Jakobs. Evaluation. Balance Top c-free GymTop USB Professional Sensago Professional. Producer of the Therapy Top and Distributor

Transcription

1 J Jakobs Evaluation Balance Top c-free GymTop USB Professional Sensago Professional Producer of the Therapy Top and Distributor Jakobs GmbH Noervenich Germany Phone: 49 (0) Fax: 49 (0) Official Website:

2 Tabel of content Introduction... 3 Basics of exercise examination... 4 Exercise 13 - the diagnosis mode...6 Exercise 14 - diagnosis mode cross Exercise 1 - balance Exercise 2 - left - right Exercise 3 - forwards- backwards Exercise 4 - circular movement, exercise 5 - oval movement Exercise 6 - the snake Exercise 7 - spiral Exercise 8 - the eight, Exercise 9 - infinity (the lying eight) Exercise 10 - basket ball Exercise 11 - labyrinth 1, Exercise 12 - labyrinth Ballon chase and Bird chase Exercising/ Examples for gyroscopes...24 SENSAGO Professional - the interpretation 1

3 Introduction The sensor enables the diagnosis and the treatment of several physiological and psycho-motoric deficits. A lot of experience is necessary to create a diagnose from the exercise summaries and the statistics. This paper should ease the start by describing all relevant possibilities of the software. Particular the diagnosis mode with all his statistical parameters are described. To every exercise exists a summary of a normal and a suspicious exercise. Furthermore the manual contains exercise instructions to verify several indications or to reach certain objectives. The interpretation of the data depends strongly to the boundary conditions, e.g. age and fitness of the patient or the exercise. It is important for the therapist to know what they want from the patient. Try out the exercises by yourself. By this you can give the patient a lot of helpful hints. Furthermore the sense for the correct interpretation of the data increases. The software collects a lot of important statistical facts, but the correct interpretation is up to you! 1st edition, April 2008 This operating instruction contains copyright protected information, which is reserved to the company Haynl-Elektronik GmbH. Each rendition or utilization outside of the borders permitted by copyright is inadmissible without previous written permission on the part of Haynl-Elektronik GmbH. The company Haynl-Elektronik GmbH reserves itself the right to make at any time and without advance notice, improvements and changes. All data in this operating instruction are regularly examined. Corrections are made in the next expenditure. Suggestions to: matthias.stefaniak@haynl.de 2 SENSAGO Professional - the interpretation 3

4 Basics of exercise examination Independent from the given indikation it is important to understand the statistical parameters. The program can evaluate the exercise 1 to 12. The evaluation is normalized for a declinition angle of 22.5 and uses grades to show the quality -1 very good to 6 insufficent. These exercises use a movement task to stress the mental and physical abilities. By this, exercise 1 to 12 is not useful for the detection of relieving posture e.g. scoliotic pelvis. Therefore Exercise 13 - diagnosis mode is useful. In opposite to exercises 1 to 12 the position of the sphere responds directly to the declinition of the sensor. Therefore smallest declinitions of the sensor are displayed directly on the screen in exercise 13 and 14. In exercise 1 to 12 the sphere uses a physical model, which simulate a real sphere, including accelerations, velocities and reflections. The exercise examination consists of 5 parts. In the left upper part you can see the estimation, the level, and the difficulty. In the diganosis mode 13 the examination is missing, because there was no movement task. summary of all important parameters diagram left/ right diagram front/ back line diagram special information of the exercise spectrogram The grades in exercise 1 to 12 are orientated on experiences. A group of 10 probands with several age and fitness complete all exercises with all 10 difficulties. The best score equates the grade 1, the worst score the grade 6. Right aside exercise specific information are shown. You can copy and paste it into other programes like Word. The diagrames Left/Right and Front/Back shows the declinition of the sensor in the course of exercise. The program recognizes every 0.01s the declinition of the sensor and can separate 150 different angles (0.03 precision). If the sensor is deflected for 2 seconds complete to the front, the program will assign the angle seconds. If the user move within one second to the back and hold these position for 2 seconds too, the program enter 10 points with 0.1s between front and back and 2 seconds on 22.5 These exercise was 15 times repeated so the left diagram was created. To see the maximum level of detail, the diagrams are scaled to their maximum. In the left diagram the maximum of the Left/Right axis is 5.7s, the maximum of the Front/Back axis 27.7s. The exercise length was one minute and it was the exercise 3. As you can see the sensor was deflected on the Left/Right axis near the zero position. In different the sensor was deflected to his maximum position on the front/left axis. Ideally the maximum value of the Front/Back axis should be 30s (half of the exercise length). But this isn t possible, because the change from the front to the back need some time. By this you can measure how long the patient needs to change his position from front to the back. The reaction/ movementcontrol ability of the patient is better, if the diagram maximum is nearer to the relative maximum. In the diagram Front/Back you can also see, that the patient stand longer in the back then in the front. You can see it on the red bar. The spectrogram symbolizes the course of the sphere in the exercise. Blue means that the sphere never was there, red symbolizes area where the sphere was the longest time. Between blue and red the colors are spreaded like in the lower part of the spectrogram shown. Note that the exercises 1 to 12 use a physical model for the sphere, so that the movement of the sphere is smooth. Exercises 13 and 14 show 4 SENSAGO Professional - the interpretation 5

5 direct the declinition of the sensor in the spectrogram. The interpretation of the spectrogram depends to the movement task. In the following of this booklet we put special emphasis to this. Exercise 13 - the diagnosis mode The diagnosis mode is discussed first because of the high importance. Statistical parameters like average, standard deviation or angular velocity are included. Furthermore a zone model is included. Often the patient is assigned to hold the balance e.g. in combination with gyroscopes. The patient stay with both legs on the gyroscope and watch on the screen. Now ask the patient to stand 30 seconds absolutely still in balance (Set the exercise length to 30 seconds). After this start a new exercise (30 seconds). Press the B key to darken the screen or turn the patient so that he cannot see the screen. By this the patient has no feedback from the screen. This has the effect, that the patient cannot verify his position. Now relieving posture e.g. after knee and hip operations are detectable. Also hip-leanings and other anatomical noticable problems like faulty posture are detectable. The average of the Left/Right axis is the important fact. A value smaller then 0 corresponds to a tendence to the left site, greater then 0 a tendence to the right site. Note: alone the average is not enough to establish a proof. If the patient change his balance continously around the zero position, an average of 0 is the consequence. Therefore the standard deviation is the second important parameter. It describes the fluctuation around the average. The value 0 means, that there is no movement. A value greater than 0.3 is a sign for sad co-ordination. The middle and maximum angular velocity (ds.v / max v) are indicators for the quality of movement too. The combination of average and standard deviation enables the therapeut to create a diagnose. If you presume a relieving posture, you can start the diagnosis mode with shaded screen. Exemplary some combinations and their meaning: Average left/right: 0 Standard deviation left/right: 0 to 0.1 Average front/back: 0 to 0.1 Standard deviation front/back: 0 to 0.1 Result: no finding - the standard deviation of 0.1 is absolutely normal Idealy it is zero. Average left/right: 0.3 Standard deviation left/right: 0 to 0. Average front/back: 0.1 Standard deviation front/back: 0 to 0.1 Result: Relieving posture on the left side. The standard deviation is very small but the average shows a significant tendence to the right side. The right foot had a higher load than the left foot. The deflection on the front/ back axis is absolutely normal because it is easier to stand on the heels than on the balls. Only with active muscular activity is it possible to stand on the balls. Average left/right: 0 to 0.1 Standard deviation left/right: 0.2 to 0.4 Average front/back: -0.1 to 0.1 Standard deviation front/back: 0 to 0.2 Result: Co-ordination disturbances. It is not possible to diagnose a relieving posture. Normaly the deflection around the left/right axis is greater than the deflection on the front/back axis. If the patient hold the balance and you see a standard deviation greater than 0.4 you should finish the diagnose because of a great danger of falling! Average left/right: -0.3 Standard deviation left/right: 0.2 to 0.4 Average front/back: 0.1 Standard deviation front/back: 0.1 to 0.3 Result: Strong co-ordination disturbances often have several reasons - disturbances of vestibular organ, vertigo, cardiovascular disease. Often you can see a tendence to a side. Note: You can diagnose false postures only if the standard deviation is less than 0.2. The exercises can be modified. For example, you can check the function of the vestibular organ by closing the eyes. Attention! Try this exercise 6 SENSAGO Professional - the interpretation 7

6 first without a gyroscope. Only if the patient accomplish this exercise, you can test the balance on a gyroscope. If the patient close his eyes, only the vestibular organ and the propriozeptors are available for balancing. One-legged balancing is useful for diagnosing the stability of the leg muscles. The fluctuating along the left / right axis is only minimal, because the patient try mainly to balance with the arms and his upper body. In contrast to the two-legged standing fluctuations along the front/ back axis are higher. By this way you can find differences between the two legs. However, these results should not be overrated. The jump leg is generally stable and strong. A non-zero average indicates mostly a position of the foot out off the center. If the patient wear shoes with heels, a deflection is possible because the angle of the foot is directly transfered. To test the co-ordination capacity outside the stable position request the patient to stand within a zone. The exercise become more difficulty when you request the patient to move in clockwise direction along a zone instead of holding a position in a zone. Hereinafter 5 examinations: Example 1 shows the examination of a proband with very good coordinatoric abilities. He had the task to stand steady on a gyroscope. The proband could see the monitor. In example 2, the same proband had the instruction to close his eyes. As you can see there are light fluctuations on the left/right axis. You can see a greater movement-zone in the Example 1: Perfect co-ordination with open eyes Example 2: Light unstableness with closed eyes Example 3: Light disturbance of equilibrium Exercise 4: Right drift after cruciate rupture in left knee Exercise 5: Task: drive in zone 2 - well done Exercise 6: one-legged standing on the right leg spectrogram. Overall the task was solved nearly perfect because the visual orientation is a great part of the balance. Example 3 is a typical examination of proband with light co-ordinatoric disturbances. As you can see the area of movement is relative huge. 8 SENSAGO Professional - the interpretation 9

7 The standard deviation is much greater than in example 1 and 2. On the left/right axis it is 0.3 and along the front/back axis 0.2. Both diagrams shows a wide movement spectrum among the center. Example 4 shows a typical rupture of the cruciate ligament. The exercise was accomplished 7 days after the operation. You can see a tendence to the right side, caused by an relieving posture. The patient disburden his left knee with the effect, that the right knee has more load. If you presume a relieving posture, it is important, that the patient never see the monitor, because he could try to compensate the defizite. In the 5th example the patient had the task to move anticlockwise direction in zone 3. Expected are some recovery area in the corners (yellow or red area in spectrogram). The proband solve the competition good. Very oftener you can see fluctuations up to the outer limit or to the center. Have a look to the zone times. The proband spent the most time in zone 3 (20.3s) and only 0.5s in zone 2. If the ball contact two zones, the zone time is counted for the outer zone. In zone 4 the ball spent 9.11s, in zone 1 0.0s and zone 0 0.0s Example 6 shows a one-legged balancing test, of the right leg. The fluctuations among the front/back axis are stronger than the fluctuations along the left/right axis. While one-legged balancing, the usage of arms and upper body are very distinctive to keep the balance. The two-legged balancing is characterized by the usage of the knees, while they buckling. The balancing of the front/back axis is mainly done by the ankle joint and partial by the knees. Exercise 14 - diagnosis mode cross This mode uses a movement task. The proband should follow the arrows as fast as possible to the corners and back to center. Ideally the ball is always over the blue lines. To get a significant examination the proband should absolvate the complete movement (1-Z-2-Z-3-Z- 4-Z) 3 times. On the right side you can see the white lines. They describe the complete movement area. The lines should be as small and short as possible. Order the proband to move as precise as possible, because a lot of patients try to finish the task as fast as possible, but not so precise. In the course of training the velocity increases, because the proband inure. The velocity equates to the index arrows per minute. On the screen you can also see the actual angular velocity and the maximal velocity in degree/s. Note that the exercise become easier if the difficulty is smaller. The smaller difficulty increases the hitbox of the ball, so it is easier to hit the arrow. At difficulty 10 the hitbox has the size of the ball itself, at difficulty level 1 the hitbox is 3 times greater than the ball. Exercise 1: unco-ordinated movements Exercise 2: good co-ordination Exercise 3: perfect co-ordination 10 SENSAGO Professional - the interpretation 11

8 The examination of example 1 is typical for insufficent co-ordination. The high maximum velocity of 183 /s und the average velocity of 23.7 /s are an indicator that the proband moves fitfully into the corners. You can see it in the 2 diagrams - in the left/right and front/back diagram the main part of movement is in the outer areas. The line diagram shows a lot of undirected movements so that you can summarize an insufficent coordination. The index of 40.5 /min is in comparison to example 2 rather small. In difference to example 1 you can see in example 2, that the proband has a good co-ordination ability. The index of 70.9/min is good for an exercise with the gyroscope. The average and maximum velocity are ordinary. In the line diagram and in the 2 diagrams you can see, that the proband moves slowly but precise. But there are some outlier - to right side, right upper corner and to the bottom where the proband shortly lost his balance. A typical exercise for the hand co-ordination is shown in example 3. The high index of 216.1/min in combination with the linediagram means that the proband has an excellent co-ordination ability. With this exercise you can show very good co-ordinatoric differences between the left and the right hand. You can see the center of movement (red point) in the middle of spectrogram. The apophysis to the corner are all light-blue which means, that the hand has all around a good co-ordination. In the case of fractures or other blockades it is possible, that you can see sectors with slower movement - the lines have then a tendence to green or yellow. Note that in occordance to the exercise the results can differ. If you test the hand co-ordination, an index of 250 to 280 is possible. If the proband stand on a gyroscope, an index of 80 is really good. Only exercises of the same kind are comparable! Exercise 1 - balance Exercise 1 - balance should started after the diagnosis mode. The difference is the movement task. The proband must try to move the ball as fast as possible into the center by shifting his weight and hold the ball there. The results of this test can be used as indicator for balance. The left statistic shows a proband with a perfect balance. In the middle statistic you can see, that the proband tried all the time to hold the ball in the center. Although the spectrogram shows, that the ball was in the center, the front/back and left/right diagram shows, that the proband must correct all the time his position. In the right statistic you can see, that the sensitiveness of this proband is missing. He works only with the maximum deflection. This is visible in the front(back and left/right diagram. There are no deflection near the center. The spectrogram shows a huge area of movement. Probands with co-ordinatoric disturbances often fail to move the ball in the center. Particular old people often have problems to estimate the movement of the ball. To verify if these problems are caused by mental or physiological problems try to give the sensor into the hand. If the patient also fail, try to reduce the difficulty (setting in the New exercise dialog). 12 SENSAGO Professional - the interpretation 13

9 Exercise 2 - left - right In the following 2 exercises are compared. On the first view you can see the different evaluation: 1.0 vs 3.3. In the left/right diagram you can see a maximum of 27.4s (optimum 30s) vs 15.23s (optimum 30s). The optimum is the half of exercise length. The spectrogram shows a spot on the left side. The proband stand longer on the left side. The ball moves relative near on the bottom wall, so that the ball often was decelerated. The proband tried to compensate this as it is visible in the front/back diagram, but overall the sensor was deflected to the back. In comparison to the first example the range is wider. The movement area in the left example is more in the middle. Obvious the proband needs more time to change his balance from the left to the right side than otherwise. Please always have a look to the exercise length. The longer an exercise lasts, the more meaningful are the results. But you should make sure that untrained people don t overstrain and so an apparend trend is shown. Five minutes should be sufficient to recognize such trends. If the exercise period is chosen too short, the influence of small errors to the result is very strong. The patient should become the possibility to practice with the device. Ten minutes to become acquainted before the actual training starts could be helpful. Exercise 3 - forwards- backwards Idealy the spectrogram should show only one red line exactly in the center. The maximum should the half of the exercise length. The reality is shown in the following example. The proband tried all the time to hold the ball in the center. In the Front/Back diagram you can see a small pyramide. The narrower the pyramid (shape of the curve) is, the better is the coordination ability. If the curve rather correspond to a U (high at the edges, towards the middle being flat) it is a sign for very little sensitivity of the proband, i.e. he may deflect only complete to the right or to the left. This results from the fact that if the sensor is deflected in one direction the proband is in a very stable position. The aim of the exercise 3 - forwards and backwards is to move the ball most often from the top to bottom and back, so it is ideal if the diagram front/ rear only shows at the edges 2 red bars. Another objective of this exercise is to minimize as good as possible collisions with the left or right edge, because this slow the ball. If you look at the spectrogram on the exercise, you can watch the way of the ball. As you can see, the course of the ball was along the central axis. Please note that the spectrogram shows the course of the ball and thus not the direct deflection of the gyroscope. The ball is subject to a physical model, with the result that the ball move with a certain speed and acceleration in one direction. If the deflection rolls the ball forward, for example, the patient must first slow down the ball until it stop and finally rolls back. In the front / back diagram are only two bars in the external areas visible. As you can see, there is a red area in the front position and a somewhat smaller orange area in the rear position. This means that the ball was longer in the front position as in the rear position, with the result that the patient can better change from the back to the front, as from the front to back. This is absolutely normal, because the extension of the calfmusculature yields in a more stabile position than the extension of the shinbone musculature, so that the change is easier and faster. 14 SENSAGO Professional - the interpretation 15

10 Overall the spectrogram is very homogen. The evaluation with 1.0 means, that there are no noticable problems. Subsequent a summary of exercise 3 is shown, which indicates a medium co-ordination ability in combination with a restricted movement estimation. The first fact ist the evaluation with 2.2. Either it has the effect that the user does not exceed the full declinition to the front and back (extreme muscle shortening, especially bodybuilding), so that the ball is not accelerated to his maximum velocity or that the patient missed the reversing points, just before the ball collides with the wall, and thus the ball is on the wall. In this case, a muscle shortening can excluded, because the diagram Front / Back shows two bars in the outer areas, so that the full declinition is reached. The Left / Right diagram also shows red bars in the outside areas, and components in the central areas. This indicates a low sensitivity of the proband. It is confirmed by the spectrogram that, unlike the previous spectrogram have one red field and a very wide and irregular movement distribution space. The presence of the components in medium left / right diagram also shows that the patient has a certain basic level of co-ordination. Probands with a very bad co-ordination, often have only 2 bars in the external areas. Exercise 4 - circular movement, exercise 5 - oval movement exercise 4 and 5 combines the horizontal and vertical movement. A very good evaluation is obtained when the ball never hit the walls. For this reason the two exercises require a very high level of coordination. Unfortunately no evidence is expected because the sensor is mostly deflected to its maximum to be as quickly as possible. If these extreme deflections aren t visible, a sad evaluation can be expected. Only the evaluation can draw conclusions about the movement speed. In the spectrogram are zones with high retention and related co-ordinatoric visible. In the right spectrogram is a red area on the left bottom visible. In the left diagram the red area is districted on the entire circle. This means that the ball almost had the same speed in the whole area. Similar statements are also possible in Exercise 5. In contrast to Exercise 4, the proband must act more sensitive to the front / back axis, which is visible in the diagram. This movement task accord rather to the human physiology than the circle of Exercise 4, because the deflection to front/ back is not so strong. In the right analysis is in the lower left corner a deficit visible where the patient apparently missed the change from rear to the right. 16 SENSAGO Professional - the interpretation 17

11 In case the exercises 4 and 5 show abnormalities, the patient should exercise the course clockwise and don t hit directly the first arrow. If then a red area is visible right below, the patient has a deficit in the change of back to an other deflection. If this is the case, you can still use Exercise 3 to verify the deficit when changing from front to rear. Exercise 6 - the snake Exercise 6 requires a good response capability. The ball should ideally stopped just before the switchback. Probands with a very good body control, rebound the ball in the curve so that the speed of the ball is constant in the curve. Ideally, the whole curve is green to yellow and show in the turns orange to light red areas. In the right analysis you can see very well that the patient had problems with the reverse direction. There are two red areas in the switchbacks and light blue areas on the straight lines. This is an indicator for an extreme difference in speed. The left front / back diagram, you can see that the maximum time spent in the maximum deflection was seconds. In the right diagram it is only 21.4 s. Furthermore, the first patient completes the curves faster than the second and thus he could spend more time on the straights well, so he reach a higher score. Make sure that the evaluation is only meaningful if the patient completes the snake at least 4 times. The exercise period should therefore at least 3 minutes. Exercise 7 - spiral Exercise 7 demands particularly to a controlled ball track, as the ball track is very closely, and thus quickly slowing collisions are possible. Since the spiral inwards getting smaller and smaller, the patient must always change his position faster and faster. In the center arrived, the rotational direction is vice versa, so that the movement components are balanced. The exercise period should be at least 3 minutes too. The spectrogram is particularly well suited to find problem areas. Especially in the center of the spiral very precise movements are neccessary. The right proband misses this ability, which is visible in the front / back or left / right chart. The left analysis shows a very homogeneous motion picture. 18 SENSAGO Professional - the interpretation 19

12 Exercise 8 - the eight, Exercise 9 - infinity (the lying eight) Exercise 8 and 9 assign a similar motion task. Exercise 8 requires more declinitions along the longitudinal axis, Exercise 9 movements along the cross-axis. Red areas in the turns means that the ball was very slow or stagnate. Exercise 10 - basket ball The red area in the middle inevitably arises because the ball passes the area twice. The special feature is the change of direction in the middle, which make the exercises to a very complex motion task. On the one hand, the sensor must deflect in any direction, and to the ball must exactly roll in the course to get a good assessment. Moreover, the patient must estimate the movement of the ball very good, in order to lose no time in the center. Ideally, the spectrogram shows a homogeneous green course, which has a narrow yellow stripe in the middle. In the center of the eight, should always be a red area visible. Exercise 10 has a random moment, that in combination with the pressure of time and an ambitious course the proband offers the possibility to use the learned skills. Only the evaluation is possible because the targets chosen randomly and more and more ways are available. Nevertheless, the evaluation is an effective fact to carry out the exercise. 20 SENSAGO Professional - the interpretation 21

13 Exercise 11 - labyrinth 1, Exercise 12 - labyrinth 2 The two labyrinths require like the basket ball exercise, a high level of body control. High speed is important as well as the precise slow down of the ball. In the labyrinths, it is less to recognize the shortest route, rather than the perfect ball control. Similarly, there are also sensitive points in Exercise 12, always where the ball must be stopped in order to cross the next lower level. In the illustrated evaluations is good to see that a homogenous course of the ball results in very good exercises evaluation. In contrast, in the right evaluation are many light blue areas. Right below it is visible, that the patient doesn t take the shortest path. Ballon chase and Bird chase The balloon and bird chase rather have a playful character. The deflection of sensor directly controls the hornet or the crosshairs. This makes it rather difficult to meet the objectives. The sensor+ control mode can be used if the patient is overstrained with the direct movement. The difficulty determines how fast the targets are moving and how long the hornet / crosshairs must be over the balloon / crosshair until it is taken. Since a certain time pressure, the co-ordinatoric abilities can be trained in stressful situations. The evaluation is done only in the form of high scores, but it depends to the duration of the exercise. In Exercise 11, there is a critical point (red circle). At this the patient must stop the ball without a wall which he can use to help. By stopping the ball, there is always a red area in spectrograph visible. If he does not stop the ball, you can see a course as shown in the right spectrogram. 22 SENSAGO Professional - the interpretation 23

14 Exercising/ Examples for gyroscopes Balance: Standing on the gyroscope with both feet, some exercises on one leg. Increase the difficulty by e.g. throwing of balls or nudging the proband. In combination with the diagnostic mode with closed eyes. Diagnosis of anatomic problems: Standing on the gyroscope with both legs in combination with the diagnosis mode. Turn off the monitor or press B to avoid that the patient can correct his position. Endurance training leg musculature: Standing with both legs on the gyroscope- Exercises 1 to 12 with a duration of 10 minutes. Carrying out in light crouch to increase the difficulty. Endurance training for trunk musculatur: Place the gyroscope on a stool with solid surface (wood, plastic), then sit down on the gyroscope, and exercises from 1 to 12. To get more stability on the gyroscope, hold up with both hands on the edge. Wearing a skidproofed trousors like a jeans or alternativly a rubber cover for the gyroscope is sensible. Psychomotor: Standing on the gyroscope with both feets, some exercises on one leg (e.g. Exercise 1 - equal weight, exercise 3 - forwards- backwards). Sitting or standing with the sensor in the hand - increasing the difficulty by standing on one leg, to stand on another gyroscope or solving parallel computing tasks. Training of hand-to arm co-ordination e.g. Comparisons of left, right hand. Hand coordination can tested/trained alternatively with the mouse control. 24