Chiropractic Products, The Magazine for Chiropractic Professionals; April 1998, p 70. Chiropractic Products (ISSN Number 1041-2360) is published monthly except January and June by Novicom, Inc., an MWC Company, 20000 Mariner Avenue, #480, Torrance, CA 90503. Phone: 310-793-4141; Fax: 310-793-4138; e-mail: novicom@earthlink.net. Copyright 1998 by Novicom, Inc. All rigths reserved.
Technology-2000: A Preventive-Rehabilitative Mix: A look at the new technology digitization by Donald G. Helt III
Have you heard the talk lately? It seems that medicine is going under some sort of a metamorphosis and no one really knows what the outcome is going to be. The many faces of professional healthcare leave most people confused and guessing what to do to protect their family, career and health. To make matters worse, most healthcare professionals are caught in the middle of a battle between insurance agencies, legal councils and patients. If we look closely at the trends over these recent years, beyond the chaos and ambiguity, certain words do however standout, giving us a hint of direction. Those words are objective data, comprehensive documentation and prevention. With the new millenium rapidly approaching, the search for sophisticated technologies that are simple to use and economically priced begins today and will play a major role within medicine.
Technology is a term that bestows fear in most people. It is not here to complicate our world, but provide us with more effective methods of performing daily routines in both our personal and professional lives. Technology also escalates the levels of comprehension for those topics often considered difficult or complex. So what does all this mean? Within both rehabilitative and preventive medicine there is a fairly new technology sprouting-up within various concentrations such as chiropractic medicine, physical therapy and orthopedics. It is called digitization. This is a fancy term for "taking an analogue signal and converting it to a binary number", permitting information and raw data to be interpreted by a computer. We are specifically referencing image digitizing, which is analyzing pictures within the computer via specialized software.
The cliché "A picture is worth a thousand words" definitely applies here but what most people do not know is that this same picture can deliver reproducible, objective data. Very often a healthcare professional can attain more viable information from an image than from physical examination or assessment. Minimally speaking, this information may even compliment their evaluation. Let's explore this for a moment. Take a traditional range-of-motion (ROM) evaluation utilizing inclinometers. First the patient needs to be properly positioned to effectively assess the motion. Bear in mind that an inclinometer operates on the pendulum theory, using gravity as its norm. If the patient is not positioned within gravity's plane, the data recorded might be inaccurate. Also realize that the required testing posture might not be the most comfortable for the patient. Often we may even have to physically attach the device to the patient via VelcroTM straps or a complex plastic apparatus. Do you think these issues could possibly effect the deliverance of "true" ROM values? After the evaluation is completed, we then have to take that raw data and integrate it into a report. This might be time consuming if you are not equipped with computerized report generator. There are even sophisticated systems on the market that use tethered inclinometers attached to a computer that automatically record your data and then generate a report. The only downfall to that is that these systems are very expensive and not always user friendly.
To perform the same ROM evaluation utilizing digitizing techniques, the first step would be to properly position your patient to effectively assess the motion. Try to make the patient as comfortable as possible. One of the greater benefits of digitizing is that the patient can be posed in virtually any posture. In order to do an evaluation, you need only to take a picture of the patient. This permits the freedom of multiple positioning. Digitization does not require wires, therefore the patient can perform uninhibited motions without the feeling of restriction or restraint. It is necessary, though, to properly align the camera with the patient. When capturing an image for evaluation, the camera must be placed perpendicular to the patient and at the proper level. Like regular photos, captured images show perspective and this must be accounted for.
The time required for a digital evaluation is substantially shorter than traditional testing techniques, usually 50 percent shorter. In essence, the patient enters the evaluation room, performs the testing activity and moves on to their therapeutic exercises. After the completion of evaluation, we receive more than just ROM values. We also attain biomechanical, anthropometric and dimensional values. This objective data can be used to enhance and help validate each evaluation, demonstrating viability and reliability.
Comprehensive documentation is a key factor in reimbursement and treatment efficacy. The only dilemma is that it is generally time consuming and highly repetitious, leading it to be cost ineffective and counter productive. Automatic report generators simplify this by reducing the time required to develop a report, complete with statistics and supportive material. Once again the issues associated with automatic generators are that they are either linked with an expensive testing system or require manual entry by a clinician or administer. Regardless of the evaluation, clinical and industrial digitization software provides all of this information plus one more vital part…images! There is no better way to express improvements, limitations, concerns or techniques than through photos. With each digitization report, a perfect set of image(s) comes standard, escalating the comprehension level via visual aids and increased objective data. For example, if we were to perform an ergonomic assessment of an assembly workstation within an industrial environment, we would be equipped with the proper resource material (questionnaires, checklists, etc.), measuring devices and a camera - preferably digital. Without disturbing, in any way, the performance of the employee, we could document and evaluate various postures and workstation settings via digitization. Simply capture a series of images and evaluate them on your time within your office, not on your client's time at the expense of the employee. When the time arrives to deliver an executive summary of your determinations and recommendations, a report supplemented with digital images can easily express areas of concern. Also remember that image digitization does not require the employee to don tethered hardware or tracking apparatus. He/she always maintains their freedom of movement.
Why on earth would we find ourselves, as healthcare professionals, inside an industrial setting performing various evaluations and taking pictures? Don't we belong in offices and hospitals? NO! We belong in any environment where our services can provide relief and improved health for all individuals. One word sums this thought up very well…PREVENTION. Throughout recent years this word has been sneaking into our vernacular and our professional lives. And it is never alone. It has a twin and that is ERGONOMICS. This science, that is the study of the intimate relationship between man and his physical surroundings, explores the mechanical and psychological synergism an individual has with their environment.
For years ergonomics has played a major role in industry. From plant layout and tool design, to rest cycles and job scheduling, it has woven itself into the fabric of an industrialized world on all levels. What is interesting is that it has now blended into the healthcare profession. The question arises, Why as medical professionals should we repeatedly treat an individual for recurring work injuries if we could alleviate those job stresses right from the start? Why not remove the problem before it generates into an issue? Many insurance agencies are asking similar questions. Why should we continually pay for treatment if the condition will only repeat itself a few months down the road? These are valid questions and pose excellent arguments. As healthcare professionals, we are specifically trained to understand the biomechanical and kinesiological theories related to the human form, along with the principles of injury, as so far as why and how they occur. We are perfect for a "prevention" movement! Third-party-payers, industry and patients are asking us to take this training to the next level, that is to avoid injuries and reduce job related stress.
How do we take it to the next level? We can do so either through consulting or training services. Consultation poses as a more theoretical approach while training is a more direct and influential methodology. Only through education can we help individuals identify and avoid industrial stresses. Fortunately we have at our disposal technologies that help facilitate these goals. Economically priced computerized applications can assist us design, redesign and evaluate both industrial and office environments. These same technologies can be utilized as comprehensive techniques to convey the importance of body mechanics, furniture layout and product form.
For those interested in the higher end of human factors engineering, three-dimensional modeling software is available to recreate virtually any human and his environment within the computer. From here, the user can investigate for stress factors and even evaluated on recommended improvements before any physical changes are made. The ability to validate designs before actual integration demonstrates professional efficacy and efficiency. To optimally utilize this technology, one must have a relatively good understanding of a computer and the principles involved with three-dimensions, such as planes-of-motion and X - Y - Z coordinates.
Another alternative is digitization. Alone this technology provides objective findings and support, but when combined with two or three-dimensional models, it provides superior documentation and comprehension. When rendering ergonomic/human factors services, it is safe to assume that your clientele does not have the same level of training or understanding in this concentration as you. Because of this, it is extremely important that documentation and presentations are in a form that can be easily understood by everyone. Once again, as in clinical documentation, we are in the position of taking a subject that is very sophisticated and presenting it in very simple terms. Without this support and proper supportive data, our services and talents might prove ineffective or useless. This support also eases the constant struggle for reimbursement and cost justification.
Remember this, it's all about money! Regardless of how you slice it, the issues surrounding healthcare and industry reflect reducing costs. Our time is very valuable and we need to be able to accomplish much more within one hour than we did a few years ago. And the only way we are going to get paid is through objective documentation containing reliable, comprehensive data. Through prevention we begin treating an individual before they actually become a patient. This is an avenue that is quickly becoming a "healthcare-highway", and one that can prove viable if traveled professionally. Technology ties all of this together and with economical tools such as digitization and three-dimensional modeling, we can lead others into a very healthy and prosperous millenium. We need to provide each other with the proper professional support. The days for playing games have long past us by.
Donald G. Helt III is Vice President and Director of Product Engineering for Med-Data Systems, Inc. of Cherry Hill, New Jersey. He holds a Master/Bachelor degree in Occupational Safety and Health Engineering along with an Associate degree in Industrial Engineering. Don is also an adjunct professor of Physical Therapy at the College of Staten Island, CUNY. Med-Data Systems, Inc. is a software development corporation producing leading edge medical and industrial technologies.
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