy mode is available by actuation of select switch 24. As
represented at line 524 and block 526 a determination is made as to
whether a fixed mode of therapy or a stepped mode of therapy is to
be elected. A fixed therapy is elected by actuation of select
switch 24 as represented at line 527 extending to block 528. Block
528 indicates that the fixed exercise configuration mode has
entered. With such entry, as represented at line 530 and block 532
readout 18 prompts that the user will be given opportunities to
adjust the target load factor, the number of repetitions of trials
of the grip therapy, the duration of the holding of the grip force
at a target value and the interval for a intergripping rest.
However, as an initial component of the procedure, the maximum grip
force value for a given patient is determined. Accordingly, upon
actuating switch 24 as represented at line 534 and block 536 the
user is prompted to squeeze the grip with maximum force by
publishing the terms: "squeeze hard!!!". Then, as represented at
line 538 and block 540, the squeeze generated load or force value
is outputted to the microprocessor 180 (FIG. 10). The maximum
valuation of this initial force evaluation then is displayed at
readout 18 as represented at line 542 and block 544. In the latter
block, it may be observed that a sample force valuation of 90.3
pounds is published at readout 18. The user can elect that
valuation as the maximum force value to be used in the program by
actuating select switch 24 as represented at line 546 and block
548. However, a prompt at readout 18 also provides that the user
may retry this maximum grip force evaluation as represented at loop
line 550 extending to line 538. Where the user or therapist
determines that an appropriate grip force has been derived, then as
represented at line 552 and block 554 the elected maximum force
value is submitted to memory and the program continues as
represented at line 556 and block 558. Employing the elected
maximum squeeze force, the program computes a target grip force
using a default factor of 50%. Additionally, the program
establishes a trial repetition number at a default number of 4; a
hold on target force interval of 45 seconds; and a default rest
interval of 120 seconds. As represented at line 560 and block 562
the computed target level then is displayed at readout 18 along
with the value of the elected maximum grip force and the default
target factor of 50%. The terms "Target 45lb" blink as a prompt
that the factor can be altered within an established range. The
user or practitioner then is given the opportunity to adjust the
target factor percentage in 10% increments from 10% to 100% as
represented at line 564 and block 566 by actuating the menu switch
22. Next, as represented at line 568 and block 570 the program
computes at a new target value based upon the elected factor, an
arbitrary designation "AA" being shown. A lower enabling grip force
threshold also is derived. Should the user elect a target factor
other than the 50% value by adjustment in connection with block
566, the program will automatically nominate hold on target
intervals and rest intervals for each available 10% selection from
within the range from 10% to 100% which the user may have elected.
This, again, is for the purpose of protecting the user from
excessive effort intervals and inadequate rest intervals. However,
still within the mandated overall ranges, the user or therapist can
change those values for the hold on target effort and rest effort.
The nominated hold or "Effort" and rest intervals contained in the
program are summarized in Table 1 below. TABLE-US-00001 TABLE 1 10%
20% 30% 40% 50% 60% 70% 80% 90% 100% Max Max Max Max Max Max Max
Max Max Max 120 120 90 60 45 15 12 10 5 3 sec. sec. sec. sec. sec.
sec. sec. sec. sec. sec. Effort Effort Effort Effort Effort Effort
Effort Effort Effort Effort 60 120 120 120 120 120 120 60 60 60 sec
sec sec sec sec sec sec sec sec sec Rest Rest Rest Rest Rest Rest
Rest Rest Rest Rest
Following the target load computation, as represented at line 572
and block 573 the program displays the newly computed target force
value at readout 18 along with the default values for number of
repetitions (which defaults at 4), and the nominated hold on target
interval and the rest interval (Table 1). As a prompt, the readout
"4 REP" blinks to indicate that adjustment is available to the
user. The program then continues as represented at line 574 which
reappears in FIG. 14B extending to block 576 which provides for
adjusting the number of repetitions between the values 1 and 10 by
actuating menu switch 22. Note that the maximum number of
repetitions made available to the user is 10. The program then
continues by actuating switch 24 as represented at line 578 and
block 580 indicating that the computed target force level (AA) and
the newly elected repetition number herein represented as "B" is
provided at the display along with the nominated values for hold on
target interval (CCC) and rest interval (DDD). In this display, the
terms: "CCC HOLD" blink to prompt the user to make any desired
adjustments within the mandated limits of from 5 seconds to 120
seconds. Accordingly, as represented at line 582 and block 584 the
user or practitioner may adjust the hold on target interval by
actuating menu switch 22. When the desired hold on target interval
has been displayed at readout 18, the select switch 24 is actuated
and the program progresses as represented at line 586 and block 588
to provide a display at readout 18 which indicates the computed
target force level AA; the elected repetition number (B) and the
elected hold on target interval (CCC). The display also will blink
the terms "DDD REST" to prompt the user to adjust the rest interval
to a desired value within the mandated interval range of 10 seconds
to 120 seconds. Accordingly, as represented at line 590 and block
592 the user or practitioner can adjust (by decade components) the
extent of the rest interval by actuating menu switch 22 until a
desired interval value is displayed. Once the desired interval is
so displayed, an actuation of select switch 24 will enter it into
memory. Next, as represented at line 594 and block 596 the program
displays the now elected values including the target force (AAlb);
repetitions (B REP); the hold on target interval (CCC); and the
rest interval (DDD). The program then provides a prompt to the user
to start the therapy by actuating the select switch 24 as
represented at line 598 and block 600. Upon such actuation of
switch 24, as represented at line 602 and block 604 the program
prompts the user at readout 18 to apply a gripping force at the
target level along with the further prompt "squeeze". Next, as
represented at line 606 and block 608 the program determines
whether the grip force applied by the user is within 10% of the
computed target force value (AA). This is the lower threshold
determination as described in conjunction with block 570. In the
event that the applied gripping force is not within 10% of the
computed target value, the program loops as represented at line 610
extending to block 604 providing for a continuation of the prompt
to hold on target. Where the applied grip force is within 10% of
the computed target force value, then as represented at line 612
and block 614 the program commences to time out the hold on target
interval previously elected or nominated (CCC) as discussed in
connection with block 584. While this hold on target force interval
is underway, as represented at line 616 and block 618 a dynamic
comparison value computation is carried out over a sequence of
short time components within the hold time out interval. That
comparison value is utilized in driving a bar graph form of display
functioning to cue the user as to a proper grip force level. During
this hold interval, as represented at line 620 and block 622 the
program also compares the applied grip force with a force upper
limit which is computed as 125% of the target force. In the event
that the applied grip force is above that upper limit, then as
represented at line 624 and block 626 an audible cue is sounded to
warn the user that excessive force is being applied which is
outside the proper protocol for the therapy. The program then
continues as represented at lines 628 and 630 whereupon as set
forth at block 632 a score as a percentage of target value is
computed for a sequence of time increments. This score may be
utilized by the user and the therapist for purposes of evaluating
the quality of the exercise regimen carried out by the user.
[0092] Turning momentarily to FIG. 15, a routine is depicted
functioning to carry out the computation and display of the noted
score values. This routine is entered into as represented at node
634 identifying it as a display of the score value. The routine
commences as represented at line 636 and block 638 indicating that
the currently applied grip force or load value is read as the user
attempts to match the target force value. Then, as represented at
line 640 and block 642, the score is determined by dividing that
read force by the pre-computed target force and multiplying the
result by 100 to provide the score as a percent. This score is
developed for sequential increments of time, preferably each
increment representing 1% of the hold on target interval (CCC). As
represented at line 644 and block 646, the score is converted into
three display characters. Then, as represented at line 648 and
block 650, three characters representing the score are sent to
readout 18 for display. The score may be above or below 100%, 100%
representing an on target grip force.
[0093] Returning to FIG. 14B, the program continues as represented
at line 652 which reappears in FIG. 14C extending to block 654.
Block 654 indicates that a display is provided at readout 18 which
cues the user as to essentially instantaneous score value, the time
remaining for holding on target and further cues the user as to the
level of grip force being applied with respect to target through
the utilization of a center pointer visual cue representing the
target load value and an effort dynamic bar graph visual cue having
a top position present as a bar graph top line. That top line will
be aligned with the center pointer when the load value at output
represents a force equal to the target load value. The top line
will move away from the center pointer when the load value output
or grip force exerted by the user represents a force which deviates
from the target load value.
[0094] Looking momentarily to FIGS. 16A-16E, a representation of
the display so provided for differing grip force activity is set
forth. In FIG. 16A, the dynamic bar graph extends to the right of
the center pointer indicating a grip force which is too low. This
lower grip force also is indicated by the lower score value of 62%.
The display also includes an indication of the time remaining for
the hold on target interval, for example, 100 seconds. FIG. 16B
also indicates through the dynamic bar graph that the asserted grip
force is still too low but improved over that shown in FIG. 16A as
indicated by the shorter extent of the dynamic bar graph to the
right of the center pointer and a higher score value of 75%. FIG.
16C shows a cue wherein the user grip force is at the target force,
the top line of the bar graph being aligned with the center pointer
and a score of 100% being displayed. Additionally, as before, the
time remaining for the hold on target interval is displayed. FIG.
16D shows that an excessive grip force is being applied by the
user, the dynamic bar graph extending to the left of the center
pointer. This excessive force also is indicated by a score value of
125%. Time remaining in seconds within the hold on target interval
also is displayed. Finally, FIG. 16E shows a still more excessive
application of grip force on the part of the user, the dynamic bar
graph top line extending well to the left of the center pointer and
a score of 137% being represented. As before, time remaining in the
"on target interval" is also displayed.
[0095] Returning to FIG. 14C the program is seen to continue as
represented at line 656 and block 658 wherein a query is made as to
whether the hold on target interval has timed out. In the event
that it has not, then the program dwells as represented by loop
line 660 extending to node I which reappears in FIG. 14B with line
662 extending to line 620. In the event of an affirmative
determination with respect to the query posed at block 658, then as
represented at line 662 and block 664 an audible cue is generated
at the annunciator 198 (FIG. 10). With the generation of this
audible cue, then as represented at line 666 and block 668 the rest
interval commences to be timed out. It may be recalled that the
rest interval was elected in conjunction with block 592 (FIG. 14B).
During this rest interval, as represented at line 670 and block 672
the program will provide a display at readout 18 which indicates
the number of trials or efforts remaining in conjunction with the
elected repetition value. At the termination of the first trial,
that value will be B-1. The display also provides the average value
of score and the interval of time remaining in the rest interval.
Next, as represented at line 674 and block 676 a query is made as
to whether the rest interval has timed out. In the event that it
has not, then the program dwells as represented at loop line 678.
Where the query posed at block 676 results in an affirmative
determination, then as represented at line 680 and block 682 an
audible cue is generated and the program continues as represented
at line 684 and block 686 providing for a reiteration of the trial
sequence. As represented at line 688 and block 690 a query is made
as to whether the elected number of repetitions of the trial (B)
has been accomplished. In the event that that elected number of
repetitions has not been completed, then the program dwells as
represented at line 692. In the event of an affirmative
determination with respect to the query posed at block 690, then as
represented at line 694 and block 696 a final or average score is
computed and submitted to archival memory in conjunction with
calendar and force data. In the latter regard, each of the average
grip force values asserted by the user for each trial are recorded.
Next, as represented at line 698 and block 700 the program
determines or selects an appropriate message of congratulation or
warning base upon the computed final score. The program then
continues as represented at lines 702 and block 704 to publish the
selected message at readout 18 and continues as represented at line
706 to node G.
[0096] Node G reappears in conjunction with line 708 (FIG. 14A) and
block 526. Where the user or therapist has determined to cause
instrument 10 to enter into a stepped therapy mode, menu switch 22
is actuated as represented at line 710 and the program displays a
prompt to the user as represented at block 712 indicating that the
step therapy mode may be entered by actuating select switch 24 as
represented at line 714 and node F.
[0097] Referring to FIG. 17A, node F reappears in conjunction with
line 716 and block 718 providing for the entry of instrument 10
into a stepped exercise configuration mode. In this therapeutic
mode the maximum grip strength unique to the user or patient is
determined, whereupon the therapeutic gripping regime is one
wherein the target load level as well as hold on target intervals
and rest intervals vary in accordance the sequence of steps or
gripping trials. The program opens as represented at line 720 and
block 722 with a display at readout 18 prompting that the user is
to be called upon to establish a maximum grip force level and carry
out a setting of the number of steps and repetitions of the
therapy. The user then actuates the select switch 24 and, as
represented at line 724 and block 726 the program displays a prompt
at readout 18 indicating that the user should carry out a maximum
grip force exercise, the prompt including the terms; "squeeze
hard!!!". Then, as represented at line 728 and block 730 the user
will have applied maximum squeezing force to the grip and that will
have generated a load value output. While this load value output is
being generated, as represented at line 732 and block 734 the
program displays a cue at readout 18 which publishes the value of
the maximum gripping force. Should the practitioner or user wish to
attempt to improve that value, he or she is prompted to actuate
select switch 24 and elect the value published or to squeeze the
grip again. Where the user elects the value published, then as
represented at line 736 and block 738 a determination is made as to
whether the select switch 24 has been actuated. In the event that
it has not, then the system dwells as represented at loop line 740
extending line 728. Where the select switch 24 has been actuated,
then as represented at line 742 and block 744 the maximum gripping
force value which was selected is submitted to memory and, as
represented at line 746 and block 748 the system provides a 1 step
default value and a repetition of the step exercise is defaulted to
a value of four. The program then continues as represented at line
750 wherein the system provides a prompt at readout 18 which
displays the value of a selected maximum gripping force and further
prompts the user that a default of 1 step is present and a default
of four repetitions is present. The term "1 step" is intermittent
or blinks as a part of this prompt to the user to elect the number
of steps desired. This display is represented at block 752. Then,
as represented at lines 754 and block 756 the user or practitioner
is permitted to adjust the number of steps within a range of 1 to 5
steps. As discussed above, this range is mandated within the system
and the adjustment in the number of steps may be carried out by
actuating menu switch 22.
[0098] The number of steps elected adjusts the percentage of
maximum grip force factor in accordance with a preordained
schedule. That schedule is provided in Table 2 below. For example,
if only one step is elected, that target grip factor will be 20%.
On the other hand if five steps are elected, the first trial will
be at 100% of maximum grip force. The second step will be at 80% of
maximum grip force and so forth. On the other hand, if four steps
are elected, the initial trial will be in conjunction with an 80%
maximum grip force factor; the second step will be at 60% and so
forth as set forth in Table 2. For each of these percentages as set
forth in Table 2, the corresponding hold on target or effort
interval and rest intervals will follow the values given above in
Table 1. TABLE-US-00002 TABLE 2 No. of Steps Elected 1 2 3 4 5
1.sup.st Step as % Max 20% 40% 60% 80% 100% 2.sup.nd Step as % Max
20% 40% 60% 80% 3.sup.rd Step as % Max 20% 40% 60% 4.sup.th Step as
% Max 20% 40% 5.sup.th Step as % Max 20%
[0099] The step value is elected by actuation of select switch 24
and the program continues as represented at line 758 and block 760.
Block 760 replicates a display at readout 18 which prompts the user
by indicating that the maximum elected gripping force selected was
90 pounds and that A steps were selected and a further prompt is
provided showing blinking or intermittent display of "4 REPS".
Then, as represented at line 762 and block 764 the operator may
adjust the number of repetitions of the program to a value within a
preordained number of 1 through 10 by actuating menu switch 22. The
elected number of repetitions then is selected by actuation of
switch 24 and, as represented at line 766 and block 768 the system
displays the now selected parameters of a maximum grip force, for
example, 90 pounds, an election of A steps in the regimen and an
election of "B" repetitions. Next, as represented at line 770 and
block 772 the stepped exercise therapy is entered. Upon entry into
this stepped exercise trial mode, target values are computed based
upon the number of steps elected and the hold on target and rest
intervals will be acquired, such data with respect to target
factors being set forth in Table 2 and the latter hold on target
and rest intervals being set forth in Table 1. This function is
represented in block 776. Line 778 reappears in FIG. 17B extending
to block 780 which prompts the user with a display indicating that
to start the step therapy the select switch 24 should be actuated.
The operator may return the system to a previous menu at this
juncture by actuating menu switch 22. In this regard, as
represented at line 782 and block 784 by actuating switch 22, the
program will again display that initially elected maximum 90 pound
grip force along with the prompt to squeeze again or press select
as represented at line 785 and node K. This returns the program to
block 752 (FIG. 17A) where node K reappears at line 750. While
again actuating switch 22, as represented at line 786 and block 788
a restarting of the step therapy test prompt is provided advising
the user to actuate switch 24. Again where switch 22 is actuated,
then as represented at line 790 and block 792 the user is provided
a prompt display at readout 18 advising that the previous menu may
be elected by actuating select switch 24. Where that switch is
actuated, then as represented at line 794 and node H the program
returns to block 712 as earlier described in connection with FIG.
14A. In this regard, node H reappears in that figure in conjunction
with line 796 extending to block 712. Where menu switch 22 is
actuated the program loops as represented at line 795 extending to
line 782.
[0100] Returning to block 780, where switch 24 has been actuated,
then as represented at line 798 and block 800 the user is prompted
to hold the grip force at the computed target level for 100%.
Additionally, the prompt tern "SQUEEZE" is provided within the
readout 18. Next, as represented at line 802 and block 804 a
determination is made as to whether the grip force exerted by the
user is within 10% of the computed target value. Where it is not,
then the system dwells as represented at loop line 806 and the
display represented at block 800 continues. Where the asserted grip
force is within 10% of the target load, then as represented at line
808 and block 810 the mandated hold on target interval timeout set
forth in Table 1 commences and, as represented at line 812 and
block 814 a dynamic comparison value is derived for dynamic bar
graph cueing. Next, as represented at line 814 and block 816 a
computation then is made as to whether the instantaneous grip force
is at or above 125% of the target value. Where that is the case,
then as represented at line 820 and block 822 an audible warning
cue is sounded. The program then continues as represented at lines
824 and 826 when the excessive force has been lessened. Line 826 is
directed to block 828 which provides for carrying out a computation
of a score value as a percentage of target for a sequence of time
increments. Computation of this score has been discussed in
connection with FIG. 15. The program then continues as represented
at line 830.
[0101] Line 830 reappears in FIG. 17C extending to block 832 which
provides a display at readout 18 with essentially instantaneous
score values, the noted dynamic bar graph and hold time remaining
for the initial step at hand. The dynamic bar graph has been
described in conjunction with FIGS. 16A-16E. Next, as represented
at line 834 and block 836 a query is posed as to whether the hold
time interval has expired. Where it has not, then the system dwells
as represented at loop line 838 extending to node J. Node J
reappears in FIG. 17B in conjunction with line 840 extending to
line 816. However, where the hold on target interval has expired,
then as represented at line 842 and block 844 an audible cue is
generated and, as represented at line 846 and block 848 a Table 1
mandated rest interval is commenced. The program then continues as
represented at line 850 and block 852 wherein the system cues the
user that (A.times.B)-1 efforts remain out of the previously
selected (A.times.B) efforts and further advises of the time
remaining for the rest interval and the current score value. With
this display, the system queries as to whether the rest interval
has expired as represented at line 854 and block 856. Where the
rest time remains at hand, then the system dwells as represented at
loop line 858 extending the line 850. However, where the rest
interval has expired, then as represented at line 860 and block 862
an audible cue is generated.
[0102] Following the generation of this audible cue, as represented
at line 870 and block 872 the program reiterates the trial sequence
following the mandates of Tables 1 and 2 and the elected
parameters. As represented at line 874 and block 876, a query then
is made as to whether the repetitions and associated efforts are
complete. This value is the product of the elected number of steps
A multiplied by the elected number of repetitions, B. Where that
number of reiterations has not occurred, then the program continues
as represented by loop line 878 extending to line 870. Where the
number of repetitions is completed, then as represented at line 880
and block 882 a final score is computed and submitted to memory
with calendar and force data. Next, as represented at line 884 and
block 886 the program selects a message to the user which will be
based upon the final score. For example, the user may be advised to
consult a therapist or the program directions in the event of a low
score and is congratulated in the event of a good score. As
represented at line 888 and block 890 those messages are selected.
Where the user actuates select switch 24, the program continues as
represented at line 892 and node H.
[0103] Turning again to FIG. 14A, node H reappears in conjunction
with line 796 leading to the block 712 displaying a prompt that, to
cause the program to enter the stepped therapy mode, the select
switch 24 should be actuated. However, where menu switch 22 is
actuated, then as represented at line 896 and block 898 the program
displays a prompt that to enter the previous menu, the select
switch 24 should be actuated. Where that select switch is so
actuated, then as represented at line 900, the program reverts to
node E which reappears in the instant figure in conjunction with
line 520 extending to block 522. On the other hand, where the user
actuates menu switch 22, then as represented at line 902 the
program reverts to node G. Node G is shown in the instant figure in
conjunction with line 708 extending to block 526.
[0104] The user has the option of powering down instrument 10 by
pressing select switch 24 for an interval of at least 2 seconds.
This power off sequence is represented in the flow chart of FIG.
18. The sequence opens with node 910 and line 912 extending to
block 914. Block 914 indicates that select switch 24 is being
actuated and held in an actuated state. During this actuated state,
as represented at line 916 and block 918 a determination is made as
to whether the 2 second interval has elapsed. If it has not, then
as represented at line 920 and block 922 a query is posed as to
whether the select switch 24 has been released before the
termination of 2 seconds. If it has not, the system dwells as
represented at loop line 924 extending to line 916. Where the query
at block 918 results in an affirmative determination, then as
represented at line 926 and block 928 the instrument 10 is powered
down. Where the determination at block 922 indicates that the
switch 24 has been released prior to the elapsing of 2 seconds,
then as represented at line 930 and block 932 the program reverts
to the previous or last display which was published at readout
18.
[0105] The protocol based isometric exercise approach of the
invention has applicability to a broad range of muscle groups of
the user. By employing the protocol which, inter alia, involves the
evaluation of maximum muscle group strength as a precondition to
then applying a factor related protocol, one of those factors may
apply to the measured maximum strength value. The remaining factors
which involve, for example, variations of target loads, hold times,
rest intervals and exercise regimen planning in terms of calendar
days achieves a safe and effective utilization of isometric
activities. The exercisable anatomical features to be strengthened
are generally identifiable as muscle groups of the human anatomy
which may include but are not limited to: jaw muscles, neck
muscles, shoulder muscles, upper arm muscles, lower arm muscles,
hand muscles, finger muscles, diaphragm muscles, abdominal muscles,
lower back muscles, upper leg muscles, lower leg muscles, ankle
muscles, foot muscles, and toe muscles.
[0106] Looking to FIG. 19, a flow diagram is presented which
outlines the methodology achieving this safe utilization of
isometric exercises. In the figure, block 950 reveals that the user
or therapist may establish a goal of strength for the muscle group
involved. This may be achieved by measuring the maximum strength of
an unimpaired contralateral muscle group. For example, a left arm
or upper leg muscle group may be tested to determine a strength
goal for a right arm or right upper leg muscle. Where no unimpaired
contralateral muscle group is available to set this goal strength,
a medical professional will establish an appropriate goal strength.
The method continues as represented at line 952 of block 954
providing for the measurement of maximum strength of the specific
anatomical feature to be treated. As represented at line 956 and
block 958, the methodology identifies a protocol matrix of factors.
In this regard, a strengthening protocol is derived which is based
upon timed efforts which are equal to a percentage of the measured
maximum strength as derived in connection with block 954. The
matrix of factors further include hold times at a factor or factors
of the measured maximum strength, the repetition of these efforts
for a given trial or exercise session and the duration of rest
periods where repetitions are involved. Such protocol further will
indicate the intervals of repetitions of the exercise sessions
themselves during a stated period of time in hours, days, weeks,
months and the like. This matrix of factors may be contained, for
example, in computer memory. Looking to line 960 and block 962, the
procedure next nominates values to the factors provided in
conjunction with block 958. In this regard, the strengthening
protocol which is developed utilizes nominated factors from the
matrix of these exercise factors. In effect, the nominated factors
may be identified as "effort" applied by the specific anatomical
feature and the effort time period during which the effort is to be
applied such that there is a relationship among the percentage of
the measured maximum strength of time wherein the higher the
percentage, the shorter the effort time and the number of
repetitions of these efforts during an exercise session, the rest
period time between cessation of one effort and the beginning of
the next succeeding effort such that there is a relationship
between the percentage of the measured maximum strength and the
rest time wherein the higher the percentage the longer the rest
time and the number of exercise sessions in a given time period
(hours, days, weeks, months). As represented at line 964 and block
966, the procedure initiates and monitors the exercise protocol
with nominated factors. In this regard, the procedure monitors and
guides the exercise effort to be applied and while being applied,
provides visual and/or audible cues to encourage compliance to the
elected protocol using symbols as the visual cues and words which
clearly guide the effort to be applied. While that effort is being
applied, using audible cues and words which assist to properly
perform the effort, rest periods and repetitions for each exercise
session. Looking to line 968 of block 970, the method provides for
annunciating an alarm when an exercise effort level is exceeded. In
this regard, an audible alarm is produced if the exercise effort
exceeds a predetermined or factor determined level beyond which it
is considered that the exercise effort could be damaging to the
human physiology or the specific anatomical feature at hand. As
represented at line 972 and block 974 the method provides
compliance scores in real-time and in summation during the course
of an exercise effort and subsequent thereto. As described herein,
the program calculates a compliance score during each exercise
effort in percent of that effort required in the strengthening
protocol and provides this compliance score in real-time as the
effort is being accomplished on the specific anatomical feature. An
averaging of this compliance score over each exercise effort time
period is devised to depict the degree to which the exercise effort
applied has been accomplished. By accumulating the compliance
scores during each rest period and then presenting a final
compliance score issued in the form of both a number as a percent
accomplished and in an instruction set an indication is derived as
to how well the exercise protocol was performed or how to improve
future compliance. Next, as represented at line 976 at block 978
the exercise data is archived for review and potential transfer to
a remote interactive entity. This step in the procedure accumulates
real-time and summary data for each effort or trial and the
specific protocol being utilized. It may be noted that these
protocols are selected each time the exercisable anatomical feature
is elected to be strengthened such that the elected protocol, the
effort being applied and the compliance being calculated during and
at the conclusion of each effort may be reviewed remotely as it is
being accomplished using suitable data communication assistance and
at the conclusion of each effort. The archive data is time-stamped
and uniquely identified for retrieval.
[0107] Since certain changes may be made in the above-described
apparatus, method and system without departing from the scope of
the invention herein involved, it is intended that all matter
contained in the description thereof or shown in the accompanying
drawings shall be interpreted as illustrative and not in a limiting
sense.
* * * * *