Monday, October 28, 2013

Outcome Measurement Report
 
Introduction
 
The two page (objective) report generator has evolved over the last 7 years to be a balance blend format which has been used by physicians, insurance companies, medical legal experts, and consumers.   It provides objective and reproducible data relative to Static and Dynamic Cyclic Load Bearing information of the person who has been imaged.
 
To make the understanding of the report simple, we have used graphic colors to indicate problems in both static and dynamic sections along with graphs as compared to established normal.   In this 1st module, we will stick to the three basic foot types, (Pes Planus or Flatfoot, Pes Rectus or normal Arch, and Pes Cavus or High Arch Feet).   We will get into more complex deformities in further blogs on this subject.
 
 
Anatomy of a Typical Report
Static Data
Static data refers to "non-movement" data collected on the 3DO Imager.   The 3DO (3D Orthodynamics) Imager is a 3D Weight Bearing Kinematic Imaging and Analysis System which determines Neutral Positioning through the use of intelligent code.  What you will see is 3D and all three body planes and their affect on load mechanics.

 


 
 (1)  Total Score and General Assessment gives the overall average how this report compares with established normal in the American Population.   It is an assessment of both the Static and Dynamic data within the report.
(2)  Weight Distribution provides a percentage of weight load on each extremity and the tell us the percentage difference.  Normal is 50% on Left Limb and 50% on right.   Anything under 3% will fall into acceptable values.   Anything over then is graded moderate to severe.   We put a high value on this because if gives us a good screening of leg shortages which can cause foot, knee, pelvic and especially spinal disease and pain.   This section is also tied to Balance Bubble (7).   When there is a leg shortage, this bubble will move to the left or right, (normal is in the middle). 
(3)  Areas of High Pressure provides data regarding peak load based on the Relative Surface Area of the foot.  So, based on the total surface of the foot, high linear peak pressures (red) will provide good visual reference to lower pressure thresholds (yellow - green - turquoiseblue), (see color bar and static images below).  Behind all these colors are numbers (Analytics).    
 
 
 
(4)  Deviation discusses the relevance of Body Balance against Mass Displacement.   On the image above, you will see three targets on the 2D imager screen.   This is the center of Mass for the Left Limb - Center of Body and Right Limb.  Patients with Equinus Disease, Vestibular conditions, Injuries to Upper torso, spine. pelvis and leg will offset these objective markers from normal.  Generally as the patients get older we see more adaption,(Wolfs Law).
 
(5)  (6)  Denotes Balance Bubbles as noted above.
(7)  Denotes Body Sway and is tied to (2) Weight Distribution and provides a quick objective analysis of potential functional leg shortages.
 
Dynamic Data
 

 
 (8)  Dynamic Mass Displacement is a critical factor in the assessment of functional disease.   This part of the report demonstrates what happens when the body is in movement over the 3D Weight Bearing Media (3DO).  3DO analysis includes calculation of the center of mass going through the foot from heel contact into midstance through the propulsive phase of gait and then graphs these results against normal established in medicine.
  • Normal angulation of the Calcaneous in most foot types is 4 to 6 degrees of varus (heel to floor) at heel contact and then goes to vertical and then reinverts after midstance.
  • As the forefoot approximates the floor, midstance begins and the center of body mass migrates along the lateral body of the Calcaneous to the Cuboid.   This occurs in milliseconds of time.   As this is occurring the foot is beginning to change from a shock absorber to a stabilizer.
  • During midstance, the Extrinsic Peroneus Longus (plantarflexor of the 1st Ray) and the Posterior Tibial tendons begin to pull to resist pronation, assisted by retrograde floor mass moves upward and equal to downward body mass migration.  The Subtalar Joint then begins to create wedge locking of the Midtarsal Joints as the foot changes to rigidity.  
  • We see medial rapid mass shift from the lateral Cuboid to the 1st Ray (Navicular - Medial Cuniform - 1st Metatarsal - Hallux) to create active propulsion and Supination of the foot in prep for the propulsive phase of gait.   This also creates external limb rotation as the foot supinates.
 


 (9)  Discusses the phases of the gait cycle and graphs these phases against normal.
 
(10) Discusses Symmetry or how much difference there is in function between the left and right limbs.   With injury, surgery and age, symmetry becomes more obvious as the body adapts to chronic abnormal cyclic load diseases or conditions.  If these numbers are high in young patients, look for serious adaption of musculoskeletal structures.