Chronic pain and general physical discomfort are common symptoms among those seeking medical or physiotherapy treatment, as it relates to disorders found in the Human Musculoskeletal System (HMS). Since this system is highly complex and large in scale, clinical pain research has been confounded by many complex factors. The goal of our research is to overcome these obstacles by applying multidisciplinary approaches including systems engineering, traditional oriental techniques, conventional medicine and related sciences. To pursue such an integrated approach this paper examines the therapist-guided exercise for restoring human musculoskeletal balance called the Somatic Balance Restoration Therapy (SBRT). The SBRT is a simple but effective self-exercise therapy with minimal assistance by a trained therapist. This therapy is analyzed by a mechanical engineering method by modeling the human body as a multi-body subject to a static equilibrium condition. In addition, the wording has been rewritten in functional anatomical terms, enabling smooth communication between specialists of three different disciplines: therapy, conventional medicine and systems engineering. Examples will be given to demonstrate an integrated and systematic approach for identifying and remedying malfunctions within the HMS.
Chronic pain and general physical discomfort can be attributed to disorders or malfunctions within the Human Musculoskeletal System (HMS). To help alleviate these symptoms, Asian countries such as Japan and China have developed various traditional medicine-based exercise techniques over many years [
The objective of this paper is to demonstrate the effectiveness of a practice of the clinical technique named Somatic Balance Restoration Therapy (SBRT) by applying mechanical and systems engineering methods. The SBRT is a therapist-guided self-exercise technique that helps the patient to perform easily a series of simple motions in a completely non-invasive manner. By applying a systems and mechanical engineering approach, a computerized visualization of the SBRT’s clinical technique has been demonstrated. This process was then evaluated by applying matrix algebra and correlation analysis. For the purpose of integration into conventional medicine, the terminology used by the therapist (one of the authors of this paper) is converted to the functional anatomical terms. This effort has turned out that such wording coincides with the mechanical symbols of robotic systems. Next, the evaluation was applied to a typical actual therapy records and the results revealed that the systems approach developed herein was proven valuable and gives scientific background of complementary medicine.
Chronic pain and general physical discomfort are common symptoms. However, these conditions convey important information on the clinically relevant state of the human body, especially relating to disorders or malfunctions found within the Human Musculoskeletal System (HMS) [
In order to overcome such difficulties, this paper aims to realize a systematic interpretation of a therapist-guided technique called the Somatic Balance Restoration Therapy (SBRT) [
Motion (patient initiated motion) listed in
No. | Motion | No. | Motion |
---|---|---|---|
1 | Turn neck toward left | 41 | Turn neck toward right |
2 | Tilt head toward left | 42 | Tilt head toward right |
3 | Elevate right shoulder to head | 43 | Elevate left shoulder to head toward head |
4 | Stretch right arm above head | 44 | Stretch left arm above head |
5 | Extend arm to left | 45 | Extend arm to right |
6 | Down rotation of right arm | 46 | Up rotation of right arm |
7 | Upward rotation of left arm | 47 | Downward rotation of left arm |
8 | Twist both arms toward left | 48 | Twist both arms toward right |
9 | Stretch right arm upward | 49 | Stretch left arm upward |
10 | Swing both knees toward right | 50 | Swing both knees toward left |
11 | Swing right knee outward | 51 | Swing right knee inward |
12 | Swing left knee inward | 52 | Swing left knee outward |
13 | Swing both legs toward left | 53 | Swing both legs toward right |
14 | Swing right lower leg inward | 54 | Swing right lower leg outward |
15 | Swing left lower leg outward | 55 | Swing left lower leg inward |
16 | Elevate left hip upward | 56 | Elevate right hip upward |
17 | Raise left knee | 57 | Raise right knee |
18 | Twist both legs to left | 58 | Twist both legs to right |
19 | Rotate right leg inward | 59 | Rotate right leg outward |
20 | Rotate left leg outward | 60 | Rotate left leg inward |
21 | Stretch right heel | 61 | Stretch left heel |
22 | Stretch right arm and heel | 62 | Stretch left arm and heel |
23 | Raise left leg off ground | 63 | Raise right leg off ground |
24 | Stretch left arm above head | 64 | Stretch right arm above head |
25 | Extend left arm to left | 65 | Extend right arm to right |
26 | Elevate left shoulder upward | 66 | Elevate right shoulder upward |
27 | Twist left shoulder off ground | 67 | Twist right shoulder off ground |
28 | Raise right shoulder & left leg | 68 | Raise left shoulder & right leg |
29 | Twist right hip off ground | 69 | Twist left hip off ground |
30 | Swing both knees toward left | 70 | Swing both knees toward right |
31 | Swing left knee inward | 71 | Swing right knee inward |
32 | Swing left knee outward | 72 | Swing right knee outward |
33 | Rotate both legs to right | 73 | Rotate both legs to left |
34 | Rotate right leg outward | 74 | Rotate right leg inward |
35 | Rotate left leg inward | 75 | Rotate left leg outward |
36 | Raise right knee to shoulder | 76 | Raise left knee to shoulder |
37 | Pull right heel toward hip | 77 | Pull left heel toward hip |
38 | Push left foot upward | 78 | Push left foot downward |
39 | Pull right foot downward | 79 | Pull right foot upward |
40 | Raise right leg off ground | 80 | Raise left leg off ground |
No. | Motion | No. | Motion |
---|---|---|---|
81 | Turn neck toward left | 110 | Turn neck to right |
82 | Elevate right shoulder to head | 111 | Elevate left shoulder to head |
83 | Raise right shoulder off ground | 112 | Raise left shoulder off ground |
84 | De-elevate left shoulder from head | 113 | De-elevate right shoulder from head |
85 | Push left shoulder against ground | 114 | Push right shoulder against ground |
86 | Pull right arm to body | 115 | Pull left arm to body |
87 | Push right hip bone to ground | 116 | Push left hip bone to ground |
88 | Contract left hip bone to head | 117 | Contract right hip bone to head |
89 | Elevate left hip bone off ground | 118 | Elevate right hipbone off ground |
90 | Close right leg inward | 119 | Close left leg inward |
91 | Push left leg outward | 120 | Push right leg outward |
92 | Pull left knee to head | 121 | Pull right knee to head |
93 | Bend left knee up off ground | 122 | Bend right knee up off ground |
94 | Bend left knee up off ground | 123 | Stretch left heel downward |
95 | Contract left heel to head | 124 | Contract right heel to head |
96 | Turn neck to right | 125 | Turn neck to left |
97 | De-elevate right shoulder from head | 126 | De-elevate left shoulder from head |
98 | Push left shoulder against ground | 127 | Push right shoulder against ground |
99 | Pull right arm to body | 128 | Pull left arm to body |
100 | Contract right arm to feet | 129 | Contract left arm to feet |
101 | Contract right hip bone to head | 130 | Contract left hipbone to head |
102 | Elevate right hip bone off ground | 131 | Elevate left hipbone off ground |
103 | Push left hip bone to ground | 132 | Push right hipbone to ground |
104 | Push left leg outward | 133 | Push right leg outward |
105 | Pull right knee to head | 134 | Push right leg outward |
106 | Contract right heel to head | 135 | Contract left heel to head |
107 | Push left knee against ground | 136 | Contract left heel to head |
108 | Raise left heel off ground | 137 | Raise right heel off ground |
109 | Push left knee against ground | 138 | Push right knee against ground |
induced only by the Active Motions from #1 to #80 in
The goal of the SBRT is to eliminate or at least alleviate overall pain or discomfort, which includes any pain during the therapy. This is achieved by the patient reporting varying degrees of difficulty while performing the motion test. As mentioned, the therapist does not have physical contact with the patient during the examination or the guided self-exercise phase of the therapy. However, to assist the patient’s performance of certain motions, the therapist may apply slight resistance against the patients’ limbs while performing problematic motions.
A patient can perform any of the Active Motions with intension to do it, but usually cannot perform a single anatomical motion.
For example, if the patient intends to extend arm to left (Active Motions #5), it is realized by horizontal adduction and retraction of the shoulder together with flexion of the elbow and extension of the wrist. It is noted that the anatomical motions correspond to the joint degrees-of-freedom of 15 body human model of
Among the 138 FMEs, the 80 Active Motions are intentionally performed by the patient (
Since the HMS is interconnected in a highly complex manner, each individual segment or component of it requires an integrative approach [
The above-mentioned processes are interpreted in terms of orthodox medicine as shown in
The SBRT process is digitized and visualized by extensive use of matrix representation, where the ( i , j ) elements of Matrix A and B are denoted by a ( i , j )
No & Joint Name (Left) | Motion Name (English) | Engineering Name |
---|---|---|
Joint #2 Trunk | Flexion | pitch (−) |
Extension | Pitch (+) | |
Leftward rotation | roll (−) | |
Rightward rotation | Roll (+) | |
Left horizontal rotation | yaw (−) | |
Right horizontal rotation | Yaw (+) | |
Joint #3 Neck | Flexion | Pitch (+) |
Extension | pitch (−) | |
Right flexion | Roll (+) | |
Left flexion | roll (−) | |
Right rotation | Yaw (+) | |
Left rotation | yaw (−) | |
Joint #4 Left Shoulder | Flexion | Pitch (−) |
Extension | Pitch (+) | |
Adduction | roll (−) | |
Abduction | Roll (+) | |
Internal rotation | Yaw (+) | |
External rotation | yaw (−) | |
Horizontal adduction | Yaw (+) | |
Horizontal abduction | yaw (−) | |
Elevation | Trans. (−z) | |
Depression | Trans. (+Z) | |
Protraction | Trans. (+X) | |
Retraction | Trans. (−x) | |
Joint #5 Left Elbow | Flexion | pitch (−) |
Extension | Pitch (+) | |
Pronation | Yaw (+) | |
Supination | yaw (−) | |
Joint #6 Left Wrist | Flexion | pitch (−) |
Extension | Pitch (+) | |
Abduction | Roll (+) | |
Adduction | roll (−) | |
Joint #7 Left Hip Joint | Flexion | pitch (−) |
Extension | Pitch (+) | |
Adduction | roll (−) | |
Abduction | Roll (+) | |
Internal rotation | Yaw (+) | |
External rotation | yaw (−) | |
Joint #8 Left Knee | Flexion | Pitch (+) |
Extension | pitch (−) | |
Internal rotation | Yaw (+) | |
External rotation | yaw (−) |
Note: Only left limb joints are cited.
No A0005_TN_0001 | No. N0005 | |
---|---|---|
Motions | Check | Pain |
41/01 Turn neck to (R/L) | e/p1 | B-2 |
42/02 Tilt head toward (R/L) | e/p2 | B-2 |
45/05 Extend arm to (R/L) | h/e | |
11/51 Swing right knee outward (R/L) | e/p3 | G-8 |
53/13 Swing both legs toward (R/L) | h/e | |
54/14 Swing right lower leg inward (R/L) | e/p6 | F-1 |
55/15 Swing left lower leg outward (R/L) | h/e | |
56/16 Elevate hip upward (R/L) | e/p4 | G16, 17, 18 |
Note: R/L = Right/Left, h = hard, e = easy, na = not applied, B-2, F-1, F-5, G-8 etc: Body portions (See
and b ( i , j ) respectively, then we can then we can define diagnostic matrices, Q by
Q = [ q ( i , k ) ] = [ w i d ( i , k ) ] ( i = 1 , ⋯ , 80 ; k = 1 , ⋯ , 80 ) (1)
where
d ( i , k ) = ∑ j = 1 136 a ( i , j ) ⋅ b ( j , k ) ( i = 1 , 80 ; j = 1 , 80 ) (2)
The Active Motion during the Motion Test is weighted by quantity wi, whose numerical value reflects the results (easy, hard or painful, denoted e, h and p, respectively). The weighting values are determined subjectively yet skillfully by the therapist or the analyzer through experience. Note that easy movements are assigned large positive weightings, while painful movements are negatively weighted. We evaluate the selection of the Active Motion by computing correlation coefficients of the joint diagnosis matrix. The correlation coefficient is given by
c o r r ( i , k ) = ∑ j = 1 n ( x j i − x ¯ i ) ( y j k − y ¯ k ) ∑ j = 1 n ( x j i − x ¯ i ) ∑ j = 1 n ( y j i − y ¯ k ) (3)
where, in the joint diagnosis matrix of Equation (1),
x j i = pain part of [ q ( i , j ) ] , (4a)
y j i = easy part of [ q ( i , j ) ] (4b)
Traditionally, the SBRT therapist (and other Eastern medicine therapists) directly records patient examination results into a simple human-body model, and then identifies the malfunctioning point as the remedial exercise motion. Because expert therapists are relied on many years of personal experience and success to diagnose and treat patients, this knowledge was not wholly available to successors. This difficulty in transferring skills and experience to the next generation has motivated us to development a computer software support system that allows successors to learn from expert therapists and their experiences. The process of this therapeutic approach, as applied to actual cases is detailed below:
1) From the motion test results, identify the body motions that cause pain or discomfort
2) List the Active Motions associated with the pain-inflicting motion(s)
3) Identify the joint movements and muscle groups that are associated with the painful motions
4) Search for a frequency distribution pattern in the identified joint movements and muscle groups
5) Identify the joints and muscles associated with the highest frequency or reoccurrence of reported pain as the most probable causes of the malfunction(s)
6) From the identified rotary joints and muscle groups associated with the highest frequency of pain reports, find the Associated Motions using the charts of relationships between FMEs and Joint Motions
7) Identify the Active Motion that is interconnected with the Associated Motion, limiting the search to motions that can be comfortably performed by the patient
8) Identify the frequency distribution of the identified Active Motion
9) The Active Motion most frequently reported as comfortable will be applied as the remedial exercise motion in therapy
Note that Steps 1 - 5 identify candidate locations of the malfunction, while Steps 6 - 9 identify the corrective motions for therapy.
The Flow Diagram of
The results of the patient feeling, easy, hard or painful, are recorded on the SBRT sheet as illustrated by an example shown in
Through the proposed process we can identify comfortable motions that induce joint motions consequent to Associated Motions. The goal of the SBRT is to find comfortable Active Motions that activate Joint Motions reported as painful. However, in general, these motions are not uniquely specified and thus the therapist must select the most effective motions among multiple comfortable Active Motions. For this purpose, we apply the cross-correlation analysis together with the “Distance Measure”, defined as the number of joints between the malfunctioning zone and the motion-related joint.
The objective is to select or specify the Active Motion(s) that most effectively
activate the malfunctioning area as identified in the previous section. For this purpose, we evaluate the painful and easily performed Active Motions through cross-correlation analysis typified by the Correlation Coefficient evaluation defined by Equation (3).
We observe that there are still two or more candidates to remedy the pain, and in such cases we will apply other selection criteria by defining another criterion of optimization.
The intention of this paper is to bridge the gap between conventional medicine and traditional therapy by removing obstacles and applying multidisciplinary approaches based on the systems engineering, and this has been attained to some degree. To demonstrate such an integrated approach, we have taken a therapist-guided exercise for restoring human musculoskeletal balance called the Somatic Balance Restoration Therapy (SBRT). With this approach the practitioner has converted terminology used in therapy into wording of functional anatomical terms, and this effort has turned out to be useful for communication between the specialists of three different disciplines, namely, therapy, conventional medicine and systems engineering. Some examples have demonstrated a first step of
integrated and systematic approach for identifying malfunctions and remedying corrective exercise within the Fundamental Motion Elements.
The authors wish to express their appreciation to Dr. Motonaga of the Miyako-Jima Prefecture Hospital for his valuable advice.
Kayo, M.M. and Ohkami, Y. (2017) Effectiveness of Somatic Balance Restoration Therapy to Alleviate Pain of Musculoskeletal System. Health, 9, 1390-1403. https://doi.org/10.4236/health.2017.910102
DOF Degrees-of-Freedom.
FME Fundamental Motion Elements.
HMS Human Musculoskeletal System.
SBRT Somatic Balance Restoration Therapy.
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