Surgery – Diagnostic testing
Reexamination Certificate
1998-02-16
2004-02-17
Winakur, Eric F. (Department: 3736)
Surgery
Diagnostic testing
C128S898000
Reexamination Certificate
active
06692435
ABSTRACT:
Pursuant to 37 CFR 1.71(e); A portion of the disclosure of this patent document contains material which is subject to copyright protection. The copyright owner has no objection to the facsimile reproduction by anyone of the patent document or the patent disclosure, as it appears in the Patent and Trademark Office patent file or records, but otherwise reserves all copyright rights whatsoever.
CROSS-REFERENCES TO RELATED APPLICATIONS (IF ANY.)—None
STATEMENT AS TO RIGHTS TO INVENTIONS MADE UNDER FEDERALLY-SPONSORED RESEARCH AND DEVELOPMENT—None
References in parenthesis in the specification are to sources appended at the end.
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention is directed to using and testing devices or compounds which reduce onset of symptoms of median nerve entrapment or carpal tunnel syndrome or repetitive stress syndrome, reduce tactile deficit of fingers, and increase identification of foreign mass in breast and other self examinations, disability accommodation, medical and physical therapy, cancer discovery and prevention. Devices will improve the movement of the fingers, reduce the inflammation in the carpal canal, reduce the tendon excursion in the carpal canal, reduce finger flexion, reduce loss of nerve sensation, reduce loss of tactile sensation, increase tactile sensitivity of the fingers, increase movement of the dorsal interossei muscles of the hand, increase movement of the volar interossei palmar muscles of the hand, and increase movement of the lumbrical muscles of fingers, as well as many other applications.
2. Description of the Prior Art
Rehabilitation and prevention of median nerve entrapment has generally dealt with wrist angle, body posture, and fatigue, rather than finger movement. Most authors consider the wrist flexion of prime importance. “Within the work place, repetitive wrist flexion and extension and continuous use of the fingers with the wrist either extended or more commonly flexed palmarly are the usual hazards associated with this cumulative trauma disorder syndrome.” (23A) pp. 1347 et seq, at 1373.
“. . . intracanal pressure rises with flexion and extension.” (24B) at 348. Similarly, subcutaneous cancer prevention, has focused on self examination instruction rather than the ability to tactilely identify a foreign mass. Thus, neither biomechanics of engineering nor medical research has related the health of the finger tips with preservation of the sensory and motor operations of the nerves.
2A. Background of the Invention: Keyboards
Communication has always been necessary. By the end of the Second Millennium A.D. keyboards and computers have become ubiquitous, to inform, solve, record, measure, compose, design, entertain and plan. Until the typewriter was invented, all written communication was one handed. The typewriter allowed two handed composition, and an increase in efficiency by an increase in finger flexion.
For a discussion of the QWERTY, Dvorak and efficient keyboard layouts see U.S. Pat. No. 5,352,050, 1996 U.S. Pat. No. 5,498,088, 1872 circa. Sholes created the QWERTY keyboard (based on the left six letters on the third row). According to Beeching, Sholes' ruse was “probably one of the biggest confidence tricks of all time . . . the idea that the so-called ‘scientific arrangement’ of the keys was designed to give a minimum movement of the hands was, in fact, completely false!” In 1873, the Remington Company bought Sholes' patent for the ‘typewriter’ and began shipping it in 1874. In 1905 an international conference of typewriter manufacturers and teachers decided the future of print communication. The QWERTY layout was adopted because typing teachers had been teaching QWERTY for decades. According to Beeching: “The battle raged backwards and forwards. Nobody could agree on what a new keyboard should be, but the biggest opposition came from teachers of typing. As it still does today. They wanted things to remain as they were, and they are still the most reluctant to change their methods and learn all over again. All present keyboards are, therefore, based on the ‘QWERTY’ layout.” (5) pg. 40-41.
QWERTY has its critics: “awkward . . . designed to slow typing” (46). “worse possible arrangement” Typists' Speed & Efficiency, by Virginia Russell, Computer Technology Review, Winter 1985; “very poor” Illustrated World Encyclopedia, Vol 14, 1970, Glen Cove, New York, p. 4694: “wrong thing” interview in Conquering the Keyboard, by Robert Alonso, Personal Computing, August 1985, at 72; “costly . . . error . . . slows . . . produces fatigue” U.S. Pat. No. 3,847,263, 1974, col. 1, USPTO; inefficient” U.S. Pat. No. 4,655,621, 1987, column 1, USPTOY “not the best . . . (makes) much more work” 1994 Compton's Encyclopedia, Typewriter p. 342; and also see “The Case Against QWERTY” at National Museum of American History, Smithsonian Institution, Wash. D.C. circa 1992. As of 1998, QWERTY continues as the standard keyboard layout.
Since Sholes, several inventors have designed keyboards to increase efficiency, increase speed, reduce awkward positions, reduce cramping, avoid rhythm slow down, reduce errors, and reduce fatigue. These include Rowell, Hoke, Dvorak, Bower, Dodds, X, Einbinder, Malt, Menn, Holder, and Diernisse. Recent efforts include:
1991. Key Arrangement and Method of Inputting information from a key arrangement, U.S. Pat. No. 5,003,301. Romberg selects Rower's letters for the home row.
1994. Keyboard Arrangement to maximize typing speed and ease of transition from a Qwerty keyboard. U.S. Pat. No. 5,352,050, 1996 No. 5,498,088. Choate places Bower's letters on home row.
1998. Novel Keyboard arrangements and method for increasing typing speed. Application Ser. No. 08/652,109 issuing as U.S. Pat. No. 5,718,590. Choate outlines a method of training.
Although a report on telephone company employees concluded the use of DVORAK versus QWERTY keyboard was not associated significantly with any listed musculoskeletal outcome measures. (22) The methodology of the report was deficient as the questionnaire sampled a small portion of the work force, and did not seek information or compare workmen's compensation claims or absenteeism, even though both statistics were available company wide. “Hadler's analysis of the U.S. West case casts doubt, in his opinion, on occupational causation of these CTDs. He implicated the following locally intrinsic geographic factors which, he felt, accounted for the increased reports and disability in the Denver area: increased worker complaints, psychosocial factors, health services that were more receptive to the work relatedness of complaints, and increased utilization or surgical intervention among physicians in the community.” Hadler, N; Arm Pain in the workplace: a small area analysis, J. Occup Med 34(2):113-119, 1992. (53) Hadler noted a significant geographic variation in incidence of CTS (approaching ten fold in four of the U.S. West states). Ibid at 49. The operators reporting the ten fold increase of CTS were in states using QWERTY. (58)
Since Sholes, many efficient layouts have been invented. Each reducing the flexion and travel of the fingers.
2B. Background of the Invention: Health, Median Nerve Entrapment
i. Carpal Tunnel Syndrome
“Carpal Tunnel syndrome” refers to the compression of the median nerve (due to inflammation of flexor retinaculum, arthritis, or tenosynovitis) as it passes through the osteofibrous carpal tunnel along with the tendons of the long digital muscles which typically results in paresthesia (tingling), anesthesia (loss of tactile sensation), or hypesthesia (diminished sensation) in skin areas related to the thumb, index, middle, and lateral ½ of ring fingers. The palm may be saved due to palmar cutaneous branch arising superficial to flexor retinaculum. A progressive loss of strength and coordination in thumb with diminished use of thumb, index, and middle fingers as nerve is compressed is also common. Carpal Tunnel syndrome is relieved by partial or complete division of the flexor retinaculum.” “U
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