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Dominant Upper Extremity Kinematics and Muscular Activity

1. sees enne 35 4 4 7 Questionnaire and Pain Measurements ccccccesssssscececececeesessssececececeeeeeees 36 vii 4 5 Procedure io o lvii wd b ea A ed Oda sk Adda 36 4 6 Motion Capture Data AnalySis ecceescecssnceceseececesececsceecsceecseeeeseeeesaeeessaeeesnae 41 4 7 Electromyography Data Analysis a A 45 5S ResultS doct stop EO RR Mica teak noL DE a rptu tnt Moet aos 47 5 T Shoulder Joint Angles tend aia 47 5 2 Blbow Joint Angles 4 iet E it D Sdn ARA k 52 2 9 M Sb OLN A DIOS too Rotes chat ER A R c edet eo aged ote NOU 54 5 4 Joint Angles for the Different Scanning Factors eene 56 5 5 Electromyography Results di Ue RERO IRE Use In ER UD Een E 57 6 DISCUSSION Gi 59 6 1 Comparison of Shoulder Joint Angles sess 59 6 2 Comparison of Elbow Joint Angles cece ceesceceenceceseeceeeeeeceeeeeceaeeeeseeesnteeeeaees 60 6 3 Comparison of Wrist Joint Angles ener 60 6 4 Comparison of Joint Angles to the Burnett Study sese 61 6 5 Electromyography Discussion id Rt Yat S ae rne te Qe W AL 62 Cs hie SCY GSO etse EE E E e mci E Oe ctt A 63 8 Future Research ui denn eee diee pe re d bedient plene itera eb feared et 65 9 SCONE UNE A es alee ela i MSE CE ET 66 LO eoi iles M cl dE R doda Bobo O 68 IA OSN R R AG GROZA RR A meus R 68 10 2 Matlab Code aa riada 80 10 2 1 Kinematic Evaluating Program saa i
2. Output Min and max angles angle_ranges 1 3 gleno_angles angle_ranges 4 elbow_flexion angle_ranges 5 wrist_flexion All angles for the scan angles 1 phi_gleno angles 2 theta_gleno angles 3 psi_gleno angles 4 elbow_flex angles 5 wrist_flex Joint Centers joint_centers 1 3 rd_global_gleno_IHA joint_centers 4 6 rd_global_elbow joint_centers 7 9 rd_global_wrist 91 10 2 3 Kinematic Sub programs 10 2 3 1 Marker Separation function AA TS AI AC PC marker_seperation raw_marker_data number of IHA landmarks 26 This function seperates the data into individual markers that are needed for determining the wrist elbow glenohumeral sternoclavicular and acromioclavicular joint angles Sections the data into individual markers i l j 3 SJ raw_marker_data i j 1 i 3 j j 3 C7 raw_marker_data i j 1 i 3 j j 3 T8 raw_marker_data i j i i 3 j j 3 AA raw_marker_data i j 1 i 3 j j 3 TS raw_marker_data i j i i 3 j j 3 AI raw_marker_data i j i i 3 j j 3 AC raw_marker_data i j 1 i 3 j j 3 PC raw_marker_data i j i i 3 j j 3 ELH raw_marker_data i j 1 1 3 j j 3 EMH raw_marker_data i j 1 i 3 j j 3 VHI raw_marker_data i j i i 3 92 j 3 3 VH2 raw_marker_data i j 1 i 3 j 3 3 VH3 raw_marker_data i j 1 i 3 j 3 3
3. 80 60 40 20 0 20 0 80 60 40 20 0 20 Angle Degrees Angle Degrees gt gt o pen c o o c c 2 o 0 5 0 5 o o E 0 N i i E 0 aat i n 2 80 60 40 20 0 20 2 80 60 40 20 0 20 Angle Degrees Angle Degrees gt Sonographer 4 3 Sonographer 5 amp 1 i e 4 i y W w Z o c 9 e 0 5 5 0 5 W Q N N E E Lu y o 0 6 z z C5 1 Transducer Left Kidney S 5 1 Transducer Left Kidney C5 1 Transducer Right Kidney S5 1 Transducer Right Kidney Figure 9 Normalized histogram of shoulder joint internal external rotation during scanning 5 2 Elbow Joint Angles All of the sonographers experienced flexion at the elbow joint as a result of the neutral position that was selected During this study the maximum and minimum elbow flexion generated was 102 2 and 9 3 degrees The maximum and minimum ranges of motion for flexion were 49 1 and 16 5 degrees which are displayed in Table 11 A normalized histogram of elbow flexion for each scan is shown in Figure 10 52 Table 11 Elbow joint flexion during scanning cannin Sonographer Transducer pus Duas FD OME Se OU OS ETSRU s Min Max Average Range of Motion C51 Left 57 9 NA NA NA NA Right 87 2 9 3 392 25 1 29 9 i 95 1 Left 57 1 NA NA NA NA Right 47 5 56 6 74 7 65 4 18 1 Left 64 5 46 0 70 4 60 7 24 3 ed Right 104 0 3
4. ole 20 24 As just described technical reference frames are determined using three non collinear landmarks located anywhere on the same body segment Anatomical reference frames are determined using three key skeletal landmarks Winter 2009 The skeletal landmarks used in this study were the two joint centers proximal and distal and one landmark located medially or laterally from one of the joint centers The joint rotation matrix Rjoint is determined using the global to local rotation matrices defined by two body segments located proximally and distally to the joint Rjoint Romac Repo 21 where Rgistai G is the global to local rotation matrix of the distal segment and Rproximal G 18 the global to local rotation matrix of the proximal segment The joint rotation matrix is used to determine the Euler angles 3 3 4 Joint Angle Calculation Methods The shoulder joint angles were determined using an Euler rotation sequence because the angles about three axes were of interest The dot product was used to determine the elbow joint angles because only one angle flexion extension was needed for this study The cross and dot products were used to determine the wrist angles because only one angle flexion extension was of interest 3 3 4 1 Euler Angles Euler angles are used to describe the orientation of a rigid body in 3D space by performing a series of three rotations about the axes of either a global or local referenc
5. 105 xo 3 xo 3 fi 1 xi j 2 Component z vo 1 vo 1 fi i vi Component x vo 2 vo 2 fi i vi j 1 96Component y vo 3 vo 3 fi i vi j 2 Component z ao 1 ao 1 fiG ai j Component x ao 2 ao 2 fi i ai j 1 96Component y ao 3 ao 3 fi i ai j 2 Component z j j 3 Increments to the next landmark end Determines the mean and normalizing xo vo and ao xo xo m fo vo vo m fo ao ao m fo Determines the accumulation summation matrices over all landmarks eq 54 56 for i 1 m for j 1 3 3 m X X fQG xi j j 2 xo Gi j j 2 x0 V V fiG vi j j 2 xi j j 2 x0 A A fi ai j j2 xi j j 2 x0 end end Normalizes summation matrices X X m fo V V m fo A A m fo Provides least squares smoothing of measurement errors inherent in experimental position and velocity measurements Variance covariance weighting for coordinate measurements eq 58 59 Xw X ss Vw V ss Weighted landmark point mass inertia matrix eq 61 X_pmi Xw X_pmi 3 2 Xw 3 2 X_pmi 1 1 Xw 2 2 Xw 3 3 X_pmi 2 2 Xw 1 1 Xw 3 3 X_pmi 3 3 Xw 1 1 Xw 2 2 Velocity right hand vector eq 61 V rh 1 1 Vw 3 2 Vw 2 3 V rh 2 1 Vw 1 3 Vw 3 1 V rh 3 1 Vw 2 1 Vw 1 2 Angular velocity vector eq 61 w X pmiW rh 106 Magnitude of angular velocity w_mag norm w Skew symmetric angul
6. Shoulder Joint Angles Degrees Kidney Spanni ng Sonographer Transducer Duration Abduction Scan s Mic Ma AG Range of Motion C5 1 Left 57 9 43 5 68 9 48 6 25 4 Right 87 2 70 7 86 5 78 0 15 9 2 Left 57 1 49 7 68 4 53 7 18 8 d Right 47 5 79 4 91 1 86 5 11 7 Left 64 5 64 3 83 0 73 3 18 7 ca Right 104 0 85 0 104 8 91 7 19 8 i Left 93 8 91 7 112 0 103 9 20 3 T Right 157 9 93 4 112 5 104 7 19 1 Left 47 1 44 0 62 4 50 0 18 5 7 al Right 57 9 392 753 55 5 36 1 95 1 Left 42 8 45 3 65 4 52 7 20 1 Right 63 9 43 1 80 3 60 4 37 2 Left 79 4 38 6 57 7 47 0 19 1 in Right 95 7 41 0 68 5 53 6 27 5 2 Left 73 4 42 7 68 9 52 8 26 2 a Right 54 3 56 5 78 7 64 7 22 2 49 Sonographer 2 Sonographer 3 a e a A 50 100 50 100 Angle Degrees Angle Degrees Sonographer 4 Sonographer 5 1 1 0 5 0 5 Midas A DAS 0 100 0 100 Normalized Frequency Normalized Frequency eo Normalized Frequency Normalized Frequency 50 50 Angle Degrees Angle Degrees C5 1 Transducer Left Kidney S 5 1 Transducer Left Kidney C5 1 Transducer Right Kidney S5 1 Transducer Right Kidney Figure 8 Normalized histogram of shoulder joint abduction during scanning External shoulder rotation was experienced by all of the sonograph
7. else R_GtoL Axis3 Axis2 Axis1 end 109 10 2 3 13 Reference Frame Humerus function R_GtoL reference_frame_humerus ptl pt2 pt3 axial_order Uses three non collinear points to determine the global to local reference frames from the points selected The origin of the reference frame is set to ptl Determines Axis by connecting the origin to point 2 Axisl pt2 pt1 norm pt2 pt1 Determines a temporary vector from the origin and point 3 temp pt3 ptl Vector perpendicular to Axis 1 by taking the cross product of the temporary vector and Axis Axis2 cross Axisl temp norm cross Axis1 temp Mutually perpendicular vector from the cross product of Axis 1 and Axis 2 Axis3 cross Axis2 Axis1 Set the size of the global to local reference frame R_GtoL zeros 3 3 Determines the global to local reference frame from Axis 1 Axis 2 and Axis 3 if axial_order 1 R_GtoL Axisl Axis2 Axis3 elseif axial_order 2 R_GtoL Axis1 Axis3 Axis2 elseif axial_order 3 R_GtoL Axis2 Axisl Axis3 elseif axial_order 4 R_GtoL Axis2 Axis3 Axis1 elseif axial_order 5 R_GtoL Axis3 Axisl Axis2 else R_GtoL Axis3 Axis2 Axis1 end 110 10 2 3 14 Global Position function r_global global_position R_GtoL r_local origin Determining the location of the joint center in the global reference frame r_global R GtoL r local origin 10 2 3 15
8. e You will be asked to lie on a sonography bed and expose the skin on your back near your kidneys for scanning An experienced sonographer will obtain a quality image of each of your kidneys Your kidneys will be scanned a total of 42 times They will do this using two different transducers and they will use their right and left hands e Each scan should not exceed 5 10 minutes The entire data collection process should not exceed 3 hours e There are no out of pocket costs to you for participation in this study Risks and Benefits e There is no direct benefit of your participation in this study However the information obtained may benefit sonographers in the future e We feel this study involves minimal risk You may experience back pain from scanning anxiety from providing your weight and height and fatigue from lying down Compensation for Harm If you are harmed from participating in this research emergency first aid will be provided to you and you will be referred to an appropriate medical care center Any costs for additional medical care that may be required are your responsibility and that of your medical insurance company Voluntary Participation Your participation in this research study is completely voluntary You do not have to participate You may quit at any time without any penalty to you Privacy and Confidentiality Your name will not be given to anyone other than the research team All the information collected from
9. 274 282 Stokdijk M Nagels J amp Rozing P 2000 The glenohumeral joint centre in vivo Journal of Biomechanics 1629 1636 Swinker M amp Randall S 2003 Musculoskeletal disorders Professional Safety 40 44 134 Vanderpool H Friis E Smith B amp Harms K 1993 Prevalence of carpal tunnel syndrome and other work related musculoskeletal problems in cardiac sonographers Journal of Diagnostic Medical Sonography 604 610 Veeger H 2000 The position of the rotation center of the glenohumeral joint Journal of Biomechanics 1171 1715 Vicon MX Hardware System Reference 2007 Retrieved 11 12 2011 from Vicon http vicon com support downloads_view php id 899b745c6d075 163538ed23d6 0a43db1 Village J amp Trask C 2007 Ergonomic analysis of postural and muscular loads to diagnostic sonographers International Journal of Industrial Ergonomics 781 789 Wihlidal L amp Kumar S 1997 An injury profile of practicing diagnostic medical sonographers in Alberta International Journal of Industrial Ergonomics 205 216 Winter D 2009 Biomechanics and Motor Control of Human Movement Hoboken John Wiley and Sons Woltring H 1990 Model and measurement error influences in data processing In A B Cappozzo Biomechanics of human movement applications in rehabilitation sports and ergonomics pp 203 237 Worthington World Health Organization 2012 4 15 Retrieved 4 15 2012 f
10. 5 5 Electromyography Results Electromyograms produced by the muscles pairs for sonographer 5 using the C5 1 transducer are shown in Figures 12 and 13 The muscles pairs were the flexor and extensor carpi ulnaris for the forearm and the biceps and triceps brachii for the upper arm The data was collected while scanning the patient s left kidney The rest of the electromyograms produced during this study can be found in Appendix 10 1 37 Filtered Biceps Brachii Electromyogram 0 02 T T T T m 5 al o B J A i lt zi l l 1 l l 1 1 BS 10 20 30 40 50 60 70 80 Time s Filtered Triceps Brachii Electromyogram Amplitude V 15 10 20 30 40 50 60 70 80 Time s Figure 12 Upper arm electromyograms from sonographer 5 scanning the left kidney of the patient using the C5 1 transducer Filtered Flexor Carpi Ulnaris Electromyogram 0 05 T T T T gt Q o 5 E lt E 1 l l 1 l l 1 20 10 20 30 40 50 60 70 80 Time s Filtered Extensor Carpi Ulnaris Electromyogram 0 5 s o oO 2 a lt L 0 5 1 1 l 1 1 l 1 J 0 10 20 30 40 50 60 70 80 Time s Figure 13 Forearm electromyograms from sonographer 5 scanning the left kidney of the patient using the C5 1 transducer 58 6 Discussion 6 1 Comparison of Shoulder Joint Angles The flexion and extension angles achieved by each sonographer varied Sonographer 2 generated larger flexion angles because she tilted her thorax forward when
11. Joint Angles for the Different Scanning Factors The maximum and minimum joint angles obtained for the different scanning factors are shown in Table 13 The sonographer s scanning position had the greatest difference for maximum shoulder flexion extension and the least difference for shoulder abduction Ultrasound transducer design had the greatest and least difference for maximum and minimum elbow flexion The kidney that was scanned had the greatest difference for maximum internal external shoulder rotation and the least difference for minimum elbow flexion 56 Table 13 Minimum and maximum joint angles achieved for all of the scans based on the different scanning factors Joint Angles Degrees Scan Factors Shoulder Flexion Extension Shoulder Abduction Shoulder Internal External Elbow Flexion Wrist Flexion Extension Min Max Min Max Min Max Min Max Min Max Seated 0 8 91 2 43 5 112 5 90 0 6 9 9 3 80 8 63 9 1 4 Standing 12 5 44 8 38 6 80 3 74 0 22 4 49 5 102 2 70 4 8 8 C5 1 Transducer 12 5 91 2 38 6 104 8 88 8 22 4 9 3 102 2 63 9 1 4 S5 1 Transducer 0 1 82 7 42 7 112 5 90 0 16 3 9 5 84 9 70 4 8 8 Left Kidney 44 90 0 38 6 112 0 90 0 17 4 9 5 86 9 639 8 8 Right Kidney 12 5 91 2 39 2 93 4 61 8 22 4 9 3 102 2 70 4 1 4
12. Local Position function r_local local position R GtoL r global origin Determining the location of the joint center in the local reference frame r_local R GtoL r global R_GtoL origin 10 2 3 16 Euler Sequences This program determines the joint rotation matrix for Euler angle sequences that are used for the sonographer research study phi sym phi First rotation angle theta sym theta Second rotation angle psi sym psi 2o Third rotation angle YX Y rotation sequence Primary rotation Y axis yl cos phi O sin phi O 1 0 sin phi O cos phi Secondary rotation X axis x 1 0 0 0 cos theta sin theta O sin theta cos theta Tertiary rotation Y axis y3 cos psi O sin psi O 1 0 sin psi O cos psi YX Y joint rotation matrix YXY rotation y3 x yl 111 10 2 3 17 YXY Euler Sequence function phi theta psi yxy_euler_sequence R_GtoDistal R_GtoProximal Determines the joint rotation matrix and the Euler angles for ONLY a YX Y Yosequence Determines the joint rotation matrix distal segment s orientation relative to the proximal segment R_joint R GtoDistal R GtoProximal Secondary rotation X axis Determines the Euler angle for theta in radians theta rad acos R joint 2 2 Primary rotation Y axis Determines the Euler angle for phi in radians phi rad atan R_joint 2 1 sin theta_rad R_joint 2 3 sin theta_rad 6 Tertiary rotat
13. P2 IHA landmarks P2 st rk IHA start P2 st rk IHA end P2 st rk forearm P2 wrist marker 82 Subject 4 Large transducer left kidney scan P4 It Ik angle ranges P4 lt Ik angles P4 lt Ik joint centers upper extremity joint angles Fs Fc P4 It Ik markers 13 P4 It Ik markers PA IHA landmarks P4 IHA start P4 It Ik rows P4 Ik forearm frame option P4 wrist marker Zo Large transducer right kidney scan P4 It rk angle ranges P4 lt rk angles P4 lt rk joint centers upper extremity joint angles Fs Fc P4 It Ik markers 13 P4 It rk markers PA IHA landmarks P4 IHA start P4 It rk rows P4 forearm frame option P4 wrist marker Small transducer left kidney scan P4 st Ik angle ranges P4 st Ik angles P4 st Ik joint centers upper extremity joint angles Fs Fc P4 It Ik markers 13 PA st Ik markers PA IHA landmarks P4 IHA start P4 st Ik rows P4 Ik forearm frame option P4 wrist marker Small transducer right kidney scan P4 st rk angle ranges P4 st rk angles P4 st rk joint centers upper extremity joint angles Fs Fc P4 It Ik markers 13 PA st rk markers PA IHA landmarks P4 IHA start P4 st rk rows P4 forearm frame option P4 wrist marker Subject 5 Large transducer left kidney scan P5 It Ik angle ranges P5 lt Ik angles P5 lt Ik joint centers upper extremity joint angles Fs Fc P5 It Ik markers 1 P5 lt Ik
14. USP raw_marker_data i j i i 3 j j 3 RSP raw_marker_data i j 1 i 3 j 3 3 VFl raw_marker_data i j i i 3 j 3 3 VF2 raw_marker_data i j i i 3 j j 3 VF3 raw_marker_data i j i i 3 j j 3 hand raw_marker_data 1 j i i 3 j j 3 Determines the single matrix for the instantaneous helical axes method if number of IHA landmarks 5 m l n 3 AA_TS_AI_AC_PC m n AA m m 3 n n 3 AA_TS_AI_AC_PC m n TS m m 3 n n 3 AA TS AI AC PC um n Al m m 3 n n 3 AA TS AI AC PC m n AC m m 3 n n 3 93 AA_TS_AI_AC_PC m n PC elseif number_of_IHA_landmarks 4 m l n 3 AA_TS_AI_AC_PC m n AA m m 3 n n 3 AA TS AI AC_PC m n TS m m 3 n n 3 AA TS AI AC PC m n Al m m 3 n n 3 AA TS AI AC PC m n AC else m l n 3 AA_TS_AI_AC_PC m n TS m m 3 n n 3 AA_TS_AI_AC_PC m n Al m m 3 n n 3 AA_TS_AI_AC_PC m n PC end 94 10 2 3 2 Marker Separation Static function ELH EMH VH1 VH2 VH3 USP RSP VF1 VF2 VF3 marker_seperation_static raw_marker_data This function seperates the data into individual markers that are needed for determining the wrist elbow glenohumeral sternoclavicular and acromioclavicular joint angles Sections the data into individual markers 1 l j 3 SJ raw_marker_data i j 1 i 3 j 3 3 C7 raw_marker_d
15. Wrist flexion occurs when 0 is positive 3 4 Electromyography and Co contraction Electromyography is a technique for evaluating and recording the electrical voltage generated by muscle fibers prior to the generation of muscle forces 29 Electromyograms are produced from the recorded voltage They can be used to detect co contraction in muscle pairs by comparing if both muscles are producing an increase in voltage at the same instance Co contraction is when the antagonist and agonist muscles around a joint simultaneously contract Co contraction is an inefficiency in movement because the muscles are working against each other without producing a net moment Winter 2009 3 5 Superficial Muscle Selection Superficial muscle pairs in the dominant forearm and upper arm were investigated during this study because it has been hypothesized that frequent co contraction of muscles has resulted in the pathophysiology of repetitive strain injury which is a type of work related musculoskeletal disorder Malmivaara van Tulder amp Koes 2007 The muscles selected in the forearm were the flexor carpi ulnaris and extensor carpi ulnaris This pair was selected because the flexor carpi ulnaris had been used in a previous sonography study to obtain electromyography data Village amp Trask 2007 The muscles selected in the upper arm were the biceps brachii and triceps brachii 30 4 Methodology 4 1 Participant Criterion and Recruitment T
16. you will be asked to expose your lower torso only Three experienced sonographers will take images of your kidneys The entire process is quick performed in one day Please Email the Researchers If you are Interested in Participating 131 e Participation in this study is voluntary and safe e Snacks will be provided 11 Bibliography American Society for Hand Therapists ASHT clinical assessment recommendations 1981 Indianapolis American Society of Hand Therapists Berkowitz J Pike I Russo A Lessoway V amp Baker J 1997 The prevalence of musculoskeletal disorders among diagnostic medical sonographers Journal of Diagnostic Medical Sonography 219 227 Brown G amp Baker J 2004 Work related musculoskeletal disorders in sonographers Journal of Diagnostic Medical Sonography 85 93 Bullock H Conroy C amp Vetter L 2011 Variation of pinch and grip force between different size transducers and the related perception of pain experienced by sonographers Grand Valley State University Occupational Therapy Master s Thesis Grand Rapids Burnett D amp Campbell Kyureghyan N 2010 Quantification of scan specific ergonomic risk factors in medical sonography International Journal of Industrial Ergonomics 306 314 Cram J Kasman G amp Holtz J 1998 Introduction to Surface Electromyography Gaithersburg Aspen Publishers Garg A Hegmann K amp Kapellusch J 20
17. 3 matrix then NAN is returned else skew_sm 0 0 end 10 2 3 11 Interpolated Joint Center function inter_jc interpolated joint center ptl pt2 This function determines the midpoint between the reflective markers on the bony landmarks located medially and laterally from the joint center inter jc pt2 pt1 2 ptl 108 10 2 3 12 Reference Frame function R_GtoL reference_frame ptl pt2 pt3 axial order Uses three non collinear points to determine the global to local reference frames from the points selected The origin of the reference frame is set to ptl Determines Axis by connecting the origin to point 2 Axisl pt2 pt1 norm pt2 pt1 Determines a temporary vector from the origin and point 3 temp pt3 ptl Vector perpendicular to Axis 1 by taking the cross product of the temporary vector and Axis Axis2 cross temp Axis1 norm cross temp Axis1 Mutually perpendicular vector from the cross product of Axis 1 and Axis 2 Axis3 cross Axisl Axis2 Set the size of the global to local reference frame R_GtoL zeros 3 3 Determines the global to local reference frame from Axis 1 Axis 2 and Axis 3 if axial_order 1 R_GtoL Axisl Axis2 Axis3 elseif axial_order 2 R_GtoL Axisl Axis3 Axis2 elseif axial_order 3 R_GtoL Axis2 Axisl Axis3 elseif axial_order 4 R_GtoL Axis2 Axis3 Axis1 elseif axial_order 5 R_GtoL Axis3 Axisl Axis2
18. Male Female Location of Sonography Practice Area of Sonography Specialty Date of Birth Race Ethnicity Hand Preference Weight Height BMI Weight kg height m Functional Pain Scale Goth et al Rating Description No pain Tolerable and does not prevent any activities Tolerable but does prevent some activities Intolerable but can use telephone watch TV or read Intolerable but cannot use telephone watch TV or read MA BI DO Dl Re o Intolerable and unable to verbally communicate because of pain Using the scale above please answer the following questions 1 Are you currently experiencing any pain 2 Have you experienced any pain while performing scans If so where is your pain localized Ro N N W W AG u u 125 Please place an X on the area s where you experience pain while performing scans 2250089 AIR ee urn II Right AK s wyo Side zma porte ens 40 ACROMION PROCESS OF SCAPULA CLAVICLE CORACOID PROCESS OF SCAPULA MEDIAL EPICONDYLE Sid LATERAL STYLOID PROCESS OF RADIUS MEDIAL STYLOID PROCESS OF ULNA Have you experienced any pain while performing activities of daily living such as bathing dressing or cooking Please specify If so what level would you classify your pain as 012345 Where is your pain localized 126 Ple
19. P2 st Ik n P2 st Ik xoutput scan hist P2 st Ik angles P2 st rk n P2 st rk xoutput scan hist P2 st rk angles Subject 4 P4 It Ik n P4 It Ik xoutput scan_hist P4_lt_1k_angles P4 It rk n P4 It rk xoutput scan hist P4 1t rk angles P4 st Ik n P4 st Ik xoutput scan hist P4 st Ik angles P4 st rk n PA st rk xoutput scan hist P4 st rk angles Subject 5 P5 It Ik n P5 lt Ik xoutput scan hist P5 lt Ik angles P5 t rk n P5 It rk xoutput scan hist P5 lt rk angles P5 st Ik n P5 st Ik xoutput scan hist P5 st Ik angles P5 st rk n P5 st rk xoutput scan hist P5 st rk angles Plots the normalized histograms for the joint angles Determines what angle column to plot for i 1 5 Sets the x and y axis limits ifi Shoulder flexion and extension angles x min 20 x max 95 elseif i Shoulder abduction and adduction angles x min 0 x max 115 elseif i Shoulder internal and external rotation angles x min 90 X_max 25 elseif i Elbow flexion angles x min 0 x max 110 else Wrist flexion and extension angles X_min 75 x max 10 end figure subplot 221 plot P1_It_Ik_xoutput i P1_It_Ik_n i P1_It_lk_rows r P1 t rk xoutput P1 lt rk n i Pl lt rk rows gS P1 st Ik xoutput 1 Pl st Ik n i Pl st Ik rows ko P1 st rk xoutput 1 P1 st rk n i Pl st rk rows cd LineWidth 2 xl
20. Sums the normalized FFT values until it is over 99 percent of the power while sum_FFT lt power_cutoff sum FFT sum_FFT FFT_norm j location j j j l end Returns the frequency at which 99 percent of the power is contained below this frequency Fe frequency 1 location 99 10 2 3 5 Filtering function filtered_data filtering Fs Fc raw_data This program performs a power spectral density analysis to determine the cutoff frequency for each marker in each component direction Constant Fn Fs 2 Nyquist frequency order 4 Order of the filter Filters the data using a 4th order lowpass Butterworth filter and a zero phase digital filter b a butter order Fc Fn low filtered data filtfilt b a raw data 100 10 2 3 6 Instantaneous Helical Axis Pivot Point function opp rms IHA pivot pt Fs xi 9o This function determines the optimum pivot point using the positions determined from the instantaneous helical axes method IHA 9o Reference article Woltring H Model and measurement error influences in data processing In Biomechanics of human movement applications in rehabilitation sports and ergonomics by A Berme N Eds Cappozzo 203 237 Worthington 1990 Constants t I Fs Time interval between frames r c size xi Number of landmarks there should be at least 3 ldentity matrix I zeros 3 3 for j 1 3 Ij 1 end Determines the velocity of the
21. and average pressure and force applied to the ultrasound transducers Bullock Conroy and Vetter 2011 Maas Max Pressure Average Max Pressure Max Force Average Force kPa kPa N N C5 1 149 45 57 86 82 70 37 09 S5 1 125 84 64 58 88 86 54 33 2 Literature Review The qualitative studies that have been performed have had larger sample sizes and a larger demographical area than the quantitative studies The demographical area investigated was larger for qualitative studies because the majority involved surveys that were sent to sonographers throughout the United States of America Data collected from qualitative studies has been analyzed using cross tabulation meta analysis cross sectional analysis and statistical analysis The quantitative studies have focused on muscle activity and arm position in reference to the shoulder Roll et al 2009 performed an extensive literature review on work related musculoskeletal disorders in sonographers which is summarized in Table 2 Table 2 Assessment of researched publications on work related musculoskeletal disorders experienced by sonographers and vascular technologists Roll et al 2009 Sonography Studies Qualitative Quantitative Vanderpool et al 1993 Murphey and Milkowski 2006 Necas 1996 Village and Trask 2007 Pike et al 1997 Bastian et al 2009 Smith et al 1997 Roll and Evans 2009 Wihlidal and Shraw
22. attire and reflective markers were placed on the lower extremities upper dominant extremity and torso The sonographer s skin was prepared by lightly abrading it to remove dead skin cells and then rubbed with alcohol to reduce the impedance of the electrode skin interface The surface electromyography electrodes were cleaned using alcohol then secured above the prepared skin using gaffer tape Placement of markers and electrodes is shown in Figure 4 38 Figure 4 Reflective markers and surface electromyography electrodes on a sonographer participant while she is scanning the right kidney of the patient After instrumentation was applied to the sonographer a static capture of the reflective markers was taken using the Vicon MX motion capture system Then the surface electromyography electrodes were connected to the MA300 backpack The backpack was placed on the floor next to the sonographer or on the bed The electromyography signals generated were examined using the Vicon MX motion capture system to ensure they would not become saturated during maximum voluntary isometric contraction This required the sonographer to apply her maximum amount of force for the superficial muscle that was being examined If the signal was saturated then the gain for that individual electrode was decreased on the backpack When it was determined that none of the signals would saturate the maximum isometric voluntary contraction for each muscle was recorded
23. elseif forearm_frame_option 2 j l for i 1 r Rfd GtoL j j 2 1 3 2 reference_frame rd_global_elbow VF1_D VF3_D 4 j j 3 end elseif forearm_frame_option 3 j 1 for i 1 r Rfd_GtoLG j 2 1 3 reference frame rd global elbow 1 VF1_DG RSP_D 4 j j 3 end else j l for i 1 r Rfd_GtoL j j 2 1 3 reference_frame VF1_DG VF2_DG VF3_DG 4 j J 3 end end Wrist joint center j l for i 1 r rd_global_wrist i 1 3 global_position Rfd_GtoL j j 2 1 3 rfs_local_wrist VF1_DG j j 3 end Determines the anatomical reference frame for the dynamic trial at each frame Thorax j l 88 for i 1 r R_GtoL_thorax j j 2 1 3 reference frame T8 D i C7_DG SJ_DG 5 j j 3 end Humerus j 1 for i 1 r R_GtoL_humerus j j 2 1 3 reference_frame_humerus rd_global_elbow rd_global_gleno_IHA i ELH_D i 3 j j 3 end A O A IAE EE OIN ee OR RE RENEM Determines the joint angles at every single frame of the dynamic trial Glenohumeral joint Using humerus and thorax reference frames j 1 for i 1 r phi gleno i 1 theta_gleno i 1 psi_gleno i 1 yxy_euler_sequence R_GtoL_humerus j j 2 1 3 R_GtoL_thorax j j 2 1 3 j j 3 end Elbow joint for i l r humerus_vector rd global elbow i 1 3 rd global gleno IHA 1 1 3 forearm vector rd global wrist i 1 3 rd global elbow i 1 3 vector mag norm forearm vector norm humerus v
24. in succession using the Vicon MX motion capture system 39 After these signals were recorded the sonographer was given the opportunity to adjust the bed ultrasound machine and chair if she was using it The final step before data collection was identifying the location of the sonographer s fingers on the sensor mat The sonographer gripped the C5 1 transducer in the configuration that she would use scanning the patient A researcher pressed on all of the sonographer s fingers located on the sensor mat individually while the Pliance data collection software was recording to determine the cell locations of the individual fingers This would allow researchers to distinguish the force and pressure applied by the individual fingers to the sensor mat during scanning The sonographer was instructed to maintain these finger positions on the sensor mat throughout the scan The sonographer instructed the patient to lie on his back on a standard examination bed with his abdomen exposed The patient s right side was located next to the sonographer so that his right kidney could be scanned An alternative position used for the right kidney scan was the patient lying on his left side with his back to the sonographer The sonographer s arm was extended out from the body to expose her entire upper extremity reflective markers prior to scanning The sonographer was directed to take four longitudinal scans of patient s right kidney using the same procedur
25. is applied to the transducer could establish if the sonographer is using a power grip or pinch grip Additionally it could determine the distribution of forces and pressures among individual fingers The type of grip that the sonographer uses could affect the work related musculoskeletal disorders in the hand Examining the joint torques would establish a baseline for future transducer designs since there currently are no published studies that have examined joint torques These further studies would build upon the qualitative studies by identifying factors that contribute to work related musculoskeletal disorders 12 potentially verifying the qualitative studies conclusions Further research could improve by joint angle observations and measurement techniques 13 3 Background 3 1 Motion Capture Motion capture is a process used to record and track the movements of a subject The motion capture system used for this study was a Vicon MX motion capture system This system records at a frame rate of 100 Hertz the three dimensional position of reflective markers placed on a subject in key landmark locations relevant to the research being performed The positions of the markers are determined using the LED strobe lights on each camera As the subject moves through the motion capture field the light from the strobes are reflected back into the camera lens by the markers The lens collects the light and forms a focused image of the markers on
26. is the velocity of landmark i The velocity of each landmark was determined using a central difference formula _ Xit1 Xi 1 AT 4 where x 4 is the global position of landmark i in the next frame of data collection x 4 is the global position of landmark i in the previous frame of data collection and At is the change in time between data collection frames The skew symmetric angular velocity matrix 0 is 0 0z Wy wz 0 Wy 5 where w is the angular velocity about the x axis wy is the angular velocity about the y axis and w is the angular velocity about the z axis Woltring 1990 The angular velocity vector w was determined using the calculation provided by Sommer III 1992 19 in Determination of First and Second Order Instant Screw Parameters from Landmark Trajectories Wy X X33 8 Xiz 7413 Va Vos W o Xa1 X11 X33 X23 Vig V31 6 W X3 X32 X11 t X22 Vas Vie where X is the landmark product matrix and V is the landmark velocity moment matrix The landmark product matrix was determined used the following equation T TEE Zi X zizi Xo Xi Xo 7 where n is the number of landmarks The landmark velocity moment matrix was determined using the following equation 1 E I V X Vi Xi xo 8 The magnitude of angular velocity w was determined using the following equation w o Jw wy wz 9 where w is the angula
27. j j 3 AI raw_marker_data i j 1 i 3 j j 3 AC raw_marker_data 1 j 1 i 3 jeje PC raw marker data ji j i i 3 j 3 3 ELH raw_marker_data i j 1 i 3 j j 3 EMH raw_marker_data i j 1 1 3 j 3 3 VHI raw_marker_data i j 1 i 3 j j 3 97 VH2 raw_marker_data i j i i 3 j j 3 VH3 raw_marker_data i j i i 3 jeje USP raw marker data i j i i 3 j 3 3 RSP raw_marker_data i j i i 3 j j 3 VF1 raw_marker_data i j i i 3 j j 3 VF2 raw_marker_data i j i i 3 j j 3 VF3 raw_marker_data i j i i 3 j 3 3 hand raw_marker_data 1 j i i 3 j j 3 98 10 2 3 4 Power Spectral Density Analysis function Fc psd_analysis Fs raw_data This program performs a power spectral density analysis to determine the cutoff frequency for each marker in each component direction Applies a rectangular window and takes the FFT of the raw data sigLength length raw_data win rectwin sigLength Fast Fourier Transformation of rectangular window FFT fft win raw_data Frequency figLength sigLength 2 1 frequency 1 figLength Fs 2 figLength FFTs are normally two sided this returns a one sided FFT FFT_onesided FFT 1 figLength Normalizes FFT data FFT_norm abs FFT_onesided sum abs FFT_onesided Determines cutoff frequency Initial values sum_FFT 0 jah power_cutoff 0 99
28. landmarks using the numerical difference method vi linear_velocity xi t Determines the velocity of the landmarks using the numerical difference method ai linear_acceleration xi t Determines the IHA position in the global coordinate system for each frame excluding the first and last frame because of the velocities and accelerations determined for k 2 1 1 IHA p k 1 u k 1 IHA_position xi k vi k ai k end 9oDetermines Q I have no idea what it stands for Q_sum 0 for jzl r 2 Q G 3 2 1 3 1 u j u j Q sum Qi j j 2 1 3 Q sum end Q_inital Q sum r 2 Zo Checking for singularity which will result in Q being undefined if the inverse is taken check_matrix zeros 3 3 if Q_inital check_matrix 101 Q 1 else Q Q inital end Determines the optimum pivot point k 1 Qi_si_sum 0 for j l r 2 Qi k k 2 1 3 I u j u j Qi_si_sum Qi k k 2 1 3 IHA_p j Qi si sum k k 3 end Qi_si Qi_si_sum r 2 opp Q 1 Qi si Returns a 3x1 matrix Zo Root mean square sum diff sq zeros 1 3 for i 1 r 2 sum diff sq 1 1 sum diff sq 1 1 IHA p i1 opp 1 1 2 sum diff sq 1 2 sum diff sq 1 2 IHA p i2 opp 2 1 2 sum diff sq 1 3 sum diff sq 1 3 IHA_p i 3 opp 3 1 2 end rms sqrt sum diff sq r 2 102 10 2 3 7 Linear Velocity function vi linear_velocity xi t This function determines
29. of data and a large number of calculations The complete kinematics of a single body segment requires 18 data variables center of mass position in three directions center of mass linear velocity in three directions center of mass linear acceleration in three directions angle of the segment about three axes angular velocity of the segment about three axes and angular acceleration of the segment about three axes Winter 2009 Kinematics was used to determine the joint centers and angles for the shoulder elbow and wrist The methods used to determine the joint centers are discussed in the following section 3 3 1 Joint Center Calculation Methods The process used to determine the joint angles is discussed in section 4 6 Motion Capture Data Analysis 3 3 1 Joint Center Calculation Methods Reflective markers for motion capture cannot be placed at joint centers for in vivo subject studies because joint centers are located below the skin surface As a result joint centers were calculated based on the position of landmarks surrounding the joints The instantaneous helical axis method was used to determine the shoulder joint center because it was modeled as a ball and socket joint The half distance between medial and lateral landmarks was used to determine the elbow and wrist joint centers because they were modeled as hinge joints 17 3 3 1 1 Instantaneous Helical Axis Method The instantaneous helical axis method was recommended by the
30. representation of the sonography profession The work environment for sonographers depends on the clinic that employs them location of the clinic number of sonographers employed availability of adjustable equipment and specialty of the clinic Techniques that are used for scanning depend on the education that the sonographer received Variations in education could be learning ergonomic techniques ambidextrous techniques or how to use equipment that aids in reducing muscle load The location on the patient s body that sonographers scan determines scanning duration posture and joint movement The size of the patient being scanned affects the grip pressure of the sonographer and the normal and lateral forces applied The qualitative studies can generate bias by targeting sonographers that scan in pain or have experienced pain This could result in an overestimation of sonographers that suffer from work related musculoskeletal disorders 2 2 Quantitative Studies The purposes of the quantitative studies were evaluating muscle activity across the shoulders of sonographers using surface electromyography quantifying posture during ultrasound scanning and determining techniques to reduce muscle activity In the quantitative study by Village and Trask 2007 surface electromyography was used to study activity in the following upper extremity muscles supraspinatus trapezius infraspinatus and flexor carpi ulnaris Shoulder injuries have been sug
31. she needed to use the keyboard on the ultrasound machine Additionally sonographer 2 maintained a smaller angle range for a longer duration of time compared to the other sonographers In other words she was not flexing and extending her shoulder as much as the other sonographer Sonographer 3 had a similar flexion angle range for all of the scans except when she scanned the patient s right kidney using the C5 1 transducer For this scan the angle range was offset about 20 degrees less than the other scans because the sonographer decreased the distance between her thorax and the patient s kidneys In the scans performed by sonographers 4 shoulder flexion was within the same angle range regardless of the transducer used or the kidney scanned Higher flexion angles were achieved by sonographers 2 and 3 who were seated during the scanning procedures The abduction angles that were generated by sonographers 2 4 and 5 are similar during left kidney scans Sonographer 3 had larger abduction angles because she rested her arm on the patient while she scanned Higher abduction angles were obtained when the S5 1 transducer was used to scan the patient s right kidney Shoulder abduction exceeded the acceptable limits for all of the scanning factors reference Figure 8 The acceptable limits for shoulder abduction are between 0 and 20 degrees McCulloch Xie amp Adams 2002 When the shoulder is elevated over 30 degrees of abduction it can cause fatigue
32. slight increase in the size of the transducer This system collected data that was evaluated by the occupational therapy graduate students 4 4 4 Jamar Dynamometer and Baseline Pinch Gauge Jamar dynamometer and Baseline pinch gauge use hydraulic mechanisms that indicate the force applied by an individual to the instrument on a gauge dial JAMAR 34 Hydrolic Hand Dynamometer User Instructions 2004 A Jamar dynamometer was used to determine the isometric grip force of sonographers before the study Then a Baseline pinch gauge was used to determine the three jaw chuck lateral pinch and tip pinch forces These forces were used by the occupational therapy graduate students in their study 4 4 5 Philips iU22 Ultrasound System A Philips 1U22 ultrasound system was used by the sonographer to display real time imaging and save images of the patient s left and right kidney scans C5 1 and S5 1 ultrasound transducers were used in conjunction with the Philips 1U22 ultrasound system The C5 1 transducer is a larger size than the S5 1 transducer Difference transducer sizes were used during this study as a result of the joint collaboration with occupational therapy graduate students The occupation therapy students were investigating whether the design of the transducer affects the amount of pressure exerted by the sonographer 4 4 6 Miscellaneous Instrumentation Miscellaneous instrumentation used during this study included a tape measure s
33. sonographer s position rather than that of an ultrasound examination Measuring the muscle activity of 10 a sonographer holding a position may not accurately represent the activity experience during ascan The study by Burnett and Campbell Kyureghyan 2010 was unable to determine shoulder flexion extension and shoulder internal external rotation because electrogoniometers were used to determine the joint angles The test groups of these studies were small which caused large standard deviations due to the variety of techniques used by each sonographer Localizing the muscle loads and joint movements to the shoulder only evaluates a portion of the movements that are occurring while a sonographer scans 2 3 Acceptable Range of Motion Limits McCulloch Xie and Adams 2002 define the acceptable limits for shoulder abduction between 0 and 20 degrees When the shoulder is extended beyond the acceptable limits it can result in joint instability Shoulder injuries can result from a reduction in blood flow to the supraspinatus and infraspinatus muscles This can occur when the shoulder is abducted over 30 degrees which increases intramuscular pressure Garg Hegmann amp Kapellusch 2006 Village amp Trask 2007 Hedge 1998 defines the acceptable limits of wrist flexion extension as 15 degrees flexion to 15 degrees extension When the wrist is within these limits carpel tunnel pressure typically remains below 30 mmHg A substantial increas
34. sonographer for 30 seconds Muscle activity in the supraspinatus was reduced by 46 when shoulder abduction decreased from 75 to 30 degrees When a sonographer used a support cushion under the forearm during scanning at 75 and 30 degrees of shoulder abduction muscle activity was further reduced by 32 Muscle activity in the upper trapezius was reduced by 65 when forward shoulder flexion was reduced from 50 to 0 degrees When both postures were compared for greatest and least shoulder abduction and flexion muscle activity was reduced by 88 These researchers suggest that the optimum posture for sonographers while using a support cushion under the forearm is 30 degrees or less shoulder abduction and zero degrees flexion In the study performed by Burnett and Campbell Kyureghyan 2010 they determined joint angles for the scanning arm of seven sonographers using electrogoniometers for the following scans thyroid right abdominal left abdominal right deep venous thrombosis and left deep venous thrombosis The following joint angles were evaluated wrist flexion and extension wrist radial and ulnar deviation elbow flexion and extension forearm pronation and supination and shoulder abduction The results that they obtained for joint angles are shown in Table 3 Table 3 Minimum maximum and average joint angles for five sonography scans Burnett amp Campbell Kyureghyan 2010 Scan Joint
35. using a S5 1 transducer to scan the patient s left kidney Filtered Flexor Carpi Ulnaris Electromyogram e s w 0 5 ko E a o E lt n 0 5 10 20 30 40 50 60 Time s Filtered Extensor Carpi Ulnaris Electromyogram 0 10 20 30 40 50 60 Time s Figure F Sonographer 2 filtered forearm muscles pair electromyogram using a S5 1 transducer to scan the patient s left kidney 70 Filtered Biceps Brachii Electromyogram 2 i gt E cdi gt 0 Ser c ee eS Pe PE a eS ee o 2 i a a lt 15 10 20 30 40 50 60 Time s Filtered Triceps Brachii Electromyogram 0 5 T o ko 2 a E L n bun 10 20 30 40 50 60 Time s Figure G Sonographer 2 filtered upper arm muscles pair electromyogram using a S5 1 transducer to scan the patient s right kidney Filtered Flexor Carpi Ulnaris Electromyogram o E lt i T 10 20 30 40 50 60 Time s Filtered Extensor Carpi Ulnaris Electromyogram o ko 2 a E ix I 29 10 20 30 40 50 60 Time s Figure H Sonographer 2 filtered forearm muscles pair electromyogram using a S5 1 transducer to scan the patient s right kidney 71 Filtered Biceps Brachii Electromyogram 0 1 T T T o o 2 E 0 1 l 1 l 1 I 1 1 1 L 0 5 10 15 20 25 30 35 40 45 50 Time s Filtered Triceps Brachii Electromyogram 0 1 T T T T T T o oO 2 a E a 1 l l 1 1 1 1 1 1 a 5 40 15 20 25 30 35 40 45 50 Time s F
36. using a fixture that constrains the sonographer s arm during maximum voluntary isometric contraction would ensure that the electromyography signal does not saturate This would also make it possible to determine the percent maximum voluntary isometric contraction for each muscle Furthermore determining joint torques and investigating co contraction between muscle pairs can be used to determine the percent of co contraction that is occurring Winter 2009 65 9 Conclusion This study evaluated upper extremity kinematics and determined if co contraction was present in upper extremity muscle pairs during kidney scanning because of the prevalence of work related musculoskeletal disorders in sonographers There were three scanning factors in this study sonographer s position ultrasound transducer design and kidney that was scanned Sonographers upper extremity movements and muscular activity were recorded using a Vicon MX motion capture system The kinematics investigated in this study was shoulder elbow and wrist joint angles The results were compared 1 for each joint angle to determine if there was a trend present as a result of the scanning factors 2 for shoulder abduction adduction and wrist flexion extension to acceptable published limits and 3 to results published in a previous study by Burnett and Campbell Kyureghyan 2010 The kinematic evaluation concluded that the sonographers were scanning with their shoulders in flexi
37. vector vector mags wrist_flex i wrist flex rads 180 pi 7b Continuity test Determines the difference between two angles in succession and if the angle changes more than 5 degrees in 0 20 seconds then the sign of the previous angle is applied to the current angle ifi gt 1 wrist_diff abs wrist_flex i wrist_flex i 1 wrist_diff_check i wrist_diff if wrist diff gt 5 wrist rads acos dot hand vector forearm vector vector mags sign check i 1 1 sign check i 1 sign check i 1 1 wrist_flex i wrist rads 180 pi end end end Determines the min max and average for each joint angles Minimum joint angles Glenohumeral gleno_angles zeros 3 3 gleno_angles 1 1 min phi_gleno gleno_angles 1 2 min theta_gleno gleno_angles 1 3 min psi_gleno Elbow joint elbow_flexion 1 1 min elbow_flex Wrist joint wrist_flexion 1 1 min wrist_flex Maximum joint angles Glenohumeral gleno_angles 2 1 max phi_gleno gleno_angles 2 2 max theta_gleno gleno_angles 2 3 max psi_gleno Elbow joint elbow flexion 2 1 max elbow_flex Wrist joint wrist_flexion 2 1 max wrist_flex Average joint angles Glenohumeral gleno_angles 3 1 mean phi_gleno gleno_angles 3 2 mean theta_gleno gleno_angles 3 3 mean psi_gleno Elbow joint elbow_flexion 3 1 mean elbow_flex Wrist joint wrist_flexion 3 1 mean wrist_flex
38. you or about you will be kept confidential and filed in a locked cabinet in the Occupational Therapy Department Research file Research Study Results If you wish to learn about the results of this research study or if you have any questions after the study you may request that information by contacting Dr Jeanine Beasley at beasleyj gvsu edu or 616 331 3117 123 11 Payment There will be no payment for participation in the research 12 Agreement To Participate By signing this consent form below you are stating the following e The details of this research study have been explained to me including what I am being asked to do and the anticipated risks and benefits e Ihave had an opportunity to have my questions answered e am voluntarily agreeing to participate in the research as described on this form e may ask more questions or quit participating at any time without penalty Initial here I have been given a copy of this document for my records Print Name Sign Name in ink Date Signed If you have any questions about your rights as a research participant please contact the Research Protections Office at Grand Valley State University Grand Rapids MI Phone 616 331 3197 e mail HRRC GVSU EDU 124 10 5 Occupational Therapy Survey and Questionnaire GRANDVALLEY STATE UNIVERSITY www gvsu edu Pre Scan Questionnaire Sonographer Number Years of Sonography Work Experience
39. 06 Short cycle overhead work and shoulder girdle muscle fatigue International Journal of Industrical Ergonomics 581 597 Go Further with Vicon MX T Series 2011 Retrieved 12 2011 11 from Vicon http vicon com support downloads_view php id 0858b2e0e0fb895f5a7236644c 60edcd 132 Hedge A 1998 Design of hand operated devices In Human Factors in Consumer Products pp 203 222 London Taylor amp Francis Hutmire C Baker J Evans K amp Roll S 2010 Factors that contribute to wrist hand finger discomfort in diagnostic medical sonographers and vascular technologists Journal of Diagnostic Medical Sonography 121 129 Jakes C 2001 Sonographers and occupational overuse syndrome Cause effect and solutions Journal of Diagnostic Medical Sonography 312 320 JAMAR Hydrolic Hand Dynamometer User Instructions 2004 Lafayette Lafayette Instruments Malmivaara A van Tulder M amp Koes B 2007 Repetitive strain injury The Lancet 1815 1822 McCulloch M Xie T amp Adams D 2002 Cardiovascular sonography the painful art of scanning Cardiac Ultrasound Today 69 96 Mesker C van der Helm F Rozendaal L amp Rozing P 1998 In vivo estimation of the glenohumeral joint center from scapular bony landmarks by linear regression Journal of Biomechanics 93 96 Milkowski A amp Murphey S L 2006 Surface EMG evaluation of sonographer scanning postures Journal of Diagnostic Me
40. 1 7 80 8 65 9 49 1 i 95 1 Left 93 8 9 5 33 0 15 5 23 5 Right 157 9 11 0 46 2 32 4 35 2 C5 1 Left 47 1 68 9 86 9 77 9 18 0 4 Right 57 9 69 0 95 9 83 4 27 0 95 1 Left 42 8 51 7 75 2 63 8 23 5 Right 63 9 59 6 84 9 71 6 25 4 C5 1 Left 79 4 56 5 85 0 64 2 28 4 5 Right 95 7 57 7 1022 79 4 44 5 95 1 Left 73 4 50 6 72 4 57 8 21 8 Right 54 3 49 5 66 0 56 0 16 5 53 z Sonographer 2 e Sonographer 3 5 5 2 2 g 0 5 gt 0 5 N N E 0 pm A E 0 de 2 0 50 100 2 0 50 100 Angle Degrees Angle Degrees gt Sonographer 4 3 Sonographer 5 S S Z O O 5 0 5 505 l S g A S 0 50 100 2 0 50 100 Angle Degrees Angle Degrees C5 1 Transducer Left Kidney S 5 1 Transducer Left Kidney C5 1 Transducer Right Kidney S5 1 Transducer Right Kidney Figure 10 Normalized histogram of elbow joint flexion during scanning 5 3 Wrist Joint Angles All of the sonographers experienced extension at the wrist joint Additionally sonographer 4 experienced flexion The maximum wrist flexion generated was 8 8 degrees and the maximum extension was 70 4 degrees The maximum and minimum ranges of motion for extension were 58 3 and 20 5 degrees which are displayed in Table 12 A normalized histogram of wrist extension for each scan is shown in Figure 11 54 Table 12 Wrist joint flexion extension duri
41. 1 I L l l l AE 10 20 30 40 50 60 70 80 Time s Filtered Triceps Brachii Electromyogram 0 17 4 T T T z o oO 2 a E lt x 2 10 20 30 40 50 60 70 80 Time s Figure Q Sonographer 5 filtered upper arm muscles pair electromyogram using a C5 1 transducer to scan the patient s left kidney Filtered Flexor Carpi Ulnaris Electromyogram 0 05 T T T T T Amplitude V l 0 05 0 10 20 30 40 50 60 70 80 Time s Filtered Extensor Carpi Ulnaris Electromyogram 0 5 e o o 2 a E c 0 5 l 0 10 20 30 40 50 60 70 80 Time s Figure R Sonographer 5 filtered forearm muscles pair electromyogram using a C5 1 transducer to scan the patient s left kidney 76 Filtered Biceps Brachii Electromyogram 0 02 T T T T w 0 01 pe 2 a 0 E 0 01 1 l I 1 I 1 i 1 l 0 10 20 30 40 50 60 70 80 90 100 Time s Filtered Triceps Brachii Electromyogram 0 1 T T T T T T T e o oO 2 a E lt A 1 l 1 1 1 1 1 1 l a 10 20 30 40 50 60 70 80 90 100 Time s Figure S Sonographer 5 filtered upper arm muscles pair electromyogram using a C5 1 transducer to scan the patient s right kidney Filtered Flexor Carpi Ulnaris Electromyogram 0 2 T T T o 3 o E lt x 0 1 l 1 l L l 1 i l 2 10 20 30 40 50 60 70 80 90 100 Time s Filtered Extensor Carpi Ulnaris Electromyogram 0 5 T T T T e o ko 2 a aj i l l 1 1 1 1 1 L 0 5 10 20 30 40 50 60
42. 16 10 3 Occupational Therapy Results Table A Pinch and grip strength in the dominant hand of the sonographer Pinch Strength Ibs Grip Strength Ibs Three S h dcs M Jaw Norms pue Norms Tp Norms Grip Norms Pinch Pinch Chuck 1 14 16 14 15 7 11 11 7 60 57 3 4 12 3 19 3 15 18 7 12 3 12 6 83 3 78 7 5 16 3 17 7 18 6 17 7 12 6 11 9 80 74 5 Table B Pressures and forces for the entire sensor mat during left kidney scans Left Kidney Scans C5 1 Transducer S5 1 Transducer Sonographer Max Average Max Ayers Max Average Max RSA Max Max Force Force Pressure Pressure Force Force Pressure Pa W 3 Go y 0 ro des 1 62 67 30 99 88 33 41 67 81 60 88 126 67 91 68 4 89 83 45 81 190 69 81 100 33 57 69 130 58 16 5 88 83 53 69 140 63 01 74 5 47 8 76 67 39 67 Table C Pressures and forces for the entire sensor mat during right kidney scans Right Kidney Scans C5 1 Transducer S5 1 Transducer Sonographer Max Average Max BRE Max Average Max LE Max Max Force Force Pressure po Force Force Pressure Pressure N N kPa kPa N N kPa kPa 1 52 67 11 7 121 67 28 58 65 67 46 8 150 81 79 4 115 5 43 37 175 60 87 127 67 63 6 165 58 4 5 86 67 36 9 181 67 77 22 84 48 93 106 67 57 77 117 Table D Maximum pressure exerted by the thumb and on the entire sensor mat Maximu
43. 16 channels for data collection Electrodes are conductive elements that are placed on the surface of the skin to record the electrical voltage generated by the muscle fibers prior to the generation of muscle forces The 33 electrodes are non invasive and a minimal risk to the sonographers being studied The MA300 backpack processes and transmits the digital signal collected from the electrodes to the MA300 desk top unit Additionally it can be used to adjust gain on individual electrodes The MA300 desk top unit transforms the digital input signals into analog output signals Motion Lab Systems User Manual 2007 The MA300 multi channel EMG system was used to transmit the analog surface electromyography data to the MX Giganet 4 4 3 Novel Pliance X System The Novel Pliance X system consist of a s2054 Pliance X sensor mat Pliance X sensor cable Pliance X box Pliance X fiber optic cable with fiber optic USB adapter belt Pliance X battery Pliance X battery cable Bluetooth dongle and Pliance data collection software The Pliance X box transmits data from the s2054 Pliance X sensor mat via Bluetooth to the collection computer with Pliance data collection software Pliance X System Manual 2011 The Novel Pliance X system was used to determine the amount of force and pressure that the sonographers applied to the transducers The s2054 Pliance X sensor mat was secured to the ultrasound transducer using micropore tape This resulted in a
44. 2 7 47 6 41 7 Right 47 5 0 8 20 4 11 9 19 6 Left 64 5 29 7 52 1 43 9 22 4 sik Right 104 0 9 2 27 3 17 2 18 1 85 1 Left 93 8 33 4 49 3 40 6 16 0 Right 157 9 32 2 61 0 45 3 28 7 sa Left 47 1 47 39 7 21 2 35 0 4 Right 57 9 7 5 39 9 20 3 32 4 51 Left 42 8 0 1 40 6 25 3 40 5 Right 63 9 9 3 38 4 20 7 29 1 65 1 Left 79 4 4 4 24 6 9 0 29 0 Right 95 7 12 5 44 8 1 8 57 3 7 Left 73 4 33 22 6 13 4 19 3 post Right 54 3 10 2 42 0 20 0 31 8 47 Sonographer 2 Sonographer 3 o un e o aj 1 Z 0 20 40 60 80 Angle Degrees Sonographer 5 0 20 40 60 80 Angle Degrees Sonographer 4 o Normalized Frequency Normalized Frequency Normalized Frequency Normalized Frequency No 1 HP No NC 0 20 40 60 80 0 20 40 60 80 Angle Degrees Angle Degrees C5 1 Transducer Left Kidney S5 1 Transducer Left Kidney C5 1 Transducer Right Kidney S5 1 Transducer Right Kidney Figure 7 Normalized histogram of shoulder joint flexion extension during scanning Only shoulder abduction occurred during scanning with maximum and minimum angles of 112 5 and 38 6 degrees The maximum and minimum ranges of motion were 37 2 and 11 7 degrees which are shown in Table 9 A normalized histogram of shoulder abduction for each scan is displayed in Figure 8 48 Table 9 Shoulder joint abduction during scanning
45. 3 1 Joint Center Calculation Methodis eese nenne 17 3 3 1 1 Instantaneous Helical Axis Method eee 18 3 3 1 2 Difference between Medial and Lateral Landmarks 21 A ence PEAIIOS S acido otto za van ak cook M a R EA 22 3 3 3 Rotation Matrices iere ok A PGA 23 3 3 4 Joint Angle Calculation Methodis esee 25 D 9 ET Buler Angles osse get Read lem tote Raita pits ts dato Sanc Sp ut 25 Dias DobPEodUCE c etes iise AO Al EZ nS 27 3 943 Dot and Cross Products 4d oio EO it 28 3 4 Electromyography and Co contraction ccceescecsseceeseeceeeeeceeceeceeeeeceeeeecsteeeeeaeees 29 23 9 Superticial Muscle select O ld dius 30 4 Methodology A ES Nira AO O O AA 31 4 1 Participant Criterion and Recruitment sees rennen 31 4 2 Sonographer Participation and Data Collection eene 31 4 3 Participant Demographics and Characteristics seen 32 4 4 Instrumentation and Materials eoe A even i daos 33 4 4 1 Vicon MX Motion Capture System sees 33 4 4 2 MA300 Multi Channel EMG System eese rennen 33 44 3 Noyel Pliangee X Systems ui beste e eaaet wb 34 4 4 4 Jamar Dynamometer and Baseline Pinch Gauge eese 34 4 4 5 Philips 1U22 Ultrasound System eese enne enne 35 4 4 6 Miscellaneous Instrumentation
46. 31 Table 11 Elbow joint flexion during scanning eee e eee a aaa aaa aaa aaa wana wiaaa 53 Table 12 Wrist joint flexion extension during scanning eee 55 Table 13 Minimum and maximum joint angles achieved for all of the scans based on the ditferentscanning factors GE a O R A 57 xi Appendices Table A Pinch and grip strength in the dominant hand of the sonographer 117 Table B Pressures and forces for the entire sensor mat during left kidney scans 117 Table C Pressures and forces for the entire sensor mat during right kidney scans 117 Table D Maximum pressure exerted by the thumb and on the entire sensor mat 118 Table E Maximum force exerted by the thumb and on the entire sensor mat 118 xii List of Figures Figure 1 Anatomical locations of discomfort experienced by sonographers Russo Murphy Lessoway amp Berkowitz 2002 esses eene enne enne eene 3 Figure 2 Location of the proximal plane used to determine if the wrist is in flexion or RUSS HON TA area scat OZ O OOOO TWE vu oU cec iot tienen 29 Figure 3 Pliance X sensor mat wrapped around the transducers sssss 38 Figure 4 Reflective markers and surface electromyography electrodes on a sonographer participant while she is scanning the right kidney of the patient 11221112 1 39 Figure 5 Neutral and anatomical po
47. 70 80 90 100 Time s Figure T Sonographer 5 filtered forearm muscles pair electromyogram using a C5 1 transducer to scan the patient s right kidney 77 Filtered Biceps Brachii Electromyogram 0 02 T T T w 0 01 pe 2 a 0 E lt E I l L l 1 1 AE 10 20 30 40 50 60 70 80 Time s Filtered Triceps Brachii Electromyogram 0 1 T 1 T T T T e o oO 2 a E lt 24 1 L l 1 L l 1 a 10 20 30 40 50 60 70 80 Time s Figure U Sonographer 5 filtered upper arm muscles pair electromyogram using a S5 1 transducer to scan the patient s left kidney Filtered Flexor Carpi Ulnaris Electromyogram 0 05 T T T T T T Amplitude V S 1 l l 1 1 l 1 E 10 20 30 40 50 60 70 80 Time s Filtered Extensor Carpi Ulnaris Electromyogram 0 5 T T Amplitude V e 2 85 10 20 30 40 50 60 70 80 Time s Figure V Sonographer 5 filtered forearm muscles pair electromyogram using a S5 1 transducer to scan the patient s left kidney 78 Filtered Biceps Brachii Electromyogram 0 02 w 0 01 o a 0 E r 28 10 20 30 40 50 60 Time s Filtered Triceps Brachii Electromyogram 0 1 T T o ko 2 a E lt x 0 1 l u 0 10 20 30 40 50 60 Time s Figure W Sonographer 5 filtered upper arm muscles pair electromyogram using a S5 1 transducer to scan the patient s right kidney Filtered Flexor Carpi Ulnaris Electromyogram e EY Amplitude V 5 10 20 30 40 50 60 T
48. Angles l Right Left Right Deep Left Deep AE Abdominal Abdominal Ma M Thrombosis Thrombosis Wrist Min 64 3 59 7 51 3 52 5 60 4 Extension Flexion Max 15 2 31 7 21 5 50 4 21 8 Degrees Average 27 9 20 9 14 3 8 9 10 9 Wrist Radial Ulnar Min 23 1 26 6 20 1 25 2 27 7 Deviation Max 20 4 22 1 26 4 26 8 19 1 Degrees Average 1 8 1 7 6 5 8 7 5 2 Min Pow er Max 84 1 98 1 85 6 78 1 82 7 Degrees Average 26 31 7 31 4 45 1 27 3 Forearm Pronation Min 34 2 58 3 43 8 51 2 60 1 Supination Max 70 5 67 4 71 9 76 6 67 5 Degrees Average 9 3 0 6 13 9 5 9 7 5 Min 56 5 39 6 36 8 52 5 29 2 See ren Max 104 5 99 1 99 2 107 7 93 6 Degrees Average 74 8 72 8 71 9 78 9 68 9 2 2 1 Quantitative Study Shortcomings Shortcomings of the quantitative studies were using a trained observer to determine joint angles from recorded video maintaining a position to record muscle activity using small test groups and localizing the focus of the studies to muscle activity and joint movement in the shoulder Determining shoulder abduction and outward rotation using a trained observer on stop motion playback affects the accuracy of the joint angles because the observer is using a 2D image to determine a 3D angle This method of joint angle measurement could introduce a large angular error in the study The study by Miklowski and Murphy 2006 focused on the muscle activity of a
49. Grand Valley State University ScholarWorks GVSU Masters Theses Graduate Research and Creative Practice 4 1 2012 Dominant Upper Extremity Kinematics and Muscular Activity in Sonographers during Kidney Scanning Jennifer Elizabeth Edwards Grand Valley State University jenn e edwards gmail com Follow this and additional works at http scholarworks gvsu edu theses Recommended Citation Edwards Jennifer Elizabeth Dominant Upper Extremity Kinematics and Muscular Activity in Sonographers during Kidney Scanning 2012 Masters Theses Paper 17 This Thesis is brought to you for free and open access by the Graduate Research and Creative Practice at ScholarWorks GVSU It has been accepted for inclusion in Masters Theses by an authorized administrator of ScholarWorks GVSU For more information please contact scholarworks gvsu edu Dominant Upper Extremity Kinematics and Muscular Activity in Sonographers during Kidney Scanning Jennifer Elizabeth Edwards A Thesis Submitted to the Graduate Faculty of GRAND VALLEY STATE UNIVERSITY In Partial Fulfillment of the Requirements For the Degree of Master of Science in Engineering with an emphasis in Biomedical Engineering Seymour and Esther Padnos College of Engineering and Computing April 2012 Acknowledgements I would like to acknowledge the following people for their help guidance and eagerness to participate in this study committee members volunteers occupation therapy
50. Ik markers Pl IHA landmarks P1 IHA start P1 st Ik rows Pl st Ik forearm P1 st Ik wrist marker Small transducer right kidney scan P1 st rk angle ranges P1 st rk angles P1_st_rk_joint_centers upper extremity joint angles Fs Fc Pl st rk markers 1 P1 st rk markers P1 IHA landmarks P1 IHA start P1 st rk rows P1 st rk forearm P1 wrist marker go Subject 2 Large transducer left kidney scan P2 It Ik angle ranges P2 lt Ik angles P2 lt Ik joint centers upper extremity joint angles Fs Fc P2 lt Ik markers 742 P2 lt Ik markers P2 IHA landmarks P2 lt Ik IHA start P2 lt Ik IHA end P2 It Ik forearm P2 wrist marker Large transducer right kidney scan P2 lt rk angle ranges P2 lt rk angles P2 lt rk joint centers upper extremity joint angles Fs Fc P2 lt Ik markers 742 P2 lt rk markers P2 IHA landmarks P2 lt rk IHA start P2 lt rk IHA end P2 lt rk forearm P2 wrist marker Small transducer left kidney scan P2 st Ik angle ranges P2 st Ik angles P2 st Ik joint centers upper extremity joint angles Fs Fc P2 lt Ik markers 742 P2 st Ik markers P2 IHA landmarks P2 st lk IHA start P2 st Ik IHA end P2 st Ik forearm P2 wrist marker 9b Small transducer right kidney scan P2 st rk angle ranges P2 st rk angles P2 st rk joint centers upper extremity joint angles Fs Fc P2 lt Ik markers 742 P2 st rk markers
51. International Society of Biomechanics to determine the shoulder joint center Wu et al 2005 The instantaneous helical axis of a rigid body is a line in space that represents both the axis of rotation and the line along which translation occurs The position and direction of the instantaneous helical axis is uniquely defined if the angular velocities of the landmarks are not equal to zero Winter 2009 The location of a point on the instantaneous helical axis when the angular velocities of the landmarks are not equal to zero was determined using the following equation el SI o 1 GI Il o where p is the location of a point on the instantaneous helical axis x is the global position of the centroid of landmarks is the skew symmetric angular velocity matrix V is the mean velocity of the landmarks and w is the magnitude of angular velocity In the special case of pure translation p Xo The variables to determine the instantaneous helical axis are defined in the following equations The global position of the centroid of landmarks x was determined using the following equation Daf 2 o 18 where n is the number of landmarks i is the capture frame and x is the global position of landmark i The global positions of landmarks were determined by the Vicon MX motion capture system Mean velocity of the landmarks v was determined using the following equation 2 1 Do EXHT 6 where v
52. T o ko 2 a E lt x 45 5 10 15 20 25 30 35 40 45 Time s Figure M Sonographer 4 filtered upper arm muscles pair electromyogram using a S5 1 transducer to scan the patient s left kidney Filtered Flexor Carpi Ulnaris Electromyogram T T o N Amplitude V 0 l 1 1 l l 1 1 1 2 5 10 15 20 25 30 35 40 45 Time s Filtered Extensor Carpi Ulnaris Electromyogram 0 5 T T gt o oO 2 a E lt x i 05 5 10 15 20 25 30 35 40 45 Time s Figure N Sonographer 4 filtered forearm muscles pair electromyogram using a S5 1 transducer to scan the patient s left kidney 74 Filtered Biceps Brachii Electromyogram T T T T Amplitude V E l l 1 L 1 1 2 8 10 20 30 40 50 60 70 Time s Filtered Triceps Brachii Electromyogram T Amplitude V 1 l L 1 1 l BE 10 20 30 40 50 60 70 Time s Figure O Sonographer 4 filtered upper arm muscles pair electromyogram using a S5 1 transducer to scan the patient s right kidney Filtered Flexor Carpi Ulnaris Electromyogram 0 5 T o 2 E lt x 0 5 l l L 1 i L 0 10 20 30 40 50 60 70 Time s Filtered Extensor Carpi Ulnaris Electromyogram 2 T T 10 20 30 40 50 60 70 Time s Figure P Sonographer 4 filtered forearm muscles pair electromyogram using a S5 1 transducer to scan the patient s right kidney 75 Filtered Biceps Brachii Electromyogram 0 02 T r 3 w 0 01 E halal a 0 E il L l
53. TS Committee Chair Dr Jeanine Beasley EdD OTR CHT 3 Purpose of Study One purpose of this study is to determine if the design of an ultrasound transducer affects the amount of pressure exerted by sonographers to achieve a quality scan An additional purpose of this study would be examining the possibility of repetitive strain injuries resulting from awkward posture repetitive movement and griping force The study will also examine if the amount of pressure exerted by the sonographer correlates with any possible subjective level pain as reported by the sonographer 4 Reason for Invitation You are being invited to participate in this study because you are a sonographers with a minimum of 5 years experience practicing in the field of sonography 119 10 How Participants Were Selected Participants were selected due to personal relationships with Grand Valley State University Radiological Imaging Faculty and experience in the field of sonography Procedure Of Study e The study will take place in Cook DeVos Center for Health Sciences 4 Floor Sonography Room in Grand Rapids MI e You will be asked to complete a pre scanning form and a post scanning form e You will be asked to obtain a quality scan of each kidney of a model volunteer You will be asked to use two different types of transducers and use your right and left hand to scan You will be asked to obtain 14 scans overall Reflective markers will be placed on the arm
54. X motion capture system will merge the markers into one or one marker could obscure the location of another marker The entire landmark marker set is shown in Table 4 Table 4 Reflective marker set to determine upper extremity joint angles Extremity Location Anatomical Location Landmarks Upper Torso Sternoclavicular joint C7 T8 Shoulder Angulus acromialis Trigonum spinae scapulae Angulus inferior scapulae Acromioclavicular Processus coracoideus Elbow Epicondylus lateralis humeri Epicondylus medialis humeri Wrist Ulnar styloid process Radial styloid process Hand 2nd metacarpal base 2nd metacarpal head 2nd distal phalange head 4th metacarpal base Ist distal phalange base Humerus Virtual marker 1 Virtual marker 2 Virtual marker 3 Forearm Virtual marker 1 Virtual marker 2 Virtual marker 3 Lower Hip Posterior superior iliac spine Anterior superior iliac spine Greater trochanter femoral Shank Lateral tibial plateau Lateral malleolus tibial Foot Calcaneus 5th metatarsal head 16 3 3 Kinematics Kinematics is the study of motion independent of forces It focuses on the details of movement Kinematic variables used to describe movement are linear and angular displacement velocity and acceleration A complete and accurate quantitative description of a simple movement requires a large amount
55. abel Angle Degrees fontsize 30 ylabel Normalized Frequency fontsize 30 xlim x_min x_max ylim 0 1 title Sonographer 2 fontsize 30 84 subplot 222 plot P2_It_Ik_xoutput i P2_It_Ik_n i P2_It_lk_rows r P2_It_rk_xoutput i P2_It_rk_n i P2_It_rk_rows gs P2_st_lk_xoutput i P2_st_Ik_n i P2_st_Ik_rows ko P2_st_rk_xoutput i P2_st_rk_n i P2_st_rk_rows cd Line Width 2 xlabel Angle Degrees fontsize 30 xlim x_min x_max ylim 0 1 ylabel Normalized Frequency fontsize 30 title Sonographer 3 fontsize 30 subplot 223 plot P4_lt_1k_xoutput 1 P4_lt_1k_n 1 P4_lt_Ik_rows 1 P4_It_rk_xoutput i P4_It_rk_n 1 P4_lt_rk_rows gs P4_st_Ik_xoutput 1 P4_st_Ik_n 1 P4_st_Ik_rows ko P4_st_rk_xoutput i P4_st_rk_n i P4_st_rk_rows cd LineWidth 2 xlabel Angle Degrees fontsize 30 xlim x_min x_max ylim 0 1 ylabel Normalized Frequency fontsize 30 title Sonographer 4 fontsize 30 subplot 224 plot P5 It Ik xoutput C 1 P5 It Ik n C 1 P5 It Ik rows r P5 It rk xoutput 1 P5 lt rk n 1yP5 lt rk rows gs P5 st Ik xoutput 1 P5 st Ik n i P5 st Ik rows ko P5 st rk xoutput 1 P5 st rk n i P5 st rk rows cd Line Width 2 h legend C5 1 Transducer Left Kidney C5 1 Transducer Right Kidney S5 1 Transducer Left Kidney S5 1 Transducer Righ
56. ale He had a body mass index of 31 3 which was within the desired range for this study 32 Table 5 Demographics and characteristics of participant sonographers Sonographer e 5 NR Gender Areas of Specialty 1 57 4 16 Right Female General 2 44 4 14 Right Female Obstetric abdominal and vascular 3 60 2 34 Right Female General 4 32 8 3 Right Female General 5 25 9 3 5 Right Female General 4 4 Instrumentation and Materials 4 4 1 Vicon MX Motion Capture System The Vicon MX motion capture system consists of a MX Giganet eight Vicon T40 cameras Vicon Nexus software and reflective markers The Vicon T40 cameras each have 320 LED strobe lights that are used to produce the signal that is sent to the MX Giganet The MX Giganet connects the cameras and external devices to the capturing computer that contains the Vicon Nexus software Vicon MX Hardware System Reference 2007 An external device that was connected to the MX Giganet for this study was the MA300 multi channel EMG system which is discussed in the following section The Vicon MX motion capture system was used to track and record the location of bony landmarks on sonographers and the recorded surface electromyography data 4 4 2 MA300 Multi Channel EMG System The MA300 multi channel EMG system consist of a MA300 desk top unit MA300 backpack surface electromyography electrodes and coaxial cable The MA300 multi channel EMG system has
57. an 1997 Gregory 1998 Jakes 2001 McCulloch et al 2002 Ransom 2002 Russo et al 2002 Brown and Baker 2004 Muir et al 2004 David 2005 Evans et al 2009 2 1 Qualitative Studies Targeted areas of interest for the qualitative studies were general health status history of work related injury risk of injury equipment utilized overall work environment demographic data work experience techniques for performing an ultrasound and physical activity The information collected from sonographers was used to determine factors that contribute to work related musculoskeletal disorders risks of work related musculoskeletal disorders modifications that are required for equipment utilized consequences of work related musculoskeletal disorders and recommended workloads and procedures Quanbury Friesen Friesen amp Arpin 2006 Hutmire Baker Evans amp Roll 2010 Berkowitz Pike Russo Lessoway amp Baker 1997 Vanderpool Friis Smith amp Harms 1993 Factors that were determined to contribute to work related musculoskeletal disorders were work experience manipulating the transducer while maintaining pressure shoulder abduction twisting of the neck and trunk inadequate recuperation time between patients awkward posture and scanning in a standing position Hutmire Baker Evans amp Roll 2010 Vanderpool Friis Smith amp Harms 1993 Modifications sug
58. and a reduction in blood flow to shoulder muscles leading to injury or pain 59 Garg Hegmann amp Kapellusch 2006 Village amp Trask 2007 During this study the sonographers were always over 30 degrees of abduction The internal and external rotation angles varied for each sonographer When sonographer 2 scanned the patient s left kidney she maintained a smaller angle range External rotation was greater for sonographers 2 and 3 who were seated Sonographer 4 experienced larger ranges of motion because she would shift her weight from one foot to the other when she needed to use the keyboard resulting in her twisting her torso Additionally external rotation was greater when the sonographers were scanning the patient s left kidney because of the position of the patient 6 2 Comparison of Elbow Joint Angles There were no similarities between the sonographers for elbow flexion Elbow angles were not obtained for sonographer 2 when she scanned the patient s left kidney because not enough markers were detectable by the cameras on the forearm When sonographer 3 scanned the patient s right kidney she had a larger range of motion because she would move her chair or tilt her torso more often Sonographer 5 had larger flexion angles than the other sonographers which could be because of the location of the patient kidneys in relation to the sonographer s shoulder joint Her shoulder joint was at a higher elevation in comparison to th
59. ar velocity matrix eq 3 w_skew skew_symmetric w Determines IHA location Constraint to use the point on the IHA at the root of its perpendicular through the centroid of the landmarks if w_mag gt eps Unit direction vector eq 2 u w w_mag IHA position eq 16 IHA_p xo w skew vo w mag 2 Constraint pure translation magnitude of angular velocity is zero else Unit direction vector eq 29 u vo norm vo IHA position eq 16 IHA p xo end Transposes IHA p into a 1x3 matrix IHA p IHA p 107 10 2 3 10 Skew Symmetric function skew_sm skew_symmetric vector This function creates a skew symmetric matrix from the input vector that is a 3 1 or 1 3 matrix Determines the size of the vector m is the number of rows n is the number of columns m n size vector Returns the skew symmetric matrice of the vector The vector has to be a 3 1 or 1 3 matrix if m 223 amp amp n 1 m 1 amp amp n 3 if m n skew sm zeros m m skew sm 1 2 vector 3 1 skew sm 1 3 vector 2 1 skew sm 2 3 vector 1 1 skew sm 2 1 vector 3 1 skew sm 3 1 vector 2 1 skew sm 3 2 vector 1 1 end if m n skew sm zeros n n skew sm 1 2 vector 1 3 skew_sm 1 3 vector 1 2 skew_sm 2 3 vector 1 1 skew_sm 2 1 vector 1 3 skew_sm 3 1 vector 1 2 skew_sm 3 2 vector 1 1 end 1f the vector is not a 3 1 or 1
60. arkers filtered marker seperation filt dynamic IHA landmarks scapula markers raw marker seperation dynamic raw data IHA landmarks Determines the joint centers Instantaneous helical axes method IHA Determines the glenohumeral joint center in the global coordinate system if IHA_end lt r global_gleno_ IHA IHA_pivot_pt fs scapula markers raw IHA start IHA end else global gleno IHA IHA pivot pt fs scapula markers filtered IHA start IHA end end Difference between medial and lateral markers about the joint Determines the elbow joint center in the global coordinate system jc elbow global interpolated_joint_center ELH_S EMH_S Determines the wrist joint center in the global coordinate system jc wrist global interpolated joint center USP S RSP S Determines the technical reference frame for a static frame Humerus 86 Rhs GtoL reference_frame VH1_S WH2_S VH3_S 4 Forearm if forearm_frame_option 1 Rfs_GtoL reference frame jc elbow global VF1_S VF2_S 4 elseif forearm frame option 2 Rfs_GtoL reference frame jc elbow global VF1 S VF3 S 4 elseif forearm frame option 3 Rfs GtoL reference frame jc elbow global VF1_S RSP_S 4 else Rfs GtoL reference frame VF1 S VF2 S VF3 S 4 end Determines the local position of the joint centers using the static technical reference frame For the glenohumeral joint calculated usin
61. ase place an X on the area s where you experience pain during activities of daily living PRA ACROMION PROCESS i OF SCAPULA ee CLAVICLE CORACOID PROCESS w NOJ MEDIAL Sid anco EPICONDYLE Sid LATERAL STYLOID ZJKIA PROCESS OF RADIUS qio rere MEDIAL STYLOID pev PROCESS OF ULNA A Have you experienced any pain while performing leisure activities such as card games hiking or gardening Please specify If so what level would you classify your pain as 012345 Where is your pain localized 127 Please place an X on the area s where you experience pain during leisure activities ACROMION PROCESS OF SCAPULA CLAVICLE CORACOID PROCESS Right Left Side Side EPICONDYLE LATERAL STYLOID PROCESS OF RADIUS MEDIAL STYLOID PROCESS OF ULNA Gloth F M Scheve A A Stober C V Chow S amp Prosser J 2001 The functional pain scale Reliability validity and responsiveness in an elderly population Journal of American Medical Directors Association 2 3 110 11 128 Sonographer Number GRANDVALLEY STATE UNIVERSITY www gvsu edu Volunteer Number Scanned Post Scan Questionnaire Rating Description 0 No pain 1 Tolerable and does not prevent any activities 2 Tolerable but does prevent some activities 3 Intolerable but can use telephone watch TV or read 4 Intolerable but cannot use telephone watch TV or rea
62. ata i j i i 3 jeje T8 raw marker data 1 j i i 3 j j 3 AA raw_marker_data i j i i 3 j j 3 TS raw_marker_data i j 12143 j 3 3 AI raw_marker_data i j 1 i 3 j 3 3 AC raw_marker_data 1 j 1 i 3 j j 3 PC raw_marker_data i j i i 3 j 3 3 ELH raw_marker_data i j i i 3 jeje EMH raw marker data ji j i i 3 j 3 3 VHI raw_marker_data i j 1 i 3 j j 3 95 VH2 raw_marker_data i j i i 3 j 3 3 VH3 raw_marker_data i j i i 3 j 3 3 USP raw_marker_data i j i i 3 J J 3 RSP raw_marker_data i j i i 3 j j 3 VF1 raw_marker_data i j i i 3 j j 3 VF2 raw_marker_data i j i i 3 j 3 3 VF3 raw_marker_data i j i i 3 j 3 3 hand raw_marker_data 1 j i i 3 j 3 3 96 10 2 3 3 Marker Separation Dynamic function SJ C7 T8 AA TS AI ELH VH1 VH2 VH3 RSP VF1 VF2 VF3 hand marker_seperation_dynamic raw_marker_data This function seperates the data into individual markers that are needed for determining the wrist elbow glenohumeral sternoclavicular and acromioclavicular joint angles Sections the data into individual markers 1 l j 3 SJ raw_marker_data i j 12143 j 3 3 C7 raw_marker_data i j i i 3 j j 3 T8 raw_marker_data i j i i 3 j 3 3 AA raw_marker_data 1 i i 3 jeje TS raw marker data i j 12143
63. bow flexion angles during this study was 9 3 to 102 2 degrees The wrist joint was always in extension except for portions of one scan The wrist joint angles exceeded acceptable published limits during all scans The electromyograms indicated that the agonistic muscles in the upper arm and forearm were activated simultaneously with the antagonistic muscles at iv multiple instances throughout the scans indicating co contraction was regularly occurring Table of Contents le wevisiIsIiT E A iii Abstract Sos ctsote oves Ansa ebd i enne fedt es qd RZA GE iv Tableof Contents ooo asi o A vi Ego p MAR xi Listof PI QUIES C eta xiii Defmition Ot Permis ona EZ BAe e dba dee A A Medea a tesa xvii A A 1 ELSCOBE GEREDUDE REA E EE E E CE 3 2 Literat re Review uio oe WA GLi dad dead OCR AR Akka 5 DW Qualitative Studies ii satel EG re naso R a 6 2 1 1 Qualitative Study Shortcomings ceecceceeseceececeseeeceeeeeceeeeeceeeeeceeeeecseeeesaes 7 2 2 Quantitatrye OUdIES ini aito I D e Ye 8 2 2 1 Quantitative Study Shortcomings essere nennen 10 2 3 Acceptable Range of Motion Limits ette persto doeet YE els occa tente aces 11 24 Basis tor Purther Researeli s usarla 12 A tete sigs nU NAE Rs me AWR W A 14 21 Moton Captur siiis KAS O b Rell ats situ sce Sah te 14 D2 Landmark Sel ec HOT s KG O 14 3 3 AA 17 vi 3
64. cale alcohol wipes two sided tape micropore tape and gaffer tape The tape measure was used to measure the height of the sonographers and patient A scale was used to determine the weight of the sonographers and patient Alcoholic wipes were used to abrade and clean the sonographers skin where the surface electromyography electrodes would be placed Additionally they were used to clean the surface electromyography electrodes Two sided tape was used to affix the reflective markers to the sonographers Micropore tape was used to secure the s2054 Pliance X sensor mat to the ultrasound 35 transducer that was being used Micropore tape was used to prevent the remnants of tape residue on the s2054 Pliance X sensor mat Gaffer tape was used to secure the surface electromyography electrodes to the sonographers 4 4 7 Questionnaire and Pain Measurements A pre scan questionnaire was administered to determine demographic information and if pain has been experienced in the upper extremities or torso of the sonographers A post scan questionnaire was administered to determine if pain had been experienced while scanning during the study and if there was a preference for transducer design The pain level experienced was based on a functional pain scale ranging from no pain to intolerable and unable to verbally communicate because of the pain zero to five respectively The questionnaires were utilized by the occupational therapy graduate students in t
65. cles pair electromyogram using a S5 1 transducer to scan the patient s right EOD aa l sete eed laut oie Figure X Sonographer 5 filtered forearm muscles pair electromyogram using a S5 1 transducer to scan the patient s right kidney seeeo eee aaa aaa aaa aaa aaa aaa enia xvi Definition of Terms Directional human motion terms Medial toward midline Lateral away from midline Proximal toward the head or trunk Distal away from the head or trunk Superior toward the head Inferior toward the feet Anterior front side of the body Posterior back side of the body Joint motion terms Flexion decrease in joint angle between body segments Extension increase in joint angle between body segments Abduction movement away from midline Adduction movement toward midline Internal rotation rotates the anterior surface toward midline External rotation rotates the anterior surface away from midline xvii 1 Introduction Work related musculoskeletal disorders are a group of syndromes characterized by soft tissue discomfort caused or aggravated by workplace exposures which can affect the muscles joints tendons ligaments or nerves Berkowitz Pike Russo Lessoway amp Baker 1997 Sonographers suffer from work related musculoskeletal disorders as a result of ergonomic hazards and working conditions Ergonomic hazards that are a risk for repetitive strain injury are repetitive motion forcefu
66. cos zu Vproximal 28 IFdistal Pyrozimat where sign is the direction of the vector normal to the proximal plane The direction of the vector normal to the proximal plane was determined using the following equation d v Vnorinal 29 where V is a vector above the proximal plane and its direction points away from the proximal plane and normal is a vector normal to the proximal plane If d is negative then the normal vector is below the proximal plane the wrist is in flexion and sign is 1 If d is positive then the normal vector is above the proximal plane the wrist is in extension and sign is 1 reference Figure 2 28 Extension Proximal plane Flexion Figure 2 Location of the proximal plane used to determine if the wrist is in flexion or extension The vector above the proximal plane v was determined using the wrist joint center and a proximal body segment marker located above the proximal plane The vector normal to the proximal plane Vrorma was determined using the following equation Vnormal Vproximal X Uparallel 30 where Vparaliel is the vector parallel to the proximal plane The following equation was used to determine the vector parallel to the proximal plane Vparallel Vaistal X Vproximal 31 The joint centers were used to create a vector in the proximal body segment A marker on the distal body segment and the joint center were used to create a vector in the distal body segment
67. ctromyography Data function bicep fft tricep fft flexor_fft extensor_fft fft_raw_emg fs raw data Divides the signal into the seperate muscles bicep raw raw data 1 tricep raw raw data 2 flexor raw raw data 3 extensor raw raw data 4 Constants for the signal ts 1 fs Sample time N length bicep_raw Length of signal NFFT 24nextpow2 N fre fs 2 linspace 0 1 NFFT 2 1 frequency Determines the FFT for the bicep bicep_fft abs fft bicep_raw 1201 end 1 NFFT Plots the FFT figure subplot 41 1 plot fre bicep fft 1 length fre xlabel Frequency Hz ylabel Magnitude title FFT of Bicep Raw MVIC EMG Data Determines the FFT for the tricep tricep_fft abs fft tricep_raw 1201 end 1 NFFT Plots the FFT subplot 412 plot fre tricep_fft 1 length fre xlabel Frequency Hz ylabel Magnitude title FFT of Tricep Raw MVIC EMG Data Determines the FFT for the flexor flexor_fft abs fft flexor_raw 1201 end 1 NFFT subplot 413 Plots the FFT plot fre flexor_fft 1 length fre xlabel Frequency Hz ylabel Magnitude title FFT of Flexor Raw MVIC EMG Data Determines the FFT for the extensor extensor_fft abs fft extensor_raw 1201 end 1 NFFT subplot 414 Plots the FFT plot fre extensor_fft 1 length fre xlabel Frequency Hz ylabel Magnitude title FFT of Extensor Raw MVIC EMG Data 1
68. d 5 Intolerable and unable to verbally communicate because of pain 1 Did you experience any pain while scanning If so what level would you classify your pain as 012345 Where is your pain localized 129 Please place an X on the area s where you experienced pain while scanning 720044 ACKOMION PROCESS OF SCAPULA 7 CORACOID PROCESS Left NOG MEDIAL Side 3040400 EPICONDYLE LATERAL STYLOUD PROCESS OF RADIUS MEDIAL STYLOID PROCESS OF ULNA 1 Did you have preference of A or B transducer handle design If so which design do you prefer Why 2 Do you prefer scanning with your right or left hand Why Gloth F M Scheve A A Stober C V Chow S amp Prosser J 2001 The functional pain scale Reliability validity and responsiveness in an elderly population Journal of American Medical Directors Association 2 3 110 11 130 10 6 Volunteer Flyer Researchers Hannah Bullock OTS Chad Conroy OTS Lauren Vetter OTS Committee Chair Dr Jeanine Beasley EdD OTR CHT Research Volunteers Needed for Occupational Therapy Study Did you know that many sonographers experi ence pain in the hand and wrist due to ob taining ultrasound images Students in the Occupational Therapy Master s program at GVSU along with the Sonography Department are performing a master s thesis in attempt to combat this problem If you choose to participate
69. d in saturation of the electromyography signal in some instances If the sonographers continually moved their body backwards and forwards during scanning it would cause the shoulder to translate affecting the shoulder joint center calculations Furthermore the study was performed outside of the sonographers typical work environment in order to utilize the Vicon MX motion capture system As a result 63 the sonographers could have been working with unfamiliar equipment causing them to scan differently 64 8 Future Research This study provides a baseline of kinematic results for the dominant upper extremity of sonographers while they are scanning Further research could include joint analysis for the thorax wrist ulnar and radial deviation angles joint torques and using a fixture that would restrain the sonographer s arm during maximum voluntary isometric contraction readings Since one of the contributing factors to sonographer injuries is awkward posture that results in twisting the torso investigating movement about the thorax could quantify the amount of movement that contributes to injuries Further analysis of the wrist joint to determine ulnar and radial deviation could be used to determine if sonographers experience more movement about the wrist or the shoulder joint when they scan Determining the joint torques would help quantify the amount of loading in the upper extremity of sonographer while they scan Additionally
70. dical Sonography 298 305 Motion Lab Systems User Manual 2007 November 19 Retrieved February 7 2012 from Motion Lab Systems http www udel edu PT Research MLS_MA300_EMG_manual pdf Murphy C amp Russo A 2000 An Update on Ergonomic Issues in Sonography Employee Health and Safety Services 133 Pliance X System Manual 2011 February Retrieved 5 19 2011 from http www novelusa com assets pdf manuals plianceX_v20_final pdf Quanbury A Friesen M Friesen R amp Arpin S 2006 Musculoskeletal injuries among ultrasound sonographers in rural Manitoba A study of workplace ergonomics AAOHN Journal Official Journal of the American Association of Occupational Health Nurses 32 Roll S Baker J amp Evans K 2009 Work related musculoskeletal disorders WRMSD among registered diagnostic medical sonographers and vascular technologists A representative sample Journal of Diagnostic Medical Sonography 287 299 Russo A Murphy C Lessoway V amp Berkowitz J 2002 The prevalence of musculoskeletal symptoms among british columbia sonographers Applied Ergonomics 385 393 Schoenfeld A Goverman J Weiss D amp Meizner I 1999 Transducer user syndrome an occupational hazard of the ultrasonographer European Journal of Ultrasound 41 45 Sommer III H 1992 Determination of first and second order instant screw parameters from landmark trajectories ASME Journal of Mechanical Design
71. e 25 frame The Euler rotation sequence used in this study was YX Y which was recommended by the International Society of Biomechanics Wu et al 2005 This is the rotation of the reference frame about the y axis first the new x axis second and about the new y axis last The first rotation sequence is p about the y axis which results in the new reference frame x y z The second rotation sequence is about the new x axis which results in the new reference frame x y z The third rotation sequence is Y 999 about the new y axis which results in the final reference frame x y z Based on this sequence the Euler angles can be determined using the joint rotation matrix Rjoint cy 0 syin 0 01 cp 0 s Rjoint Ry Rx Ry 0 1 0 l ce so 0 1 0 22 sp 0 cy 1l0 s c llsp 0 co where Ry is the rotation matrix for the third rotation about the y axis Ry is the rotation matrix for the second rotation about the x axis Ry is the rotation matrix for the first rotation about the y axis c is the cosine function and s is sine function Winter 2009 Equation 22 can be expanded into Rjomt Rjointy Rjoint cpcy cOsysw sysO cysq cpcOsy Rjoint Rjoint Rjoint gt sqs ce cQs8 23 Rjoint 5 Rjoint 45 Rjoint 5 cosy cyc sp cys0 cepcwcd sosy Using equation 21 the Euler angles can be determined The second rotation angle is found wit
72. e in carpel tunnel pressure over 30 mmHg is undesired because it can cause detrimental affects to the median nerve In animal studies increasing carpel tunnel pressure from 30 to 50 mmHg over short durations can disrupt blood flow along the side of the median nerve Animal 11 and human studies have shown if carpel tunnel pressure ranges from 40 to 50 mmHg for 8 hours it can result in the complete blocking of nerve signals Hedge 1998 2 4 Basis for Further Research Areas of further research for studying work related musculoskeletal disorders could be examining muscle activity joint angles and joint torques for the entire upper extremity measuring how force is applied to the transducer and using motion capture to determine the joint angles The shoulder was the focus of previous investigations because most pain was experienced in the shoulder Examining the muscle activity in the entire upper extremity could demonstrate how the sonographer coordinates all upper extremity muscles to perform an ultrasound scan This could be used to establish the efficiency of the muscles by determining if excessive co contraction of the muscles is occurring Examining the joint angles in the upper extremity allows a baseline comparison of scanning techniques between sonographers 3 D motion capture could be used to determine the joint angles in the upper extremity with more accuracy than stop motion playback of a 2 D video Determining how force and pressure
73. e methods to determine the center of rotation for the shoulder joint In each of these studies one of the following methods was used linear regression Mesker van der Helm Rozendaal amp Rozing 1998 instantaneous helical axis method Veeger 2000 and sphere fit method Stokdijk Nagels amp Rozing 2000 Three virtual markers were placed on both the forearm and the upper arm to determine the joint centers relative to a local coordinate system anatomical reference frames and joint angles The hand marker locations were selected so that they could be used to calculate rotation about three axes at the wrist if desired The lower extremities had reflective markers placed on them for visualization purposes The markers that were selected for the clavicle scapula humerus and forearm matched the International Society of Biomechanics recommendations Wu et al 2005 The processus xiphodeus and suprasternal notch markers recommended for the thorax were not used The processus xiphodeus was not used because it is intrusive for female subjects and the attire worn by the sonographers could result in inaccurate representation of the location The suprasternal notch was not used because of its proximity to the sternoclavicular joint Additionally the sternoclavicular joint could be used to determine the sternoclavicular and acromioclavicular joint angles if desired If there is not adequate space between two 15 reflective markers the Vicon M
74. e other sonographers so she did not need to extend her elbow as much while scanning 6 3 Comparison of Wrist Joint Angles All of the sonographers experienced wrist extension Only sonographer 4 experienced wrist flexion when she scanned the patient s left kidney using the S5 1 60 transducer Wrist angles were not obtained for sonographer 2 during the scanning of the patient s left kidney for the same reason described above Sonographer 4 had greater extension angles when she scanned the patient s right kidney Sonographer 5 obtained larger extension angles and had a similar angle range when she scanned the patient s left kidney Sonographers 2 3 and 4 had large ranges of motion Acceptable wrist extension is between 0 and 15 degrees Hedge 1998 The average wrist angles for all of the scans were over 15 degrees except when sonographer 5 used the C5 1 transducer to scan the patient s right kidney which can be seen in Table 12 6 4 Comparison of Joint Angles to the Burnett Study The joint angles in the left kidney scans from this study were 1 8 degrees higher than the minimum shoulder abduction angle 12 8 degrees higher than the maximum shoulder abduction angle and 1 3 degrees higher than the maximum elbow flexion angle obtained in the left abdominal scans recorded by Burnett and Campbell Kyureghyan 2010 For the right kidney scans shoulder abduction was 0 4 degrees less than the minimum and 5 7 degrees less than the maxim
75. e the position of landmarks The Vicon MX motion capture system determines the position of landmarks with respect to a global reference frame The origin of the global reference frame was determined during the calibration process which is discussed in section 4 5 Procedure Local reference frames are fixed with respect to rotating and translating bodies and are used to describe the position of landmarks relative to body segments Local reference frames can be defined as technical reference frames or anatomical reference frames Local technical reference frames were determined for the thorax humerus and forearm using three non collinear landmarks on the same body segment The equations to determine the three axes defining a local technical reference frame are given below Axis1 14 x2 x4 22 where Axisl is a vector that points from x4 to x2 where x and x are landmarks on the same body segment Axis 1X X3 X1 Axis2 g Axis 1X X3 X1 15 where Axis2 is a vector that is perpendicular to the plane defined by x4 x2 and x3 where x is a landmark on the same body segment as x4 and x3 Axis3 Axis1 x Axis2 16 where Axis3 is a vector mutually perpendicular to Axisl and Axis2 The order of the cross products in Equations 15 and 16 is interchangeable depending on the desired direction of Axis2 and Axis3 Winter 2009 3 3 3 Rotation Matrices A global to local rotation matrix Ry can be used to determine the pos
76. ector elbow flex rads acos dot humerus vector forearm vector vector mag elbow_flex i elbow flex rads 180 pi end Wrist joint Determines what wrist marker is used to determine the marker vector if wrist_marker_option 1 wrist_marker VF1_D elseif wrist_marker_option 2 wrist_marker VF2_D elseif wrist_marker_option 3 wrist_marker VF3_D elseif wrist_marker_option 4 wrist_marker RSP_D end for i 1 r 89 V ector representing the long axis of the proximal body segment forearm_vector rd_global_wrist i 1 3 rd_global_elbow i 1 3 V ector representing the long axis of the distal body segment hand_vector hand D i 1 3 rd global wrist i 1 3 V ector that points lateral to medial about the wrist points from thumb to pinky vector norm zaxis cross hand vector forearm vector Vector that points from anterior to posterior at the wrist points from the palm to the top of the hand vector norm xaxis cross forearm vector vector norm zaxis Marker vector to check direction of vector norm xaxis marker vector wrist_marker i 1 3 rd global wrist i 1 3 9o The direction of vector norm zaxis determines if the wrist is in flexion or extension check dot marker vector vector norm xaxis if check 0 sign 1 else sign 1 end sign check i 1 sign vector mags norm hand vector norm forearm vector wrist flex rads sign acos dot hand vector forearm
77. ed based on availability 4 2 Sonographer Participation and Data Collection This study had five sonographers participate but complications with equipment prevented complete data collection for each participant Motion capture data was 31 collected for all five sonographers but the data collected for sonographer 1 was insufficient for kinematic analysis Electromyography was collected for sonographers 2 4 and 5 Force and pressure applied to the transducers was collected for sonographers 1 4 and 5 Sonographers 2 and 3 were sitting in a backless height adjustable swivel chair while they were scanning Sonographers 1 4 and 5 were standing while they were scanning All of the sonographers used the C5 1 and S5 1 ultrasound transducers to scan the patient s left and right kidney 4 3 Participant Demographics and Characteristics All five sonographers were female right hand dominant and had at least three years of experience in diagnostic medical sonography General sonography was the area of specialty for four of the sonographers The additional sonographer participating in this study specialized in obstetric abdominal and vascular sonography Pain had been experienced at some level either during scanning or as a result from scanning by four of the sonographers prior to the study Demographics and characteristics of the sonographers can be found in Table 5 The patient that was scanned by each of the sonographers was a 23 year old m
78. ers Internal shoulder rotation was only experienced by sonographers 2 and 4 The maximum shoulder internal rotation generated was 22 4 degrees and the maximum external rotation was 90 degrees The maximum and minimum ranges of motion for internal and external rotation were 66 3 and 12 6 degrees respectively These values can be found in Table 10 A normalized histogram of internal and external shoulder rotation for each scan is displayed in Figure 9 50 Table 10 Shoulder joint internal external rotation during scanning Shoulder Joint Angles Degrees Kidney pea ng Sonographer Transducer Duration Internal External Rotation Scan s Min Max Area Range of Motion C5 1 Left 57 9 66 4 42 3 53 1 24 1 Right 87 2 61 8 31 3 43 8 30 5 Left 57 1 66 5 50 2 60 2 16 3 PES Right 4715 299 69 2 5 36 8 Left 64 5 88 8 76 2 84 5 12 6 gt Right 104 0 47 5 27 3 38 8 20 2 i Left 93 8 90 0 76 1 83 7 13 8 RZ Right 157 9 60 7 36 4 46 7 24 3 Left 47 1 61 7 17 4 41 9 44 3 x gt Right 57 9 43 9 224 7 9 66 3 51 Left 42 8 74 0 26 3 53 5 47 71 Right 63 9 47 9 16 3 16 0 64 3 Left 79 4 59 2 33 1 47 71 26 1 s Right 95 7 42 5 10 3 19 4 32 2 Left 73 4 61 7 45 2 52 6 16 4 A Right 54 3 37 9 19 9 31 1 18 0 51 Sonographer 2 Sonographer 3
79. es she would in a clinical setting The sonographer was asked to save images of the scan on the Philips 1U22 ultrasound system so that the quality of the scans could be verified by a GVSU faculty member The sonographer indicated when she finished scanning and data collection was stopped The patient s abdomen was cleaned to remove any gel used by the sonographer The sonographer was instructed to maintain the same finger configuration on the transducer for the left kidney scan Researchers checked to 40 ensure that analog and marker data was collected by the Vicon Nexus software If there was a problem with data collection the scan was repeated The sonographer instructed the patient to lay on his right side facing the sonographer so that the ultrasound system would not have to be moved and the same process was repeated for the left kidney scan The sensor mat was removed from the C5 1 transducer and secured to a S5 1 transducer using micropore tape The C5 1 transducer was disconnected from the ultrasound system and the S5 1 transducer was connected A baseline zero measurement was taken of the sensor mat using the Pliance data collection software While the researchers were setting this up the sonographer was able to have a 15 to 30 minute recovery period After the recovery period the sonographer was asked to grip the S5 1 transducer in the configuration that she would use during scanning Then the same process to determine finger locatio
80. g IHA Humerus rhs_local_glen_IHA local_position Rhs_GtoL global_gleno_IHA VH1_S For the elbow joint center calculated using the difference between medial and lateral markers about the joint Humerus rhs_local_elbow_diff local position Rhs GtoL jc elbow global VH1_S For the wrist joint center calculated using the difference between medial and lateral markers about the joint Forearm rfs_local_wrist local_position Rfs_GtoL jc_wrist_global VFl_S Determines the dynamic technical reference frames Humerus j l for i 1 r Rhd_GtoL j 2 1 3 reference frame VH1 D 1 2 VH2 D 1 VH3 D 1 4 j j 3 end Determines the global position of the joint center using the technical reference frames from the dynamic trial creating nrx3 matrix Glenohumeral joint center 1IHA method j l for i 1 r rd_global_gleno_IHAG 1 3 global_position Rhd_GtoL j j 2 1 3 rhs local glen IHA VH1_D j j 3 end 87 Determines the global position of the joint center using the technical reference frames from the dynamic trial creating nrx3 matrix Elbow joint center j 1 for i 1 r rd global elbow i 1 3 global_position Rhd_GtoL j j 2 1 3 rhs_local_elbow_diff VH1 D i j j 3 end Determines the dynamic technical reference frames Forearm if forearm_frame_option 1 j l for i 1 r Rfd_GtoLG j 2 1 3 reference_frame rd_global_elbow i VF1_DQi VF2_DQ 4 j j 3 end
81. gested for current ultrasound equipment were enabling sonographers to maintain optimum joint angles balanced posture and allowing break durations similar to soft tissue recuperation time Vanderpool Friis Smith amp Harms 1993 The consequences of work related musculoskeletal injuries were absenteeism from work changing professions or hospitals paying for additional compensation and rehabilitation Wihlidal amp Kumar 1997 Brown amp Baker 2004 Working conditions that could decrease the severity of work related musculoskeletal injuries have been suggested to be using an adjustable workstation using a support cushion alternating scanning with left and right hand performing various scans wearing gloves that are textured to increase grip and taking small breaks whenever possible Jakes 2001 2 1 1 Qualitative Study Shortcomings Understanding the shortcomings of previous investigations can be useful in developing future studies with fewer limitations The shortcomings within the qualitative studies are ascertaining data from small demographical areas small sample sizes varying work environments varying scanning techniques varying scanning locations and targeting the qualitative studies at sonographers that suffer from work related musculoskeletal disorders A small demographical area limits a qualitative study because it focuses on techniques conditions and methods that are dominant in one location and might not be a true
82. gested to occur during prolonged static contractions at as little as 3 maximum voluntary contraction Muscle activity in all three shoulder muscles was above 3 maximum voluntary contraction for 90 of the scanning duration in this study Posture assessment was determined using stop motion playback on recorded video where an observer categorized shoulder abduction and outward rotation into 15 degree increments from 0 to 90 Blood flow in the supraspinatus is significantly impeded if abduction is over 30 degrees During 66 of the scan the shoulder was greater than 30 degrees The posture of a sonographer during scanning often can be described as awkward abduction and outward rotation of the shoulder Gripping force was determined by generating a calibration equation from the maximum grip force with a hand grip dynamometer and the electrical activity recorded by the electromyography electrodes on the flexor carpi ulnaris The average gripping force over the duration of scanning time was 4 kilograms The applied force to the transducer was 1 kilogram for 90 of the scanning time which indicates that the hand had little resting time In the study performed by Milkowski and Murphy 2006 surface electromyography was used to study activity in the supraspinatus and trapezius muscles for several different positions predetermined by the researchers The positions were verified using a goniometer prior to data collection Each position was maintained by the
83. graduate students Rick and Lynn Carlton and my family This project was funded under the National Science Foundation American Recovery and Reinvestment Act of 2009 ARRA Public Law 111 5 iii Abstract Due to the prevalence of work related musculoskeletal disorders in sonographers this study evaluated upper extremity kinematics and determined if co contraction was present during kidney scans The results provided a greater understanding of joint range of motion and muscular activity which could be helpful in assessing risk of injury Four sonographers had reflective markers and surface electromyography electrodes placed on their dominant upper extremity A Vicon MX motion capture system was used to record the marker positions and electromyography data while the sonographers were scanning a volunteer s kidneys The shoulder joint center was determined using the instantaneous helical axis method The wrist and elbow joint centers were determined by taking the difference between markers located medially and laterally about the joint Three shoulder angles flexion extension abduction adduction and interior exterior rotation one elbow angle flexion extension and one wrist angle flexion extension were determined by kinematics The results indicated that the sonographers were scanning with the shoulder in flexion abduction and external rotation The shoulder abduction was always greater than published acceptable limits The range of el
84. h 26 8 cos R 24 ons The first rotation angle can then be determined with R nm joint gy tan 22 02 25 cos o Rjoint g sin 8 The third rotation angle can be determined with R T joint p tan 57 E 26 sin8 In this study the first Euler angle p was used to describe shoulder flexion and extension The second Euler angle 0 describes shoulder abduction and adduction The third Euler angle Y describes shoulder internal and external rotation Shoulder flexion abduction and internal rotation occur when the Euler angles are positive 3 3 4 2 Dot Product The dot product was used to determine flexion and extension for the elbow The equation used to determine the flexion extension angles at the elbow is 98 cos 1 Vproximal Vdistal 27 Enroximal lVaistail 2 where Uoroximai 18 the vector representing the long axis of the proximal body segment and Vgistaj is the vector representing the long axis of the distal body segment The joint centers were used to create vectors in the proximal and distal body segments Elbow flexion occurs when 0 is positive The elbow will always be positive as a result of the neutral position selected for the elbow joint 3 3 4 3 Dot and Cross Products The dot and cross products were used to determine flexion and extension for the wrist The equation used to determine the flexion extension angles at the wrist is A sign
85. he upper arm humerus and forearm Body Segment Technical Reference Frame Upper Arm VH2 VH1 Xp X VH3 VH1 x 4 Z X X Humerus h wazvmap Y xp XIVH3 VH1 h h X Yn y IVF _ xf X VF3 VF1 SA chee A rav rar A xp XIVF3 VF1 fa fa f ae VF1 ejc _ Xf X VF2 ejc PY f wrFa ejc YT Xf XIVF2 ejcl fa a X Yh Forearm E VF1 ejc _ Xf X VF3 ejc EE f3 vF1 ejc Yr Xf X VF3 ejc f Xf ON fs VFi ejc xfa X RSP ejc L OLA oO Zr X x Xf WFi ejcj Yfa x x RSP ejcl fa Xf Y fa ejc is the elbow joint center in the global coordinate system The joint centers were established in the global coordinate system for every frame of data collection in order to determine the elbow and wrist joint angles and create anatomical reference frames The elbow and wrist joint angles were determined for every frame of data collection using equation 27 and 28 respectively To determine the upper arm vector the shoulder and the elbow joint centers were used To determine the forearm vector the elbow and wrist joint centers were used To determine the hand vector the wrist joint center and a marker on the hand were used The elbow joint angle was determined using the humerus and forearm vector The wrist joint angle was determined using the forearm and hand vector The neutral position for the wrist and elbow joint center is shown in Figure 5 A continuity test was applied to
86. heir thesis 4 5 Procedure Prior to the arrival of participants the Vicon MX motion capture system located in the biomechanics laboratory at GVSU Cook DeVos Center for Health Sciences building was calibrated and reflective locations in laboratory were masked The locations were masked using a built in function within the Vicon Nexus software Dynamic calibration of the capture field was obtained by continuously moving the calibration wand throughout the capture space until 1500 frames were detected by each Vicon T40 camera The Vicon Nexus software then determined the image error for each camera If the image error was less than 0 20 millimeters for each camera then the next step was static calibration Static calibration of the capture field was obtained by placing the calibration 36 wand on top of the south east corner of the first force plate to set the origin for the global coordinate system The default sampling frequencies were used for the reflective markers and surface electromyography 100 and 1200 Hertz respectively After the Vicon MX motion capture system was setup the MA300 multi channel EMG system was assembled with the exclusion of the surface electromyography electrodes Then reflective markers were prepared using two sided tape The sensor mat was calibrated before the study date using the trublu calibration device The trublu calibration device applies an equally distributed pressure to all of sensors located on the sensor ma
87. his study contained sonographer and patient participant groups The criterion for the sonographer participant group required at least three years of experience in the field of sonography This provided the study with conditioned sonographers that have adapted their techniques to accommodate the demands of their occupation Multiple sonographers were obtained for this study from the West Michigan region The criterion for the volunteer patient required a body mass index equal to or greater than 30 which is considered obese World Health Organization 2012 A patient within this body mass index range created a scenario in which the sonographers would likely need to provide a greater force to the transducer to obtain an acceptable ultrasound image than they would with patients that have lower body mass indices The patient characteristics needed to calculate body mass index were obtained using a tape measure and scale Body mass index was calculated by dividing weight in kilograms by the squared height in meters A single patient was used for this study to reduce variation The participant groups were recruited using fliers and personal connections to practicing sonographers Lynn Carlton an assistant professor at GVSU in the diagnostic medical sonography program contacted sonographers to participate in the study Fliers were posted on Grand Valley State University s GVSU Pew Campus to obtain a volunteer patient to be scanned Participants were select
88. idney 74 Figure N Sonographer 4 filtered forearm muscles pair electromyogram using a S5 1 transducer to scan the patients left kidney ueque A A vea t db K 74 Figure O Sonographer 4 filtered upper arm muscles pair electromyogram using a S5 1 transducer to scan the patient s right kidney eese 75 Figure P Sonographer 4 filtered forearm muscles pair electromyogram using a S5 1 transducer to scan the patient s right kidney seen 75 Figure Q Sonographer 5 filtered upper arm muscles pair electromyogram using a C5 1 transducer to scan the patient s left Kidney eee seen 76 Figure R Sonographer 5 filtered forearm muscles pair electromyogram using a C5 1 transducer to scan the patient s left kidney aa 76 Figure S Sonographer 5 filtered upper arm muscles pair electromyogram using a C5 1 transducer to scan the patient s right kidney ie da erred tn 77 Figure T Sonographer 5 filtered forearm muscles pair electromyogram using a C5 1 transducer to scan the patient s right kidney seen TI Figure U Sonographer 5 filtered upper arm muscles pair electromyogram using a S5 1 transducer to scan the patient s left KidNeY oooccncccnnccnoocnoonononcnannnona conocio no nocnnannnn cono en 78 Figure V Sonographer 5 filtered forearm muscles pair electromyogram using a S5 1 transducer to scan the patient s left kidney seen 78 XV Figure W Sonographer 5 filtered upper arm mus
89. igure I Sonographer 4 filtered upper arm muscles pair electromyogram using a C5 1 transducer to scan the patient s left kidney Filtered Flexor Carpi Ulnaris Electromyogram T T T T o a Amplitude V l 1 l 0 5 10 15 20 25 30 35 40 45 50 Time s Filtered Extensor Carpi Ulnaris Electromyogram 0 5 T T T T Dim 5 10 15 20 25 30 35 40 45 50 Time s Figure J Sonographer 4 filtered forearm muscles pair electromyogram using a C5 1 transducer to scan the patient s left kidney 12 Filtered Biceps Brachii Electromyogram 0 1 gt o no g E s r E 10 20 30 40 50 60 Time s Filtered Triceps Brachii Electromyogram 0 2 1 o ko 2 a E lt n 2 10 20 30 40 50 60 Time s Figure K Sonographer 4 filtered upper arm muscles pair electromyogram using a C5 1 transducer to scan the patient s right kidney Filtered Flexor Carpi Ulnaris Electromyogram o E lt x El L l 1 l l 3 10 20 30 40 50 60 Time s Filtered Extensor Carpi Ulnaris Electromyogram o o a E lt 0 5 L 1 1 0 10 20 30 40 50 60 Time s Figure L Sonographer 4 filtered forearm muscles pair electromyogram using a C5 1 transducer to scan the patient s right kidney 73 Filtered Biceps Brachii Electromyogram 0 1 T T T gt o oO g E 0 1 l l 1 l l l 1 l 0 5 10 15 20 25 30 35 40 45 Time s Filtered Triceps Brachii Electromyogram 0 1 T 1 T
90. iltered Flexor Carpi Ulnaris Electromyogram fontsize 24 subplot 2 1 2 plot time filtered_data 4 r xlabel Time s fontsize 24 ylabel Amplitude V fontsize 24 title Filtered Extensor Carpi Ulnaris Electromyogram fontsize 24 114 10 2 5 2 Electromyography Filtering function emg_bandpass emg_filtered fs raw_emgdata This function filters the EMG data using a notch filter and passband filter Removes leading zeros from the data which are the first 1200 points emg data raw_emgdata fs 1 end Determines the DC offset of the EMG output the DC offset is the difference of the mean from zero emg dc offset mean emg_data Accounts for the DC offset in the EMG output the mean is subtracted from the original data emg_dc_adjust 1 emg_data 1 emg dc offset 1 1 emg_dc_adjust 2 emg_data 2 emg_dc_offset 1 2 emg_dc_adjust 3 emg_data 3 emg dc offset 1 3 emg_dc_adjust 4 emg_data 4 emg_dc_offset 1 4 Full wave rectification absolute value of EMG output emg_fwr abs emg_dc_adjust Applys a notch filter at 60 Hz wo 60 600 bw wo 35 b a iirnotch wo bw notch_filtered filtfilt b a emg_fwr Apply a passband filter with a 20Hz lower bound cutoff and 300Hz upper bound cutoff we 20 600 300 600 a l b firl 8 we bandpass emg_bandpass filtfilt b a notch_filtered 115 10 2 5 3 Fast Fourier Transform of Raw Ele
91. ily experienced in the shoulders neck wrist back and hands as identified by several authors and is illustrated in Figure 1 Jakes 2001 Swinker amp Randall 2003 Murphy amp Russo 2000 The figure identifies the general area of discomfort rather than the specific muscles strained Eyes 45 Neck 74 PN Ww Shoulder 76 Upper Back 58 A E i Upper Arm 3896 Middle Back 3346 Lower Back 5896 E 4 Forearm 31 Hip 25 li p V Wrist 59 Z4 4 y A Tp M Hand Fingers 55 Upper Leg 7 Knee 17 Lower Leg 12 Ankle Foot 20 Posterior View Figure 1 Anatomical locations of discomfort experienced by sonographers Russo Murphy Lessoway amp Berkowitz 2002 1 1 Scope of the Study Due to the prevalence of work related musculoskeletal disorders in sonographers this study evaluated upper extremity kinematics and determined if co contraction was present in upper extremity muscle pairs during kidney scanning There were three scanning factors used in this study left and right kidney scans two different ultrasound transducer designs and two different scanning positions Sonographers upper extremity movements and muscular activity were recorded using a Vicon MX motion capture system The kinematics investigated in this study were shoulder elbow and wrist joint angles The results were compared 1 for each joint angle to determine if there was a trend present as a result of the scanning facto
92. ime s Filtered Extensor Carpi Ulnaris Electromyogram Amplitude V o c a di 10 20 30 40 50 60 Time s Figure X Sonographer 5 filtered forearm muscles pair electromyogram using a S5 1 transducer to scan the patient s right kidney 79 10 2 Matlab Code 10 2 1 Kinematic Evaluating Program This program determines the joint angles for the wrist elbow and shoulder joints Constant Fs 100 sampling frequency Fe 15 6 cutoff frequency Loads the raw marker data from the sonography research study Subject is subject 3 in thesis P1 lt Ik markers importdata P1 It Ik markers CS V P1 It rk markers importdata P1 lt rk markers CSV P1 st Ik markers importdata Pl st Ik markers CSV P1 st rk markers importdata Pl st rk markers CS V 7b Subject 2 P2 lt Ik markers importdata P2 It Ik markers CS V5 P2 lt rk markers importdata P2 lt rk markers CSV P2 st Ik markers importdata P2 st Ik markers CSV P2 st rk markers importdata P2 st rk markers CSV 7b Subject 4 PA lt Ik markers importdata P4 t Ik markers CS V5 P4 It rk markers importdata P4 lt rk markers CSV P4 st Ik markers importdata P4 st Ik markers CSV P4 st rk markers importdata P4 st rk markers CSV Subject 5 P5 It Ik markers importdata P5 It Ik markers CS V P5 It rk markers importdata P5 lt rk markers CS V P5 st Ik markers importdata P5 st Ik markers CSV P5 st rk marker
93. ion Y axis Determines the Euler angle for psi in radians psi rad atan R joint 1 2 sin theta rad R joint 3 2 sin theta rad Converts the angles to degrees phi phi rad 180 pi theta theta rad 180 pi psi psi rad 180 pi 10 2 3 18 Histogram function n xoutput scan_hist data This function determines the x and y axis for the histograms for i 1 5 n 1 xoutput i hist data i end 112 10 2 4 Electromyography Evaluating Program This program filters all of the raw emg data and plots the electromyograms fs 1200 sampling frequency loc bicep 21 column location of the bicep emg data loc tricep 2 column location of the tricep emg data loc flexor 23 96column location of the flexor emg data loc_extensor 4 column location of the tricep emg data Loads the raw EMG data files from the sonography research study Subject 1 load P1 lt Ik emg CSV load P1 lt rk emg CSV load P1 st Ik emg CSV load P1 st rk emg CSV Subject 4 load P4_lt_Ik_emg CSV load P4 lt rk emg CSV load P4 st Ik emg CSV load P4 st rk emg CSV Subject 5 load P5 lt Ik emg CSV load P5 lt rk emg CSV load P5 st Ik emg CSV load P5 st rk emg CSV Plots filtered emg Subject 1 P1_It_lk_emg_filtered emg_filt_plot fs Pl It Ik emg Pl lt rk emg filtered emg filt plot fs Pl lt rk emg Pl st Ik emg filtered emg filt plot fs Pl st Ik emg Pl st rk emg filtered emg filt plot fs Pl
94. ition of a landmark with respect to a global reference frame if the position of the landmark in a local reference frame is known The opposite transformation can be performed with the corresponding local to global rotation matrix Rg which is simply the transpose of the global to local rotation matrix Reyr Rije 17 23 Global to local rotation matrices are defined using the local reference frame axes The global to local rotation matrix can be determined using the following matrix Axis1 Axisl Axis1 Rije Axis2 Axis2 Axis2 18 Axis3 Axis3 Axis3 where Axisl Axis2 and Axis3 are the three axes defining the local reference frame In this example the axes are in the sequence 123 but five additional sequences can be defined by rearranging the order of the three axes in the global to local rotation matrix The position of a landmark expressed with respect to a global reference frame can be defined in a local reference frame using the following equation r T RL G T c RL G lc 19 where r is the position of the landmark in the local reference frame r is the position of the landmark in the global reference frame and 75 is the position of the origin of the local reference frame expressed with respect to the global reference frame The position of a landmark expressed with respect to a local reference frame can be defined with respect to the global reference frame using the equation below Ple Ryc
95. kon G RA A 80 10 2 2 Kinematic Main Progra misc cit A SER e rut dads Mdb E S cuius Woes 86 viii 10 2 3 Kinematic Sub proBrams eoa d Lo Asa 92 10 2 3 1 Marker Separation asica ia AL 92 10 23 2 Market Separation Stall A AO 95 10 2 3 3 Marker Separation Dynamic oot e ete AE OG 97 10 2 3 4 Power Spectral Density Analysis eene 99 10 2 3 5 FUE ad A ii 100 10 2 3 6 Instantaneous Helical Axis Pivot Point 101 10 2 3 7 Linear Velocity uds veo or toos ris o tase ta 103 10238 Emear Acceleration iia oe 104 10 2 3 9 Instantaneous Helical Axis Position eene 105 TZ 10 Skew S A NO auod id EE Ee ES fink ceed Seu em PUE EM CE ee doe 108 10 2 3 11 Interpolated Joint Center cies e ia 108 TOD Sul Reference Frame e ee eee 109 10 23 13 Reterenes Frame Humerus adi O AA d e na aoe 110 LOL 3 1A lO Dal Positi n noii oa eiie o ue fS Zo magis 111 10 2 3 15 Local POSIBOD s R AA A RS aout 111 10 23 16 Euler Sequences nier aid a ay 111 LO STI XXY Ber SEQUENCE ud 112 T0253 L5 USO Milo ti 112 10 2 4 Electromyography Evaluating Program eene 113 10 2 5 Electromyography Sub programs eese nene 114 10 2 5 1 Electromyography Filtered Data Plots sese 114 10 2 5 2 Electromyography Filtering eee O idiota 115 1X 10 2 5 3 Fast Fourier Transform of Raw Electromyography Data 116 10 3 Occ
96. l motion static muscle load mechanical stress and awkward posture Yassi 1997 Working conditions that contribute to work related musculoskeletal disorders are scanning durations over 45 minutes insufficient breaks between patients and nonadjustable equipment Yassi 1997 Swinker amp Randall 2003 Roll Baker amp Evans 2009 In 1997 81 of sonographers reported scanning in pain by 2009 the percentage had increased to 90 Roll Baker amp Evans 2009 Advancements in ultrasound equipment have been attributed to an increase in sonographers reporting pain because ultrasound image processing time has decreased This has resulted in shorter durations between patients and an increase in the number of patients scanned per day Schoenfeld Goverman Weiss amp Meizner 1999 The persistence of pain has resulted in 20 of sonographers prematurely retiring or leaving the profession Brown amp Baker 2004 Current treatments for many musculoskeletal disorders are anti inflammatory drugs physical therapy and occupational therapy Roll Baker amp Evans 2009 Research on work related musculoskeletal disorders in sonographers has consisted of qualitative and quantitative studies For this thesis qualitative will refer to survey studies while quantitative will refer to kinematic studies Quantitative studies have been localized to a small demographic area or had limited sample sizes Roll Baker amp Evans 2009 The quantitative
97. lexor Carpi Ulnaris Electromyogram 2 gt o go E lt 1 10 20 30 40 50 60 Time s Filtered Extensor Carpi Ulnaris Electromyogram ko 3 z E n 2 10 20 30 40 50 60 Time s Figure B Sonographer 2 filtered forearm muscles pair electromyogram using a C5 1 transducer to scan the patient s left kidney 68 Filtered Biceps Brachii Electromyogram T o un i Amplitude V eo 1 l L l L l 20 40 60 80 100 120 140 Time s Filtered Triceps Brachii Electromyogram T o c o a Amplitude V D 20 40 60 80 100 120 140 Time s Figure C Sonographer 2 filtered upper arm muscles pair electromyogram using a C5 1 transducer to scan the patient s right kidney Filtered Flexor Carpi Ulnaris Electromyogram 2 T T T o o E lt L 1 l L L 1 5 20 40 60 80 100 120 140 Time s Filtered Extensor Carpi Ulnaris Electromyogram 0 5 gt o o 2 a E c 0 5 l i l 1 1 i 0 20 40 60 80 100 120 140 Time s Figure D Sonographer 2 filtered forearm muscles pair electromyogram using a C5 1 transducer to scan the patient s right kidney 69 Filtered Biceps Brachii Electromyogram E o 0 5 no Z a 0 E lt x i T 10 20 30 40 50 60 Time s Filtered Triceps Brachii Electromyogram 1 w 0 5 o 2 a 0 E 2 10 20 30 40 50 60 Time s Figure E Sonographer 2 filtered upper arm muscles pair electromyogram
98. lts of this research study or if you have any questions after the study you may request that information by contacting Dr Jeanine Beasley at beasleyj gvsu edu or 616 331 3117 12 Payment There will be no payment for participation in the research 13 Agreement To Participate By signing this consent form below you are stating the following e The details of this research study have been explained to me including what I am being asked to do and the anticipated risks and benefits e have had an opportunity to have my questions answered e am voluntarily agreeing to participate in the research as described on this form e may ask more questions or quit participating at any time without penalty Initial here I have been given a copy of this document for my records Print Name Sign Name in ink Date Signed Email Phone If you have any questions about your rights as a research participant please contact the Research Protections Office at Grand Valley State University Grand Rapids MI Phone 616 331 3197 e mail HRRC GVSU EDU 121 O GRAND VALLEY STATE UNIVERSITY www gvsu edu Participant Consent Form Dear Volunteer You are invited to participate in an occupational therapy research study Your participation in this study is completely voluntary This study has been approved by the Human Research Review Committee at GVSU Please read the information below and ask questions ab
99. m Pressure kPa Left Kidney Right Kidney Sonographer C5 1 Transducer S5 1 Transducer C5 1 Transducer S5 1 Transducer Full Thumb Full Thumb Full Thumb Full Thumb 1 88 33 88 33 126 67 126 67 121 67 121 67 150 150 4 190 190 130 130 175 175 165 165 140 140 16 67 68 33 181 67 181 67 106 67 106 67 Table E Maximum force exerted by the thumb and on the entire sensor mat Maximum Force N Left Kidney Right Kidney Sonographer C5 1 Transducer S5 1 Transducer C5 1 Transducer S5 1 Transducer Full Thumb Full Thumb Full Thumb Full Thumb 1 62 67 25 83 81 17 17 52 67 20 67 65 67 17 4 89 83 38 100 33 31 67 115 5 44 5 127 67 38 88 83 23 5 74 5 14 83 86 67 30 67 84 19 33 118 10 4 Participant Consent Forms O GRANDWVILEY STATE UNIVERSITY www gvsu edu Participant Consent Form Dear Sonographer You are invited to participate in an occupational therapy research study Your participation in this study is completely voluntary This study has been approved by the Human Research Review Committee at GVSU Please read the information below and ask questions about anything you don t understand You are free to decide not to participate in this study at any time 1 Title of Study Hand Grip Pressures Between Various Transducers And The Related Perception Of Pain Experienced By Sonographers 2 Researchers Hannah Bullock OTS Chad Conroy OTS Lauren Vetter O
100. markers P5 IHA landmarks P5 IHA start P5 It Ik rows P5 forearm frame option P5 wrist marker Large transducer right kidney scan P5 It rk angle ranges P5 lt rk angles P5 lt rk joint centers upper extremity joint angles Fs Fc P5 It Ik markers 1 P5 It rk markers P5 IHA landmarks P5 IHA start P5 It rk rows P5 forearm frame option P5 wrist marker Small transducer left kidney scan P5 st Ik angle ranges P5 st Ik angles P5 st lk joint centers upper extremity joint angles Fs Fc P5 It Ik markers 1 P5 st Ik markers P5 IHA landmarks P5 IHA start P5 st Ik rows P5 forearm frame option P5 wrist marker Small transducer right kidney scan P5_st_rk_angle_ranges P5 st rk angles P5_st_rk_joint_centers upper extremity joint angles Fs Fc P5 It Ik markers 1 P5 st rk markers P5 IHA landmarks P5 IHA start P5 st rk rows P5 forearm frame option P5 wrist marker Determines the x and y axes for the joint angle histograms Zo Subject 1 is subject 3 in thesis Pl lt Ik n P1 It Ik xoutput scan hist P1 lt Ik angles 83 P1 It rk n P1 lt rk xoutput scan_hist P1_It_rk_angles P1 st Ik n Pl st Ik xoutput scan hist Pl st Ik angles Pl st rk nPl st rk xoutput scan hist Pl st rk angles Subject 2 P2 lt Ik n P2 It Ik xoutput scan_hist P2_lt_1k_angles P2 lt rk n P2 lt rk xoutput scan hist P2 1t rk angles
101. n was repeated The sonographer patient and researchers repeated the same process for scanning the right and left kidney of the patient with the S5 1 transducer as they did for the C5 1 transducer When the sonographer finished scanning all of the instrumentation was removed from her skin and she filled out a post scan questionnaire 4 6 Motion Capture Data Analysis A power spectral density analysis was performed to determine the cutoff frequency for the landmarks The analysis was performed on data collections that had all landmark positions available throughout the scan The power spectral density analysis determines the power distribution of a signal over frequency The cutoff frequency was determined as the frequency in which 99 percent of the power was contained below 41 Winter 2009 The cutoff frequencies were obtained for all of the landmarks in every component These cutoff frequencies were then averaged to obtain the cutoff frequency for the entire motion capture data collected which was 15 6 Hertz A 4 order low pass zero phase lag Butterworth filter with a cutoff frequency at 15 6 Hertz was then applied to smooth the data and remove high frequency noise Kinematic analysis was then performed on the data to determine the joint angles The joint centers were determined in the global coordinate system The shoulder joint center was determined by finding the optimal pivot point using at least three landmarks on the scapula refere
102. nce equation 10 The elbow and wrist joint centers were determined in the global coordinate system for a static frame using equation 13 Technical reference frames were then determined for the upper arm and forearm using the static frame see equations 14 through 18 The positions of the shoulder and elbow joint centers with respect to the static technical reference frame were calculated reference equation 19 The position of the wrist joint center was determined with respect to the local technical reference frame for the forearm Upper arm and forearm dynamic technical reference frames were determined for each frame of data collection while the sonographers were scanning The dynamic reference frame systems use the same landmark locations and axial orientations as the static technical reference frames The dynamic technical reference frame for the upper arm was used to determine the global positions of the shoulder and elbow joint centers in every frame of data collection reference equation 20 The dynamic technical reference frame for the forearm was used to determine the global positions of the wrist joint center The technical reference frames developed are shown in Table 6 reference Table 4 in section 3 2 Landmark Selection for 42 nomenclature The technical reference frames for the forearm varied because of the availability of visible markers on the forearm during each data collection Table 6 Technical reference frames for t
103. ng scanning Wrist Joint Angles Degrees Kidney AM ng 3 Sonographer Transducer Duration Flexion Extension Scan s nerd Wiese ever Range of Motion ge C5 1 Left 57 9 NA NA NA NA Right 87 2 59 7 1 4 31 4 58 3 Left 57 1 NA NA NA NA m Right 47 5 43 0 6 1 21 3 36 8 C5 1 Left 64 5 63 9 12 7 49 5 51 2 Right 104 0 53 6 3 7 25 9 49 9 Left 93 8 35 5 10 4 19 9 25 1 nos Right 157 9 56 9 15 6 383 41 3 C5 1 Left 47 1 55 3 12 0 40 7 43 3 4 Right 57 9 63 0 19 8 35 6 43 2 85 1 Left 42 8 38 5 8 8 22 9 47 3 Right 63 9 70 4 43 2 56 5 27 2 Left 79 4 47 7 21 8 35 1 25 8 Kd Right 95 7 30 4 1 7 10 8 28 7 gt Left 73 4 43 1 22 6 33 3 20 5 gt Right 54 3 34 3 9 8 15 6 24 5 55 e Sonographer 2 e Sonographer 3 4 i 1 o o Z c c 2 E 5 0 5 0 5 Oo A o E 0 LAANA n E 0 A 2 E 2 60 40 20 0 2 60 40 20 0 Angle Degrees Angle Degrees e Sonographer 4 e Sonographer 5 E 4 1 o o 3 c c o 5 0 5 5 0 5 i i Pd E em PN so 30 40 20 0 5 0 60 40 20 0 Angle Degrees Angle Degrees C5 1 Transducer Left Kidney S5 1 Transducer Left Kidney C5 1 Transducer Right Kidney S5 1 Transducer Right Kidney Figure 11 Normalized histogram of wrist joint extension during scanning 5 4
104. nt s right kidney uie eins 69 Figure E Sonographer 2 filtered upper arm muscles pair electromyogram using a S5 1 transducer to scan the patient s left kidney 70 Figure F Sonographer 2 filtered forearm muscles pair electromyogram using a S5 1 transducer to scan the patient s left KidNeY ooooonocccnnccncocnnonanoncnoncnonnononoconcnnnc crac ccoo across 70 Figure G Sonographer 2 filtered upper arm muscles pair electromyogram using a S5 1 transducer to scan the patient s right kidney seeeeeeeeeeeenee 71 Figure H Sonographer 2 filtered forearm muscles pair electromyogram using a S5 1 transducer to scan the patient s right kidney e seeeeo eee aaa aaa aaa aaa aaa enia ach 71 Figure I Sonographer 4 filtered upper arm muscles pair electromyogram using a C5 1 transducer to scan the patient s left kidney 12 Figure J Sonographer 4 filtered forearm muscles pair electromyogram using a C5 1 transducer to scan the patient s left kidney sess 12 Figure K Sonographer 4 filtered upper arm muscles pair electromyogram using a C5 1 transducer to scan the patient s right kKidmey eee eeeeeceeeeeceeeeeceeeeeceeeeeeseeeseeeeeeteeeees 73 xiv Figure L Sonographer 4 filtered forearm muscles pair electromyogram using a C5 1 transducer to scan the patient STOOL kn 73 Figure M Sonographer 4 filtered upper arm muscles pair electromyogram using a S5 1 transducer to scan the patient s left k
105. offset is the subtraction of the mean voltage 45 for the electromyography data from every data point collected Full wave rectification is taking the absolute value of the electromyography data after the DC offset has been removed Sonographer 5 C5 1 transducer left kidney Fast Fourier transform of raw maximum voluntary isometric contraction electromyography data for the extensor carpi ulnaris 2000 1500 Magnitude o e 500 A AA laannan Q 350 400 0 50 100 150 200 250 300 Frequency Hz Figure 6 FFT of electromyogram used to determine upper and lower cutoff bounds 46 5 Results 5 1 Shoulder Joint Angles During scanning all of the sonographers experienced shoulder flexion Additionally sonographer 5 experienced shoulder extension Maximum shoulder flexion and extension was 91 2 and 12 5 degrees respectively The maximum and minimum ranges of motion during a given scan were 60 9 and 16 degrees which are shown in Table 8 A normalized histogram of shoulder flexion and extension for each scan is displayed in Figure 7 Table 8 Shoulder joint flexion extension during scanning Scanning Shoulder Joint Angles Degrees Sonographer Transducer RY Duration Flexion Extension Scan s Mi as venas Range of Motion C5 1 Left 57 9 29 2 90 0 36 8 60 9 Right 87 2 35 0 91 2 51 2 56 2 gt 95 1 Left 57 1 40 9 8
106. on abduction and external rotation with their elbows in flexion and with their wrists in extension for the majority of their scanning procedures Shoulder abduction was always greater than published acceptable limits Wrist extension exceeded published acceptable limits during all of the scans The shoulder and elbow joint angles determined for this study were similar to the angles determined by other researchers in a previous study Although there were some trends observed within single joint movement by the different scanning factors within this study none of the factors had a significant impact on the entire movement of the upper extremity The electromyograms indicated that the agonistic muscle in the upper arm and forearm generated electrical voltage simultaneously with the antagonistic muscle in the pair at multiple instances during the 66 scans indicating co contraction was occurring These results could be used to improve transducer design which could minimize the risk of musculoskeletal work related disorders in sonographers 67 10 Appendices 10 1 Electromyograms Filtered Biceps Brachii Electromyogram o N Amplitude V 10 20 30 40 50 60 Time s Filtered Triceps Brachii Electromyogram gt w 0 5 ko 2 a o E lt 2 10 20 30 40 50 60 Time s Figure A Sonographer 2 filtered upper arm muscles pair electromyogram using a C5 1 transducer to scan the patient s left kidney Filtered F
107. osition of the shoulder is shown in Figure 5 Table 7 Anatomical reference frames for the thorax and humerus Body Segment Anatomical Reference Frame sjchejc yn X ELH ejc Zp Xx X Humerus Yn sjchejc h yn XIELH ejc h h X Yn C7 T8 yt X SJ T8 Cz XZ Thorax t C7 T8 Zt Yt X SJ T8 t Yt t ejc and sjc are the elbow and shoulder joint centers in the global coordinate system 4 7 Electromyography Data Analysis A fast Fourier transform was applied to the electromyograms to determine the cutoff frequencies for the band pass zero phase lag filter The upper and lower bound cutoff frequencies selected were 20 Hertz and 300 Hertz respectively These are typical cutoff frequencies for surface electromyography Cram Kasman amp Holtz 1998 Nearly all of the power within the signal is contained within the typical boundaries as shown in Figure 6 The lower bound cutoff removes electrical noise from wires swaying and biological artifacts The upper bound cutoff removes tissue noise at the electrode site A notch filter was applied to the electromyograms to remove the spike generated at 60 Hertz from electrical noise from the environment Cram Kasman amp Holtz 1998 The data was smoothed and high and low frequency noise was reduced by removing the DC offset applying a full wave rectification applying a notch filter at 60 Hertz and applying the band pass zero phase lag filter The DC
108. out anything you don t understand You are free to decide not to participate in this study at any time 1 Title of Study Hand Grip Pressures Between Various Transducers And The Related Perception Of Pain Experienced By Sonographers 2 Researchers Hannah Bullock OTS Chad Conroy OTS Lauren Vetter OTS Committee Chair Dr Jeanine Beasley EdD OTR CHT 3 Purpose of Study One purpose of this study is to determine if the design of an ultrasound transducer affects the amount of pressure exerted by sonographers to achieve a quality scan An additional purpose of this study would be examining the possibility of repetitive strain injuries resulting from awkward posture repetitive movement and griping force The study will also examine if the amount of pressure exerted by the sonographer correlates with any possible subjective level pain as reported by the sonographer This is not a medical procedure This is not intended diagnose or treat any medical problem 4 How Participants Were Selected You were selected due to personal relationships between the researchers and members of the advisory committee and a public notice advisory flyer 122 10 Procedure Of Study e The study will take place in Cook DeVos Center for Health Sciences 4 Floor Sonography Room in Grand Rapids MI e You will be weighed using a scale and your height will be measured using a tape measure Your body mass index will be calculated using these numbers
109. r velocity vector 20 After the location of a point on the instantaneous helical axis was determined for multiple capture frames the optimal pivot point or in this instance the center of rotation p i Was determined using the following equation Popt 7 2X1 E mnl E 1U nin Bi 10 where I is the identity matrix n is the unit direction vector at i and pj is the location of a point on the instantaneous helical axis at i Woltring 1990 The unit direction vector nj when the angular velocities of the landmarks are not equal to zero was determined using the following equation n 1 In the special case of pure translation the unit direction vector was determined using the following equation Sommer III 1992 Vo LE 12 3 3 1 2 Difference between Medial and Lateral Landmarks The elbow and wrist joint centers on the scanning arm of the sonographer were determined by finding the midpoint between the reflective markers on the bony landmarks located medially and laterally from the joint center This is a known and 21 accepted method used to determine hinge joints within the body The following equation was used to determine the global position of the joint centers xj Eig mA x 13 where Xm is the global position of the medial marker and x is the global position of the lateral marker 3 3 2 Reference Frames Reference frames are the global or local coordinate systems which are used to describ
110. rom http apps who int bmi index jsp introPage intro_3 html Wu G van der Helm F Veeger H Makhsous M Van Roy P Anglin C Buchholz B 2005 ISB recommendation on definitions of joint coordinate 135 systems of various joints for the reporting of human joint motion Part II shoulder elbow wrist and hand Journal of Biomechanics 981 992 Yassi A 1997 Repetitive strain injuries The Lancet 943 947 136
111. rs 2 for shoulder abduction adduction and wrist flexion extension to acceptable published limits and 3 to results published in a previous study by Burnett and Campbell Kyureghyan 2010 Co contraction of muscles pairs in the forearm and upper arm was investigated because it is a risk factor for repetitive strain injury Malmivaara van Tulder amp Koes 2007 This study was performed as a joint collaboration with occupational therapy graduate students at Grand Valley State University In their thesis they analyzed the pressure exerted on the handle of the two different ultrasound transducer designs to determine if transducer design caused a significant change in the amount of pressure that was applied by the sonographers during scanning Bullock Conroy amp Vetter 2011 Additionally they used a questionnaire to quantify the amount of pain experienced after scanning The Novel Pliance X system was used to collect the pressure exerted by the hand on the pressure sensor mat wrapped around the transducer This data was used to determine if there was a difference in the amount of pressure applied to the transducers In their results they concluded that the smaller S5 1 transducer had increased average pressure and force exerted on it in comparison to the larger C5 1 transducer The average pressure and force applied to the different transducers is shown in Table 1 Additional data from their study can be found in Appendix 10 3 Table 1 Maximum
112. s importdata P5 st rk markers CS V Constants Subject 1 is sonographer 2 in thesis angle_ranges angles joint_centers P1 It Ik rows P1 lt Ik columns size P1 lt Ik markers P1 lt rk rows P1 lt rk columns size P1 lt rk markers P1 st Ik rows Pl st Ik columns size P1 st Ik markers Pl st rk rows P1 st rk columns size P1 st rk markers P1 IHA landmarks 5 P1 It rk IHA landmarks 4 P1 It Ik IHA landmarks 4 P1 IHA start 1 PI It Ik forearm 1 Pl It rk forearm 1 P1_st_Ik_forearm 3 PI_st_rk_forearm 4 80 P1 st Ik wrist marker 4 P1 wrist marker 2 Subject 2 is sonographer 3 in thesis angle ranges angles joint centers P2 lt Ik rows P2 lt Ik columns size P2 lt Ik markers P2 lt rk rows P2 lt rk columns size P2 lt rk markers P2 st Ik rows P2 st Ik columns size P2 st Ik markers P2 st rk rows P2 st rk columns size P2 st rk markers P2 IHA landmarks 3 P2 lt Ik IHA start 1 P2 lt rk IHA start 1 P2 st Ik IHA start 2151 P2 st rk IHA start 1 P2 It Ik IHA end 5710 P2 It rk IHA end 6122 P2 st Ik IHA end 9379 P2 st rk IHA end 7337 P2 It Ik forearm 1 P2 lt rk forearm 2 P2 st Ik forearm 4 P2 st rk forearm 2 P2 wrist marker 3 Subject 4 P4_It_Ik_rows P4_It_Ik_columns P4_It_rk_rows P4_It rk columns P4 st Ik rows P4 st Ik columns P4 st rk rows P4 st rk columns size PA l
113. s to determine joint angles and surface EMGs will be placed on the arms to record muscle activity e Each scan should not exceed 5 10 minutes The entire data collection process should not exceed 3 hours e There are no out of pocket costs to you for participation in this study Risks and Benefits e There is no direct benefit of your participation in this study However the information obtained may benefit sonographers in the future e We feel this study involves minimal risk You may experience physical upper extremity pain fatigue from scanning fatigue from standing during the scanning procedures and anxiety from being watched Compensation for Harm If you are harmed from participating in this research emergency first aid will be provided to you and you will be referred to an appropriate medical care center Any costs for additional medical care that may be required are your responsibility and that of your medical insurance company Voluntary Participation Your participation in this research study is completely voluntary You do not have to participate You may quit at any time without any penalty to you Privacy and Confidentiality Your name will not be given to anyone other than the research team All the information collected from you or about you will be kept confidential and filed in a locked cabinet in the Occupational Therapy Department Research file 120 11 Research Study Results If you wish to learn about the resu
114. sition of the upper extremities ss 44 Figure 6 FFT of electromyogram used to determine upper and lower cutoff bounds 46 Figure 7 Normalized histogram of shoulder joint flexion extension during scanning 48 Figure 8 Normalized histogram of shoulder joint abduction during scanning 50 Figure 9 Normalized histogram of shoulder joint internal external rotation during Te irj o ssa T BUR NR O eM RE 52 Figure 10 Normalized histogram of elbow joint flexion during scanning 54 Figure 11 Normalized histogram of wrist joint extension during scanning 56 Figure 12 Upper arm electromyograms from sonographer 5 scanning the left kidney of the patient using the C5 1 AOS UC 58 Figure 13 Forearm electromyograms from sonographer 5 scanning the left kidney of the patient Using the 9 1 trans UE a add 58 xiii Appendices Figure A Sonographer 2 filtered upper arm muscles pair electromyogram using a C5 1 transducer to scan the patient s left kidney ad AREA 68 Figure B Sonographer 2 filtered forearm muscles pair electromyogram using a C5 1 transducer to scan the patients left kidney Lese ede o OE 68 Figure C Sonographer 2 filtered upper arm muscles pair electromyogram using a C5 1 transducer to scan the patient s right kidney seen 69 Figure D Sonographer 2 filtered forearm muscles pair electromyogram using a C5 1 transducer to scan the patie
115. st rk emg Subject 4 P4_It_Ik_emg_filtered emg_filt_plot fs PA It Ik emg P4 It rk emg filtered emg filt plot fs P4 It rk emg P4 st Ik emg filtered emg filt plot fs PA st Ik emg P4 st rk emg filtered emg filt plot fs PA st rk emg Subject 5 P5 It Ik emg filtered emg filt plot fs P5 It Ik emg P5 It rk emg filtered emg filt plot fs P5 It rk emg P5 st Ik emg filtered emg filt plot fs P5 st Ik emg P5 st rk emg filtered emg filt plot fs P5 st rk emg 113 10 2 5 Electromyography Sub programs 10 2 5 1 Electromyography Filtered Data Plots function filtered_data emg_filt_plot fs rawdata This function filters the EMG data and plots the electromyograms Filters raw EMG data filtered_data emg_filtered fs rawdata Determines the time for each data collection ts 1 fs N length filtered_data t 0 N 1 ts Time vector time t plots figure subplot 2 1 1 plot time filtered_data 1 xlabel Time s fontsize 24 ylabel Amplitude V fontsize 24 title Filtered Biceps Brachii Electromyogram fontsize 24 subplot 2 1 2 plot time filtered data 2 xlabel Time s fontsize 24 ylabel Amplitude V fontsize 24 title Filtered Triceps Brachii Electromyogram fontsize 24 figure subplot 2 1 1 plot time filtered_data 3 r xlabel Time s fontsize 24 ylabel Amplitude V fontsize 24 title F
116. studies examined muscle activity and joint movements that were localized to the shoulder or observations of upper body movement Village amp Trask 2007 Milkowski amp Murphey 2006 An ultrasound is a diagnostic procedure that uses high frequency sound waves to produce visual images of organs tissues or blood flow Ultrasounds are widely used because they are minimally invasive and unlike x ray there is no exposure to radiation An ultrasound examination is initiated by a sonographer placing gel on the patient in the area that is being studied The gel enhances the conduction of sound waves The sound waves are introduced by a handheld transducer which is moved across the area being scanned During an ultrasound examination there are several factors that Jakes 2001 identified as contributing to injury or discomfort to muscles or joints Minuscule movements of the transducer and gripping the transducer tightly may injure the muscle fibers to the fingers or tendons in the fingers hand and forearm Twisting and bending of the wrist to the extremes of range of motion while applying pressure to the patient can increase strain in the wrist Shoulder abduction while applying pressure to the patient for long durations can strain shoulder neck and back muscles Performing an ultrasound in awkward positions can result in the sonographer continuously twisting his or her torso and neck to see the monitor As a result of these movements pain is primar
117. t The Pliance data collection software indicated several pressures that needed to be applied to the sensor to ensure calibration The researchers adjusted the pressure accordingly The Pliance data collection software then calibrated the individual sensors on the sensor mat based on the pressure applied to the sensors and the pressure recorded The default sampling frequency used for calibration was 50 Hertz The Novel Pliance X system was then assembled and the s2054 Pliance X sensor mat was zeroed The sensor mat was zeroed by placing it flat on a table and using the Pliance data collection software Then it was secured to the C5 1 transducer using micropore tape and a baseline zero measurement was taken When the sensor mat was secured the researchers ensured that it was not creased which is shown is Figure 3 37 S5 1 transducer C5 1 transducer C5 1 transducer Figure 3 Pliance X sensor mat wrapped around the transducers When the volunteer patient arrived he was asked to fill out a consent form and his height and weight were measured When a sonographer arrived she filled out a consent form and pre scan questionnaire Grip and pinch forces were obtained from the sonographer using the Jamar dynamometer and Baseline pinch gauge following the procedures recommended by the American Society of Hand Therapists American Society for Hand Therapists ASHT clinical assessment recommendations 1981 The sonographer changed into the appropriate
118. t Ik markers size PA lt rk markers size PA st lk markers size PA st rk markers P4 IHA landmarks 5 P4 IHA start 1 P4 forearm frame option 4 P4 Ik forearm frame option 1 P4 wrist marker 1 7b Subject 5 P5 It Ik rows P5 lt Ik columns size P5 lt Ik markers P5 It rk rows P5 lt rk columns size P5 lt rk markers P5 st Ik rows P5 st Ik columns size P5 st Ik markers P5 st rk rows P5 st rk columns size P5 st rk markers P5 IHA landmarks 5 P5 IHA start 1 P5 forearm frame option 4 P5 wrist marker 3 81 Determines the joint angles for the marker data from the sonography research study Subject Large transducer left kidney scan Pl lt Ik angle ranges P1 lt Ik angles P1 lt lk joint centers upper extremity joint angles Fs Fc P1 st rk markers 1 P1 It Ik markers P1 IHA landmarks P1 IHA start P1 It Ik rows P1 It Ik forearm P1 wrist marker Large transducer right kidney scan Pl lt rk angle ranges Pl lt rk angles P1 lt rk joint centers upper extremity joint angles Fs Fc P1 st rk markers 1 P1 lt rk markers P1 Ilt rk IHA landmarks P1 IHA start P1 lt rk rows P1 lt rk forearm Pl wrist marker Small transducer left kidney scan P1 st Ik angle ranges P1 st Ik angles Pl st Ik joint centers upper extremity joint angles Fs Fc Pl st rk markers 1 P1 st
119. t Kidney set h Interpreter none xlabel Angle Degrees fontsize 30 xlim x_min x_max ylim 0 1 ylabel Normalized Frequency fontsize 30 title Sonographer 5 fontsize 30 end 85 10 2 2 Kinematic Main Program function angle_ranges angles joint_centers upper_extremity_joint_angles fs fc static_raw_data dynamic raw data IHA landmarks IHA start IHA_end forearm_frame_option wrist_marker_option 9o This function determines the joint centers and joint angles for the wrist elbow and shoulder joints Constants r c size dynamic_raw_data Determines the length of the inputs source assuming all inputs are of equal length time duration Static trial raw data Seperates the filtered data into individual markers ELH_S EMH S VH1_S VH2 S VH3_S USP S RSP S VF1_S VF2_S VF3_S marker seperation static static raw data Dynamic trial raw data Generates a power spectral density analysis to determine cutoff frequencies then filters the raw marker data using the cutoff frequencies for i 1 c filt_dynamic 1 filtering fs fc dynamic raw data i end Seperates the filtered data into individual markers SJ D C7 D T8 DAA DTS DAI DELH D VHI D VH2 D VH3 D RSP D VF1_D VF2 D VF3 D hand D marker seperation dynamic filt dynamic Seperates the data into one matrix with AA D TS D AI D AC D PC D for the input matrix for the instantaneous helical axes method scapula m
120. t root of perpendicular to 1IHA through the centroid of the landmarks Reference article Sommer III H Determination of first and second order instant screw parameters from landmark trajectories ASME Journal of Mechanical Design 1992 274 282 ZoInputs xi is global location of landmarks vi is velocity of landmarks ai is acceleration of landmarks Qutput 1IHA_P is the IHA location 1x3 matrix Constants r c size xi Number of landmarks there should be at least 3 m c 3 fi 1 m 1 Landmark weighting factors vector of length m eps 1 0E 5 Epsilon converge tolerance distance between points will need to be less than epsilon tolerance V ariance covariance weighting matrix for landmark measurements ss zeros 3 3 for i 1 3 ss 1 1 1 end lnitial values xo zeros 3 1 Global location of centroid of landmarks vo zeros 3 1 Mean velocity of landmarks ao zeros 3 1 Mean acceleration of landmarks X zeros 3 3 9 6Landmark inertia matrix V zeros 3 3 lLandmark velocity moment matrix A zeros 3 3 Landmark acceleration moment matrix Least squares statistical weighting Applies scalar statistical weighting factor to each landmark fo sum fi m Mean statistical weighting factor for landmarks eq 50 Scales and sums xi vi and ai for each component x y z eq 51 53 j l for i 1 m xo 1 xo 1 fi xi 96Component x xo 2 xo 2 fi i xi j 1 Component y
121. the camera s sensor plane The camera converts the pattern of light into data that represents the position and radius of each marker Vicon MX Hardware System Reference 2007 This is done by generating grayscale blobs that represent objects in the capture field then using centroid fitting algorithms to determine which of the objects are likely to be markers Go Further with Vicon MX T Series 2011 3 2 Landmark Selection Landmark locations for the reflective markers were selected based on the joint angles of interest and previous studies on the shoulder joint Joint angles were determined for the wrist elbow and shoulder The landmarks located medially and laterally from the elbow and wrist joint centers were selected to calculate the joint centers The selected landmarks located medially and laterally from the elbow joint center are the epicondylus medialis humeri and epicondylus lateralis humeri Radial and 14 ulnar styloid processes are located laterally and medially from the wrist joint center In the different studies by Mesker et al 1998 Veeger 2000 and Stokdijk et al 2000 to determine the center of rotation for the shoulder joint markers were placed in the following locations on the scapula angulus acromialis trigonum spinae scapulae angulus inferior scapulae most dorsal point of the acromioclavicular joint and processus coracoideus The five landmarks used by these researchers were selected as a result of multipl
122. the linear velocity of landmarks using the numerical difference method 9o Constants r c size xi Number of landmarks there should be at least 4 m c 3 Initial values vi zeros r c Linear velocity in the global reference frame for i 2 r 1 j l Initializes landmark location for kz1 m viij xiG 1 j xiG 1 j 2 t _ Component x vi i j 1 xi i 1 j 1 xi i 1 j 1 2 t Component y vi 1 j 2 xi i 1 j 2 xi i 1 j 2 2 t Component z j j 3 Increments to the next landmark end end 103 10 2 3 8 Linear Acceleration function ai linear acceleration xi t 2o This function determines the linear acceleration of landmarks using the numerical difference method 9o Constants r c size xi Number of landmarks there should be at least 4 m c 3 Initial values ai zeros r c Linear acceleration in the global reference frame for i 2 r 1 j l Initializes landmark location for k 1 m ai ij xi i 1 2 xi ij xi i 1 t 2 Component x ai ij 1 xidi 1 j 1 2 xi ij 1 xi i 1 j 1 t 2 Component y ai i j 2 x1 1 5 2 2 xi i j 2 xi i 1 j 2 t02 Component z j j 3 Increments to the next landmark end end 104 10 2 3 9 Instantaneous Helical Axis Position function HA_p u IHA_position xi vi ai This function determines the location of a point on the instantaneous helical axis IHA This point will lie a
123. the wrist joint angles because in some instances it would suddenly change from extension to flexion or vice versa in a single frame of data 43 collection The sudden changes were investigated using the Vicon Nexus software In the Vicon Nexus software the hand marker would not transfer between extension and flexion The continuity test applied prevented the wrist joint angle from transitioning between flexion and extension if the angular velocity was over 500 degrees per second Figure 5 Neutral and anatomical position of the upper extremities Anatomical reference frames were determined for the thorax and upper arm to create a shoulder joint matrix reference equation 21 The anatomical reference landmark locations and axial orientations used were recommended by the International Society of Biomechanics Wu et al 2005 The positive directions for the axes were posterior to anterior for the x axis inferior to superior for the y axis and medial to lateral for the z axis The anatomical reference frames are shown in Table 7 Euler rotation sequence YX Y was then used to determine the shoulder joint angles reference equations 22 through 26 As mentioned previously y describes shoulder flexion and 44 extension 6 describes shoulder abduction and adduction and y describes shoulder internal and external rotation Shoulder flexion abduction and internal rotation occur when the Euler angles are positive The neutral p
124. traction while the sonographers were scanning could be a contributing factor to injuries 62 7 Limitations of the Study Limitations for this study include the sonographer participant sample size difficulty of the cameras in detecting marker locations throughout the scans for the forearm inability of the sonographers to reposition their fingers sonographers not applying their maximum voluntary isometric contraction shoulder translation and sonographers scanning outside of their typical work environment The sample size of sonographers for kinematics was four and for electromyography was three As a result statistical analyses could not be performed on the results During the study forearm markers were not consistently located by the Vicon MX motion capture system for 7 out of the 16 scans This was a result of the scanning technique that the sonographers used and equipment location As mentioned previously this study was a joint collaboration with occupational therapy graduate students who investigated if there was a difference in the amount of pressure applied to the transducers by individual fingers and the entire hand The individual sensors on the pressure mat were correlated to fingers prior to scanning inhibiting the ability of sonographer to reposition their fingers During the maximum voluntary isometric contractions the sonographers did not apply their maximum force for the superficial muscles that were investigated This resulte
125. um and elbow flexion was 4 1 degrees higher than the maximum obtained in the right abdominal scans The wrist angles obtained in this study were substantially different in comparison to the Burnett study During this study the average wrist angle all of the scans were in extension reference Table 12 In the Burnett study the average wrist angles for the left and right abdominal scans were in flexion reference Table 3 The differences for the wrist angles could be a result of the anatomy scanned position of the patient or the position of the sonographer 61 6 5 Electromyography Discussion The maximum voluntary isometric contraction signals for the muscles investigated were inaccurate because the sonographers were not applying their peak force As a result only qualitative conclusions can be drawn from the electromyography results The electromyograms indicated that co contraction was occurring in the forearm muscles pair and the upper arm muscles pair at multiple instances throughout the short scanning durations for all of the sonographers The tricep brachii flexor carpi ulnaris and extensor carpi ulnaris appear to generate electrical voltage at the same instance for all of the electromyograms reference Appendix 10 1 As mentioned previously co contraction was investigated because it has been hypothesized as a potential cause of repetitive strain injury which is a type of work related musculoskeletal disorder The high presence of co con
126. upational Therapy Results rtt A Oy 117 10 4 Participant Consent Forms osi A A A 119 10 5 Occupational Therapy Survey and Questionnaire eese 125 10 6 Ini dgbiscm A GAR A 131 LT Bibliography asa dak ede DRE D ER HU way iii 132 12 Submission Agreement for ScholarWorks GVSU sse 137 List of Tables Table 1 Maximum and average pressure and force applied to the ultrasound transducers Bullock Conroy and Vetter 2011 ua a a i 4 Table 2 Assessment of researched publications on work related musculoskeletal disorders experienced by sonographers and vascular technologists Roll et al 2009 5 Table 3 Minimum maximum and average joint angles for five sonography scans Burnett amp Campbell Kyureghyan 2010 sese 10 Table 4 Reflective marker set to determine upper extremity joint angles 16 Table 5 Demographics and characteristics of participant sonographers 33 Table 6 Technical reference frames for the upper arm humerus and forearm 43 Table 7 Anatomical reference frames for the thorax and humerus 11 42111111111 45 Table 8 Shoulder joint flexion extension during scanning eene 47 Table 9 Shoulder joint abduction during scanning eene 49 Table 10 Shoulder joint internal external rotation during scanning

Dominant Upper Extremity Kinematics and Muscular Activity

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