A Handheld Quantifiable Soft Tissue Manipulation Device for Tracking Real-Time Dispersive Force-Motion Patterns to Characterize Manual Therapy Treatment

Abstract

Low back pain (LBP) is one of the leading neuromusculoskeletal (NMSK) problems around the globe. Soft Tissue Manipulation (STM) is a force-based, noninvasive intervention used to clinically address NMSK pain conditions. Current STM practice standards are mostly subjective, suggesting an urgent need for quantitative metrics. This research aims at developing a handheld, portable smart medical device for tracking real-time dispersive force-motions to characterize manual therapy treatments as Quantifiable Soft Tissue Manipulation (QSTM). Methods: The device includes two 3D load-cells to quantify compressive and planar-shear forces, coupled with a 6 degrees-of-freedom IMU sensor for acquiring volitionally adapted therapeutic motions while scanning and mobilizing myofascial restrictions over larger areas of the body. These force-motions characterize QSTM with treatment parameters (targeted force, application angle, rate, direction, motion pattern, time) as a part of post-processing on a PC software (Q-Ware © ). A human case study was conducted to treat LBP as proof-of-concept for the device's clinical usability. Results: External validation of treatment parameters reported adequate device precision required for clinical use. The case study findings revealed identifiable therapeutic force-motion patterns within treatments indicating subject's elevated forceendurance with self-reported pain reduction. Conclusion: QSTM metrics may enable study of STM dosing for optimized pain reduction and functional outcomes using documentable manual therapy. Clinical trials will further determine its reliability and comparison to conventional STM. Significance: This medical device technology not only advances the state-of-the-art manual therapy with precision rehabilitation but also augments practice with reproducibility to examine neurobiological responses of individualized STM prescriptions for NMSK pathology.

Implementing A Flexible Sensor to Identify Forces during Instrument-Assisted Soft Tissue Mobilization

“…Both prior studies found instrument reliability between 60-90 • [16], and 70-90 • [17]. These manufactured devices used either uniaxial [16], or triaxial [17][18][19] compressive force sensors to determine force production, whereas the ELF measurement system utilizes a resistive-based technology that gauges the change in resistance at the sensing element. Triaxial sensors offer the advantage of providing three-dimensional force assessments which are valuable when assessing the complexities of different IASTM strokes (e.g., sweeping, fanning, j-shaped strokes) that may not be linear in their application.…”

“…Thus, triaxial sensors, or simulated treatments on force plates may be necessary for future investigations to begin quantifying how different treatment strokes may be more effective at generating shear forces between the instrument and the soft tissue. Other devices have also been equipped with inertial measurement units and accelerometers to determine the three-dimensional orientation of the device in space as well as evaluate the angular motion of the treatment stroke [17][18][19]. Ultimately, these three-dimensional factors could be used to aid in the analysis and description of the various IASTM stroke types used in practice and whether specific strokes or force vectors are more effective for certain conditions.…”

“…Several methods have been utilized to analyze the amount of force used during a soft tissue treatment that include a range of instrumented handheld devices [16][17][18][19] and robotic manipulators [20,21]. Robotic set-ups, while lacking the inherent variability in force production of human applications, are impractical for clinical applications because they may not be portable or handheld and thus lack the necessary coordination for the varied treatment applications of IASTM.…”

“…For these reasons, IASTM engineers and researchers have focused their efforts on incorporating force sensors into the instrument. While these devices have been found to produce reliable and valid forces when used on force plates [16][17][18][19], they are not yet readily available for purchase by clinicians and researchers. A reliable and valid sensor that could be attached to commercially available instruments may be a viable solution for the evaluation of forces during the clinical application of IASTM.…”