Measuring and testing – Muscular force – Using a resilient force-resister
Reexamination Certificate
1999-07-26
2001-04-17
Noori, Max (Department: 2855)
Measuring and testing
Muscular force
Using a resilient force-resister
C073S865900
Reexamination Certificate
active
06216535
ABSTRACT:
1. Field of Invention
This invention relates to isoinertial lifting capacity testing devices, specifically such non-computerized equipment which is used to assess consistency of effort during a functional capacity evaluation. Various equipment and methodologies are currently in use to evaluate validity of effort in subjects who have filed insurance claims for physical injury.
2. Description of Prior Art
Work-related injuries represent a major source of financial loss for businesses in this country. Significant claims for personal injury also arise from motor vehicle accidents and other accidents which are unrelated to the workplace. Together, the medical and indemnity expenses associated with these claims cost billions of dollars annually.
A disproportionate amount of money in compensable cases is spent on a relatively small number of claims which are filed. In part, this occurs because some claimants may need to undergo surgery and/or extensive physical rehabilitation. In other cases, expenses related to treatment, rehabilitation and indemnity are inflated because individuals may attempt to abuse a compensation system and receive treatment or monetary awards that are not justified.
Various physical tests are often performed to determine the need for treatment, to make appropriate return to work restrictions or to arrive at a financial settlement for a case. In such tests it is essential that measures be incorporated in a protocol to objectively identify performances that are not reflective of maximum efforts.
Not infrequently during an assessment of an individual's functional abilities, apparent inconsistencies in performance are noted. The classic example of such inconsistent behaviors may occur during a hand grip assessment in which a low back pain patient demonstrates physical weakness and wide variability between trials on a hand-held dynamometer. (Hand grip weakness can not be explained in the physical context of a low back injury.) Some individuals in a testing or therapeutic environment, then, appear to magnify the extent of pain and disability because of non-physical factors. Mechanic and Matheson have written extensively about this phenomenon, known in the field as “symptom magnification.”
In some cases, unrealistic expectations are placed upon injured workers who are attempting to return to work after an injury. Without objective information regarding an individual's functional abilities, employers and insurance companies may expose a worker to re-injury. Furthermore, financial settlements proposed in such instances may not adequately compensate an injured party.
As a result of abuses of compensation systems by claimants and defendants alike, there is a demand for comprehensive functional assessment. Such evaluations can be used to assess validity of effort and to manage decisions regarding indemnity, treatment and an individual's ability to return to work.
In compensation systems, thus, it is necessary to objectively determine if a physical performance reflects maximum physical effort. Performances that are not highly reproducible can not logically be classified as valid expressions of maximum physical capacity. Therefore, it has become beneficial to develop tools and methods which help clinicians objectively assess consistency of effort during a test of functional abilities, particularly during lifting, carrying, pushing and pulling, because these are the most commonly performed material handling tasks.
Susan Isernhagen proposes the “kinesiophysical” approach to functional assessment. A standard protocol is administered to test subjects. Using this method of evaluation, therapists are reportedly able to identify valid efforts by noting the presence or absence of biomechanical failure during assessments of lifting, carrying, pushing and pulling capacities. Isernhagen proposes specific criteria which are said to indicate biomechanical breakdown and valid effort. The application of the criteria, however, relies on the accuracy of the therapist's assessment of the physical performance, as opposed to extensive analysis of numerical data gathered during the test.
In the kinesiophysical model, termination points for various material handling tasks in this protocol are determined by the therapist. Inter-tester variability in interpretation of performance is inevitable with such an approach. A subjective approach has the potential to expose a test subject to injury if a therapist misjudges physical ability or effort. There is also the potential to incorrectly classify consistency of effort. The evaluation of symptom magnification does not play an important role in the approach advocated by Isernhagen.
Matheson and Blankenship propose the “psychophysical” method of functional assessment. These clinicians propose that any physical performance is affected by psychological as well as physical factors. The psychophysical approach is the most common type of protocol used to evaluate claimants in a compensation system.
Material handling activities during a psychophysical assessment are terminated when a test subject indicates an inability to safely perform at a higher workload or when, in the clinician's opinion, the safe biomechanical limits of the subject have been attained. Both of these termination points are subjective. In contradistinction to the kinesiophysical approach, the method advocated by Matheson and Blankenship places more emphasis on interpretation of raw data in order to add some objectivity to the assessment of validity of effort. Furthermore, Matheson and Blankenship place a greater value on incorporating cross-reference tests and observations into a protocol. Psychological and behavioral factors are also given more weight in the analysis of a performance. For example, Waddell testing for assessing non-physical pain responses in low back pain patients are routinely administered. (In landmark research, Gordon Waddell found a correlation between reports of pain arising from purposely-benign physical maneuvers and high scores for hypochondriasis, hysteria and depression on the Minnesota Multiphasic Personality Inventory.) Pain questionnaires intended to identify possible symptom magnification are also typically filled out by the subjects in the psychophysical model.
Matheson and Blankenship also advocate the use of various multiple-trial isometric tests to assess consistency of effort. Inter-test variability between trials is analyzed with the coefficient of variation. It is noted, though, that the research on the coefficient of variation is divided as to the usefulness of this statistic in correctly classifying effort during isometric strength testing.
“Distraction testing” has become an accepted method of assessing consistency of effort. Waddell formally proposed the concept in the research previously cited. He insisted that for such testing to be valid, it must be “non-emotional, non-hurtful and non-surprising.” Clinicians using the psychophysical method of evaluation frequently develop their own distraction tests for use during functional assessment, varying the protocols proposed by Matheson and Blankenship in accordance with their professional experience and judgement.
There are a variety of testing devices capable of measuring isometric lifting capacities. Examples of a few such inventions include U.S. Pat. Nos. 4,972,711 and 5,275,045. This mode of testing maintains the test subject in a static body posture while the subject exerts a pushing, pulling or lifting force against a stationary object. However, there are few work-related activities which require the production of force which is exerted against an immovable object. Also, there is no direct relationship between isometric and dynamic physical abilities. Furthermore, clinical research, as already stated, is divided on the usefulness of the coefficient of variation in assessing consistency of effort during isometric tasks.
Numerous isokinetic devices have been invented. Examples of such inventions are U.S. Pat. Nos. 3,465,592 and 4,907,797. Some isokinetic devices have the ca
Noori Max
Schapmire Darrell William
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