Computer-aided examination of body posture
- practical hints
This page discusses practical questions concerning the way of carrying out the computer-aided examination of body posture.
Author:
Jarosław Jasięga
Graduate from Sport Academy and Academy of Economics in Wrocław.
For 10 years he has worked as physiotherapist. An Edema therapy instructor.
Participant in courses in manual therapy, craniosacral therapy, therapy according to Mulligan,
edema therapy, medical taping, osteopathy according to Ackermann.
Co-organizer of courses in Complex Edema Therapy as well as therapy according to Ackermann.
For 10 years he has been carrying out examinations of faulty postures by means of the devices
of the company CQ Elektronik System that takes advantage of Moiré projection phenomenon.
Contact: mobile phone 0606 752 976;
jasiega@wp.pl;
www.kto.com.pl
1.
Faulty postures
Correct and faulty body postures have been underestimated in the society. It is
influenced by relatively distant consequences of disturbances within motor organs.
The children themselves seldom signalize their faulty postures.
Extremely rarely they complain about pain (that will for sure appear a bit later),
and it will be related to overload in some of the spine segments.
It will appear at the time when there are structural changes, thus irreversible.
Similarly the parents are not able to detect disadvantageous changes at the very beginning.
It is mostly due to the fact that the parents and their children spend a lot of time together.
The child grows up and only an "aunt" that seldom drops by makes us realize
that since last time our toddler grew "twice as much".
All the more is detecting initially small changes within the spine or feet extremely difficult.
Therefore is an early detection and measuring of what is going on with our kid an important issue.
It is a specific activity and therefore underestimated.
The majority of measures taken in medicine are connected not with prevention,
but with a sudden need to diagnose a trouble before starting a treatment.
ECG, USG, EEG, X-Ray, resonance, laboratory tests … are used to detect reasons of troubles.
The purpose of this is to apply a specific treatment.
Therefore those tests are to some extent enforced
by the patient because if we want to treat someone we must first know what to treat?
Another group are examinations taken prophylacticly.
These are among others mammography or bone density examination towards osteoporosis.
It is here where we should place screening examinations of body posture.
The examinations mentioned above have the feature that
they prevent serious diseases or complications in future.
The healthy fashion to detect breast cancer results from awareness of consequences of negligence.
And the results are known and irreversible.
The consequences of neglecting the proper posture issue are similar.
The results are equally heavy. Over 85 per cent of today's society had,
have had or will have problems with their spine.
Treating of troubles that result from changes within the spine
is probably the biggest sore spot also among doctors.
The treatment is long; it is often characterized by large-scale and manifold investigations.
It is the spine that can cause pain in heart, kidney, head, etc.
Inefficiency of such treatment is experienced by majority of patients.
These people are convicted to more frequent or rarer visits to specialists.
A lot of examinations that are carried out while looking for trouble causes
do not often bring any answer to the question: Why does it hurt?
„Our helplessness in treating this syndrome is appalling.
The confusion that is caused by sacrodynia
in the society and among doctors is greater than caused by other diseases taken together."
Raymond Million.
Diagnostics of sacrodynia is more difficult than within other segments of motor organs (…).
Sacrodynia is most often caused by a combination of various reasons and unfavourable factors,
and not a single stimulus, e.g. raising a weight." Prof. Med. Artur Dziak
2.
The role of screening examinations (a need for a quick, non-invasive diagnostics)
A screening examination towards faulty posture detection by means of Moiré projection method can be carried out already on kindergarten children.
The terms of examinations, called screening tests to detect disturbances in motor organs whose reviewers were Prof. Med. Doctor M. Należyty and Assist. Prof. in physical education Maria Kutzner-Kozińska were given by the latest in her book about corrective gymnastics [1].
She defines the purpose of tests as detection in children and youngsters of following disturbances in motor organ:
The Moiré method defines additionally symmetric relations within the whole back (shoulders, shoulder-blades, waist triangles…) and pelvis (over back upper iliac spikes) as well as a number of additional parameters within feet, which extends the range of such a test.
The age given here is typical for screening examinations. Another question is supervision of corrective treatment. After detection of disturbances in body posture the child should undergo a corrective treatment, and in case of serious disturbances he/she should have a special medical attention.
The examinations that are supposed to pre-select a chosen group of children are in case of the devices based on photogrammetry (Moiré's) entirely safe. There are not any disadvantageous factors, such as radiation.
3.
Simplified evaluation of body posture and measurements taken before computer-aided examination
The application of specialist devises does not release from the need of observation and
initial evaluation of the examinee by simple means and the most available visual inspection methods.
Every examinee should be inspected visually in three planes: frontally, laterally and from the back.
The attention is paid (generally speaking) to all asymmetries appearing between the right
and left half of the body.
The visual inspection is to be done with natural light in a bright room
so that no shadows or smudges appear on examinee's body that could suggest the lack of symmetry.
Flection test. Using the flection test we evaluate the examinee looking at him/her from the back.
With the feet stridden at the shoulders' width we instruct the examinee to bend forward loosely
to reach the ground. From the bending position the examinee has to straighten up slowly.
The straightening should start with the lumbar, over thoracic, cervical spine and end
with straightening of head. Our attention should be concentrated on spine behaviour during movement
as well as on the symmetry of left and right side of the body.
Very often we can observe contracture of back thigh muscles
(which is often greater on one side) that results
in flection of one knee (or both) and causes disturbance in picture within spine and back.
In case of rotation of vertebrae while carrying out the flection test it is easy
to spot costal hump (at the height of cervical spine) or muscular prominence (at the height of lumbar spine).
We can also evaluate the movability of different spine segments while straightening.
It might also be important to assess the range of movements as well as forces of individual muscle groups.
Then we test muscles or joints in isolated positions.
Before we start examination with the computer-aided apparatus
it is necessary to take measurements of the examinee;
especially their present height and weight.
It is necessary not only for the computer to calculate certain parameters,
but also to make comparisons and take conclusions as to applied therapy and taken measures,
or to observe changes caused by lapse of time.
4.
Necessity for device application
Social needs for diagnosing bad postures are immense.
Which parent does not want to grant painless future for their child?
Often suffering ourselves from severe spine pains,
we want to protect our children from similar fate.
Unfortunately, the children themselves will not report to us about abnormalities in their development.
It is us adults who have to foresee and prevent.
The examinations with the use of computer-aided devices help us to objectify the results.
A number of parameters obtained after computerized edition gives us a precise picture of the child's state.
The edition of results and their analysis can proceed in many planes thanks
to a considerable number of calculated parameters.
The efficiency of the apparatus ensures a short time engagement on the side of an examinee,
and consequently examining a pretty big group of children in a short time.
We also have to find time to establish a personal contact and ask the patient about their present health,
posture, or to give the examinee a chance to ask questions.
5.
Device potential
The examinations allow us to evaluate the state of a child at a stage when the changes are small,
and consequently it is possible to correct them quickly. Therefore we can avoid a part of problems
that would appear later and would be connected with treating results of bad posture.
The method is repeatable after fulfilling certain conditions.
From my 6-year experience I can say that some characteristic,
personally changeable posture features (such as trunk inclination, shape of curves,
arrangement of shoulder-blades, etc.)
happen again in next examinations in the same children (after a year, or even after 3 years).
The next argument is the process of control that undoubtedly allows for a flexible approach
during corrective therapy and adapting our influence on the child in order to increase
the efficiency to a maximum. The apparatus does not have any bad influence on human body
and it is possible to do as many tests as necessary. We can carry out examinations,
e.g. before and after the treatment, while choosing the height of a shoe insert
in case of a shortened leg, after correcting a habitual bad posture…
6.
Examination process
While carrying out the examination we have to fulfil certain conditions that would guarantee
the comparability of results from different periods in future.
We have to create conditions for undressing before the examination
so as not to cross overmuch the shame barrier. It is good to place a screen next
to the door that would screen off direct insight into the room from outside.
If it is not possible we should place the apparatus (on a table) in such
a way that the examinees do not have to stand with their face towards the door.
The most favourable solution is when the examination place is out of view from people
who accidentally look into the examination room.
Fulfilling this condition would guarantee a certain level of comfort
for the examinee and would diminish the level of stress connected with the need to undress.
With examinations in a bigger group of children, especially at schools,
we should avoid unnecessary crowd and a greater number of examinees in one room.
We also have to divide children into groups according to their age and sex.
It improves the working conditions, prevents noise and ensures the previously mentioned intimacy.
While preparing the examinee we have to interview him about previous incidents
in relation to bad postures or previous examinations.
After registration we should take his/her measure and weight for it will be necessary
for the computer software to calculate certain parameters,
as well as it will allow us to analyse in future the changes in relation to present weight or height.
7.
Method of proper marking
Next step is marking orientation points on patient's body.
Attention must be paid to the way of point marking (it is different with slim,
and different with obese people), as well as position in which the marking is done.
Palpation is to be done with examiner's finger tip.
Inadmissible is the use of finger nails because the examinee
can change his/her position as a result of a hard, sometimes painful stimulus.
With slim people the spinous processes are often visible outside as a sort of hypodermic nodes.
Their palpation is to be done gently with index finger and it consists in moving skin over the process
in order to feel and mark its middle. It looks slightly different with obese people since
the spinous processes are often not visible. A deeper palpation is to be done with a fairly hard pressure.
It is often not possible in view of sensitivity and painfulness of tissues of the person
with whom we want to mark the points. Unfortunately, the marking has to be painless so
as the marking position could carry the features of a proper position (natural, unconstrained etc.
- the description below). Consequently we have to change the technique for such a one
that would guarantee proper marking. The finger used for palpation is the thumb (its tip).
With circling movements we shift the finger along with the skin in the place we expect
to find the peak of spinous process. Dosing pressure we should feel the place.
We have to bear it in mind that with growing pressure the contact surface of our finger
with examinee's skin has also to increase. Throughout we have to control proper position of the examinee,
and in case of its change we have to set him/her again.
When we mark the lower angle of shoulder blade, the palpation is to be done with
inner side of the thumb laying the palm on examinee's body (on his/her shoulder blade).
With the thumb slightly bent we try for the lower angle of shoulder blade to be at the height
of our interphalangeal joint which fits onto the edges of examinee's shoulder blade.
We mark the points while keeping
the proper position of the examinee: hands hang down freely, shoulders are loose (they can not be pulled up).
When marking back upper iliac spikes we have to pay attention to hollows over spikes
that appear with majority of people. We have to look for them exactly in that area.
The palpation is to be done on both spikes at the same time in order to feel their structure
(it is different with different people), and to later mark the points at the same heights.
The palpation is to be done with both thumbs directed to each other, and with the marker put aside.
Before marking the points we have to "pick" the skin around the spike from upper
lateral side and move it under the spike. In view of their build that sort of technique
is indispensable in order to make comparable markings of the points. Back upper iliac
spikes are felt as cone-shaped rises. Doing the palpation on their peaks is laden with a big error.
The skin in this area is considerably more sliding and it is hard to mark the points on both spikes
in identical places. Picking the skin and shifting it from underneath under the spikes allows
us to keep the thumbs in the same place on the "slopes" of the spike's cone.
It is considerably easier to feel and above
all it allows us (with the spikes correctly marked) to compare the right and left side.
While carrying out the examination it is good to inform the examinee about all the activities
we are about to do. It gives him/her more self-confidence and prevents,
e.g. a sudden turn at the first touch of the back with a marker.
For us it spares the necessity to put the examinee in proper position again.
8.
Examinee's position
The position for marking and later examination should be characterized by some fixed elements.
The feet should be stridden at shoulders' width.
It results from the necessity to control a steady foot load.
With stridden feet the moment of transferring weight for one leg i
s clearly visible and can be corrected immediately.
When the feet are put together the body
is constantly looking for balance since the supporting surface is small,
and consequently the movements are hard to perceive by the examiner.
Marking should take place in upright position with upper limbs hanging freely and head set straight
(with eyes looking forward horizontally). It is wrong to do the marking in bending position
(position to examine the costal hump).
It results very often in bending one knee which causes the transfer of distortions onto the spine that
do not comply with the reality. A problem is also sliding of skin that in bending is somehow pulled forward,
and during the examination in upright position it cannot present the factual line of spinous processes.
The setting of examinee during recording pictures also requires fulfilling certain conditions
that ensure keeping proper position and gives the chance of result repeatability and objectification.
Important is to keep the following sequence:
·
switching on the recording and light in the apparatus
·
switching off the light in the room
·
approaching the examinee from the back
·
correcting the position (arrangement of feet, making visible the beginning of anal cleft,
loosening the hanging upper limbs, loosening shoulders,
correcting head setting, ask for looking forward)
·
standing in front of examinee and with gentle movements of hands placed on his/her
hips bringing to symmetric arrangement of pelvis in the computer picture
·
switching off the recording and further editing examination results.
Sequence alterations can cause lack in required examination position.
An example for this is setting the examinee and then switching off the light.
It automatically results in position change, often turn, or even fear.
During the examination we stand in front of the examinee.
Thanks to this we control his/her position all the time and we look at computer screen
over examinee's shoulder.
In such a case when the examinee bends his/her knee,
loading more one leg, it is easy to notice the movement of head even with the
light switched off and with the patient's back lit only with apparatus light. Unfortunately,
standing on one of patient's sides is a fault.
It results in reflex deflection in opposite direction and the examination results
would not reflect fully the patient's state. Also standing behind the patient would
not allow us to simultaneously control the picture on computer screen and patient's position.
In case of, e.g. anisomelia the device gives the chance to take additional measurements
and pictures with the use of mats to compensate the shortening. We can here,
by means of trail and error method, choose the height of shoe insert
so as to get the most optimal change in parameters, and consequently in patient's state.
Comparing results and computer picture of several examinations,
without inserts and with several height options of inserts, we can trace the behaviour of,
e.g. spine line, changes in waist triangles, height of back upper iliac spikes,
muscular prominence within lumbar spine and many other parameters.
The examination using the Moiré projection phenomenon and the standard x-ray pictures are different
examinations. Differences in results are often caused by the difference in position applied during
taking picture. It happens that x-rays are carried out in lying position.
A position for computer-aided examinations is a standing position,
with feet stridden at shoulders' width and first of all with a steady load of lower limbs.
Standing position is a position that corresponds most to "everyday life".
What is more, the Cobb's angle that is very often calculated on the basis of x-ray pictures
does not always agree with distortion angle calculated by the computer.
In results from the fact that to establish the distortion angle be means of a computer
we take the line of spinous processes into consideration.
With bigger distortions taking place with considerable rotation of vertebrae
the spinous processes do not correspond to actual arrangement of vertebrae (we must remember that).
After the examination we have to give the examinees some time for dressing and inform
them about the way of getting the final results.
9.
What can we show in the relations child-parent-I?
During the contact in relation parent-child-examiner we have to explain first of all
the doubts with which the parent has come to the examination.
Very often a stimulus to do an examination is parents' suspicion for the child
to have a bad posture (he/she dos not sit straight, stoops, carries his/her schoolbag badly,
he/she is crooked, neighbour's child has already developed a bad posture…).
We always have to explain to the parents and show them, possibly on the child,
what is alarming and deviating from the norm.
The parent has to feel partly as an examiner, and through our observations he/she should have
an impression that he/she can also be objective to his/her own child.
Thanks to such an approach we can count on parents'
cooperation during further treatment (after defect detection).
10.
Interpretation of results
Upon examination completion and after calculations done by the computer software
the printouts have to be described in such a way that the parent who is not a specialist
could understand the examination results and at the same time could join the corrective treatment
if there is a need for such measures.
The examination contains a number of parameters,
but the most important are those that define distortions of spine, symmetry of thorax,
as well as the behaviour of pelvis. For scientific, comparative etc. purposes we can analyze
all parameters very precisely;
however doing this for a parent we only make it understandable and impossible to interpret.
While describing the examination we refer to norms foreseen for a given parameter.
The difference is considered a norm (which is what I have assumed):
Up to 5 mm for following data:
·
parameters defining shoulder blades
·
parameters defining waist triangles
·
parameter defining maximum deviation of line of spinous processes from the line C7-S1
Up to 10 mm; for the parameter defining arrangement of shoulders.
However, the parameters defining the difference in position of back
upper iliac spikes should indicate 0, 0 - if not,
there is an asymmetry within the pelvis or a shorter lower limb on one of the sides.
When we consider sagittal plane (round back, concave back, round-concave back, flat back…)
we evaluate the angle of thoracic kyphosis and lumbar lordosis.
Border angle is here the angle of 145o
°([2]
).The bigger the angle - the less the defect.
While describing the examination we should use full sentences without abbreviations
or strictly professional terminology.
Our words have to appeal to the parent who is often a layman in this area.
Last of all we also have to propose further treatment procedure.
Will it be corrective gymnastics, a necessity to pay more attention
to the child during everyday routines, or sending him/her to an orthopaedist for further diagnosis
- it will result from the parameters obtained during the examination.
While interpreting the result we have to consider the norms defined earlier, we can also compare the present examination with the result from the previous examination. Then we can compare two examinations in many respects, choosing parameters interesting for us.
11.
What with the child and examination in the future?
A repeated examination is a test of progress and changes taking place in child's body. Thanks to numerical parameters obtained during the examination it is possible to precisely define the changes in many planes (thanks to many calculated parameters). A repeated examination allows us to evaluate hitherto existing results and to make necessary corrections.
The terms for repeated examinations would depend on the results from the first examination. We could assume that:
Upon detection of disturbances in body posture it is necessary to introduce a proper
therapy and there must be a team that will supervise it.
We have to state it clearly that the work has to be done by all people as a team.
This team should consist of parents along with their child and a doctor along with
a rehab specialist or physiotherapist.
To be successful everybody's work and engagement is necessary.
It is very important, both with small asymmetries and with considerable changes,
to implant in child the need for movement and recreation sport.
The activity and effort chosen properly will guarantee correct development,
fitness and efficiency, better concentration, clear thinking …
The father of Polish orthopaedics and rehabilitation Prof. Wiktor Dega pointed out
a long time ago the need for activity as something
that can not be replaced be anything and for keeping our health it is indispensable.
The saying: "The activity would replace a lot of drugs, but no drug would replace the activity"
has a deep meaning and besides we can have the activity for free.