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    • 专利摘要:
    A method of diagnosing a patient suffering from mechanical low back pain (LBP) for the treatment of a physiotherapist or to undergo a radiological examination for further analysis of an underlying complication, said method comprises a predetermined sequence of physical examinations and image analysis. (Fig. 1) Figure 1. Patient's history and Physical examination a) Gait and posture Further examination b) Hip height symmetry Further examination c) Crista iliaca posterior inteferior (CIPI) Level, sitting position Posterior inferior crest of iliac bone Further examination d) Malleoli level, lying position Further examination e) Patricks test Further examination f) Pubic level OK NO OK~ NO . * Further examination Imaging/radiological examinations Figure 2. Mobilization test The side affected in Patricks test modified Image Test malleoli level documentation Symmetry Yes Provocate Raising a leg Symmetry Malleoli level Yes No Pubic upper level Pubic upper level symmetry symmetry Yes No Full symmetry Go to mobilization pubic/pelvic area ri 4' XX 1~ )K)g ix K) $ k ix j vi
    公开号:AU2013200977A1
    申请号:U2013200977
    申请日:2013-02-21
    公开日:2013-09-12
    发明作者:Stellan Eriksson
    申请人:STESON PRAKTIK AB；
    IPC主号:A61B5-11
    专利说明:
    Steson's algorithm Technical field [0001] The present invention relates to a method of diagnosing a patient suffering from mechanical low back pain (LBP) for treatment by physiotherapy or to undergo a radiological examination for further analysis of an underlying complication. Background of invention [0002] Mechanical low back pain (LBP) produces major societal, industrial and personal problems, resulting in substantial annual health care costs and sick-leaves. [0003] In the US the costs has increased from 11.4 billion US Dollars 1989 to 100 billion US dollars 2009 (E-medicine from Webb MD, Mechanical low back pain, Hills EC, updated March 24, 2010). Besides the economical facts, there is a personal tragedy with pain and physical disability that will be prolonged if not properly handled. [0004] Lumbar muscle function is considered to be an important component of chronic low back pain (LBP). LBP is a common symptom of muscular skeletal disorder. Complementary studies have documented compromised muscle function in patients with LBP. Although the mechanism associating muscle insufficiency to LBP is not clearly understood, it is commonly held that the passive tissues of the spine are increasingly stressed with increasing functional muscle insufficiency. Only a small percentage of LBP complaints can be diagnosed definitely because current techniques are effective only for diagnosis of LBP associated with damage or abnormality of the skeleton. However, a substantial percentage of these complaints cannot be diagnosed because existing techniques are ineffective for diagnosis of mechanical LBP associated with muscular dysfunction. [0005] The term mechanical low back pain is used to describe the condition of up to 85% of patients for whom a specific diagnosis is said to be impossible. [0006] Muscle aches, muscle sprains, tendonitis, sacroiliac and low back strain, lumbago, mechanical LBP, and lumbar strain are some of the currently used diagnoses in clinical use.
    2 [0007] The high incidence of back injury among people costs the society a lot of money each year partly because there is no fast and safe diagnosis methods and the physicians do not have better methods than referring the patient to myelography, fluoroscopy, X-ray radiation, computer tomography (CT), and magnetic resonance imaging (MRI) or other radiological methods that in addition to the costs also may expose the patients for unnecessary radiation. Fluoroscopy and computed tomography use ionizing radiation that may be potentially harmful to the patient and the interventional radiologist. Ultrasound suffers from image quality and tissue contrast problems. Magnetic resonance imaging provides superior tissue contrast, at the cost of being expensive and requiring specialized instruments that will not interact with the magnetic fields present in the imaging volume. [0008] Earlier lack of evidence-based research for idiopathic low back pain has focused on two opposing opinions; a tissue derived pain or a nonspecific one. The pain is of neurologic origin and pressure from muscle and skeleton on nerve structures exert the prime action. However, disclosure of medical conditions presenting as LBP is of importance. [0009] It is of great importance to improve the methods for diagnosing LBP since a major diagnostic problem with LBP is that many anatomic abnormalities seen on imaging tests are common in healthy individuals. The abnormalities often result from age-related degenerative changes, which begin to appear early in the adulthood and are in some ways analogous to gray hair and wrinkles (Richard A. Deyo. Diagnostic evaluation of LBP. American Medical Association. Arch intern med. Vol. 162, 2002). [0010] Conventional therapeutic measures have been regarded as obsolete and a broader view of the underlying mechanisms behind back pain is taken into account. [0011] Moreover, the physicians have no other choice than put patients on the sick list when the patient has pain. [0012] In prior art the Veteran Health Administration and the Department of Defence (VHA/DoD) has published a clinical practice guideline for the management of low back pain or sciatica (Management of low back pain or sciatica. Veteran Health Administration, Department of Defence. May, 1999). This document presents an algorithm of 22 steps for the diagnosis of 3 LBP. However the method does not include checkpoints for an efficient investigation and includes many patient visits. [0013] Moreover, many leading scientists have regarded non-specific low back pain (LBP) to be a psychiatric disease and diagnosis as for example Wadell G, 1987; Nachemson A and Jonsson E, 2000, and Slipman CW, et al., 2008. [0014] Most diagnostic methods available today which assess muscle deficiencies are either nonobjective or they lack rigorous clinical validation and reliability. The circulated guidelines for clinical use fail to offer clinical algorithms for the various non-disk-related back problems that might cause the patient's pain. [0015] There is still a need for a reliable methodology to perform an early discrimination between patients suffering from LBP who are treatable by physiotherapy and those patients who are suffering from other conditions. [0016] The object of this invention, therefore, is to provide an improved method for analyzing muscle fatigue associated with mechanical LBP and also reduce the costs for unnecessary expensive and time consuming investigations. Summary of invention [0017] This method describes a physical examination procedure in perpendicular planes that will explain the common pathology of mechanical low back pain (LBP) and its treatment. [0018] An object of the present invention is to provide an improved method based on an algorithm for diagnosis and treatment of mechanical low back pain (LBP). [0019] It is another object of the present invention to obviate at least some of the disadvantages in the prior art and provide a more effective and reliable method for the elucidation and treatment of mechanical lumbago. [0020] In a first aspect there is provided a fast and accurate method of diagnosing a patient suffering from low back pain (LBP) for the treatment of a physiotherapist or to undergo a radiological examination for further analysis of an underlying complication. The treatment steps performed by a 4 physiotherapist are also included as well as simultaneous recording by using, for example, a digital camera or a video recorder for further image analysis of the tests performed. By recording the examination steps, it is possible to analyze e.g., hip symmetry, the level of the pubic bone or the prominence of the ankle (malleolus) by means of a commercial image analysis software. The recorded file and documentation thereof may also be used to monitor the patient recovery (or worsening) over time, and may also be used for research. [0021] In the present application the term image analysis comprise marked-based or marked-free methods. In the marked-free method is the levels to be compared measured by using commercial software for image analysis. The marked-based method comprise marking the reference points on the patient with for example a mark or laser point before the image is taken, or as in the marked-free method, use a soft ware program to mark certain points on the patient in the image. The reference points, are predetermined reference points for example the hips, pubic, or malleoli. [0022] In a second aspect the use of the method is provided to electing a patient suffering from mechanical low back pain (LBP) for the treatment by a physiotherapist or to undergo a radiological examination for further analysis of an underlying complication. [0023] In the present application the term radiological is a medical specialty that employs the use of imaging to diagnose a disease visualized within the human body. Radiological examinations means common interventional imaging modalities which include fluoroscopy, Positron emission tomography (PET), computed tomography (CT), ultrasound (US), and magnetic resonance imaging (MRI). [0024] The provided method of diagnosing a patient suffering from mechanical low back pain (LBP) for treatment by physiotherapy or for a radiological examination for analysis of an underlying complication, said method comprising: a) examining the gait and posture of the patient to determine any abnormality thereof, b) examining the hip height symmetry of the patient in both a standing position and a sitting position to determine any asymmetry thereof, 5 c) examining the crista iliaca posterior inferior (CIPI) level of the patient by observing the associated bone prominences during forward bending movement of the patient in a sitting position to determine structure and function and any asymmetry thereof, d) examining the malleoli level of the patient in a lying position by observing the associated bone prominences to determine any asymmetry thereof; e) performing a modified Patricks' test in a lying position by flexing the patient's knee to ninety degrees, resting the associated foot on the other knee, holding the pelvis firm against an underlying surface, and pushing the flexed knee toward the underlying surface to determine the distance of movement of the knee and the degree of outward rotation and not if pain is obtained, and f) examining the pubic level by observing the associated bone prominences to determine any asymmetry of the pubic bones, wherein the method is conducted by performing each of the examination steps a) to f), wherein the patient is diagnosed for physiotherapy if an abnormality is determined in step a) - f), If no asymmetry is found the patient is diagnosed for a radiological examination for analysis of an underlying complication. The method also may comprise that each examination step and marked examination point(s) in the process are documented by using a video camera or a digital camera, to subsequently be able to perform precise measurements of length and/or level differences between two examination points in the images obtained using image analysis. Each examination step and examination point(s) (examples are shown in Fig. 4) in the process are documented by using a video camera or a digital camera, to subsequently be able to perform precise measurements and comparisons of the obtained images using image analysis and store the data and images for later comparison between two examinations or more or for research. Steps a)-f) are performed in the recited sequence and may be performed in less than 5 minutes. When pain results in step e), the method further comprises mobilization test to diagnose muscular causes of such pain, wherein the mobilization test comprises: i) applying pressure to a knee of the patient in a lying position in a direction perpendicular to an underlying surface and then lifting the associated 6 pelvis to a fists' distance for five seconds and returning the leg and pelvis to the underlying surface; and ii) raising the pelvis of the patient from the underlying surface while maintaining the feet and shoulders of the patient on the underlying surface; and iii) examining the malleoli level of the patient by observing the associated bone prominences to determine any asymmetry thereof in back position, wherein asymmetry indicates an associated muscular disorder. The mobilization test is repeated using the other knee and associated leg of the patient, wherein asymmetry indicates an associated muscular disorder. When asymmetry of the pubic bone in step f) described above is determined, the method further comprises a pubic bone mobilization test to diagnose muscular causes of such asymmetry, wherein the pubic bone mobilization test comprises: i) rotating the pelvic bone to loosen muscular tension, ii) examining the malleoli level of the patient by observing the associated bone prominences to determine any asymmetry thereof after said rotation, iii) raising the pelvis of the patient from the underlying surface while maintaining the feet and shoulders of the patient on the underlying surface; and iv) examining the malleoli level of the patient by observing the associated bone prominences to determine any asymmetry thereof after the pelvis is in the raised position, wherein asymmetry indicates an associated muscular disorder. After step iv), the method further comprises examining the crista iliaca posterior inferior (CIPI) level of the patient again by observing the associated bone prominences during forward bending movement of the patient in a sitting position to determine structure and function and any asymmetry thereof, wherein asymmetry indicates an associated muscular disorder. [0025] The consequence of when one of the steps in the algorithm does not pass the physical examination is that underlying cause of LBP is a muscular complication that can be treated by a physiotherapist. On the contrary, if all investigation steps in the algorithm pass and is considered to 7 be normal, the cause for the LBP is probably not muscular but more likely to involve complications in the lumbar vertebrae or spine. [0026] In the context of the present investigation, the tests in the algorithm are described in the best mode of performance, some patients may have difficulties to comply with them e.g. to flex the knee to ninety degrees, therefore, the angles and movements may differ depending on the patient's ability to move his/her body. [0027] One advantage of the method is the fast (1-5 minutes) and reliable election of patients that suffer from LBP for the treatment by a physiotherapist or if they need further examinations by imaging methods. [0028] Another advantage of the invention is that many people will not have to undergo costly and unnecessary investigations such as NMR, X Ray, CT etc that includes harmful radiation to the patient. In addition, the sick-listing of patients with mechanical low back pain will be lower since they get correct treatment by a professional physiotherapist or similar. [0029] Another advantage is that the sick-listing of patients after a back pain investigation may be for a short time or even not necessary at all when excluding other causes than muscular to the back pain. [0030] A further advantage is the lowered cost for the society for unnecessary investigations and sick-leaves, and for the patient it results in lower radiation due to the unnecessary investigations and also less time wasted on investigations. [0031] Further aspects and embodiments are defined in the appended claims, which are specifically incorporated herein by reference. Brief description of drawings [0032] The invention is now described, by way of example, with reference to the accompanying drawings, in which: [0033] Figure 1 shows an algorithm for electing patients suffering from low back pain to physiotherapy or further investigation by imaging methods. [0034] Figure 2 shows the mobilization examination test including treatment obtaining symmetry that discriminates muscular causes in a positive Patricks' test.
    8 [0035] Figure 3 shows the mobilization examination test that discriminates muscular causes in a positive pubic upper level examination, thus obtaining symmetry in the pubic upper level and the whole pelves. [0036] Figure 4 shows examples of predetermined reference points for measuring level differences of a body. Detailed description [0037] In the following part, a detailed description of the invention will follow, but before doing that it must be clear that the tests described here may somewhat be modified to agree with the patient's ability to move. [0038] In the context of the present invention the examination tests are performed by a health care provider, e.g., a physiotherapist, chiropractor, naprapath or a physician. [0039] Figure 1 shows the present invention in the form of an algorithm. The algorithm is used for electing a patient suffering from LBP for the treatment of a physiotherapist or if further investigations by a physician if needed. If muscular causes are identified in any investigation step of the method presented in figure 1 the patient will be sent to a physiotherapist (or similar) for further investigations or treatment. If no muscular causes are identified by the investigation steps comprised in the algorithm, the patient must undergo further investigations by a physician that may refer the patient for further investigations such as imaging methods. [0040] The algorithm presents the physiological examination of the patient step by step and in also what order they should be investigated. The result of each examination step (step a) to f) in figure 1) has to be in the physiological normal range to pass the step i.e., show symmetry (OK in figure 1), to be allowed to go to the next examination step presented in the algorithm. [0041] The first step involves an ocular investigation to determine whether or not the patients gait and posture (examination step a) in figure 1) is normal. If not, the cause to asymmetry must be investigated. Attempts to correct the failure by known methods to a person skilled in the art will also be performed. The patient may also improve the gait and posture by time. For example, if the cause to abnormal gait or posture is because of apparent different lengths of the legs (i.e., skeleton-related) that may be 9 the cause to the back pain and the length should be corrected by e.g. an insert in the shoe. But if the examiner can't identify any problems in step (a) and find that the hips are in asymmetry, it is most likely that the problems have a background in muscular dysfunction. Therefore, a physiotherapist should be contacted (dotted arrow in fig 1) and an unnecessary costly investigation is avoided. If the gait and posture seem to be normal, the next step is to investigate the symmetry of the hips (step b). [0042] The symmetry of the hips is investigated by both an ocular and physical examination both in a standing and a sitting position, respectively. The back hands are pointing upward upon upper pelvic regions in a standing position. If an estimation of difference is noticed in the cranio caudal plane, go to step c. If there is an asymmetry and the hips are disturbed because of e.g. hip deformity/infection in the young or an accident try to correct the level of the hips with known methods and/or contact a physiotherapist for further investigation. [0043] The next step (step c) is to investigate Crista Iliaca posterior inferior level (CIPI) (posterior inferior crest of iliac bone). First of all, the structure and function in a sitting position is examined. The structure is obtained by the level of the examiner's thumbs positioned below the bone prominences on persons in a sitting position. The functional component is obtained from the thumbs positioning, when the client is bending forward. It is very important to observe whether the thumbs movement is congruent or not. Differences less than 0.5 cm will be identified. The rotation forward makes it possible to see a functional symmetry or asymmetry, which in turn can explain a virtual paradox later on. If the examinations do not show any muscular abnormal conditions, go to examination step d. If the patients do not pass the muscular test, they should be sent for further examination by a physiotherapist or similar. The crista test is necessary in cases where one foot or one leg is missing, or even extension of a leg. [0044] Next step is to investigate the symmetry of the malleoli level (step d). This is done when the patient is in a lying position. The examiner holds the thumbs preferentially positioned below the medial malleoli close to each other and determines whether the malleoli level show symmetry or not. If they show symmetry, the next examination step is performed. If not, the patient should be sent for further examination by a physiotherapist or similar.
    10 [0045] The examination of the hip/pelvic zone is performed by outward rotation by using a modified Patrick's test (Step e) which is performed by supporting the heel below the knee level of the other leg, a slight pressure in- and upward on the knee is applied for about a second and then, an outward reverse movement (MET) of knees is done for the purpose to obtain an optimal movement that will discriminate the positive side with less mobility. The heel level may vary somewhat due to physical problems for the patient. Side discrimination, is a qualitative and quantitative test that obtains the side of pain(s) and degree of movement. If a difference in malleoli level was identified earlier, or from the symmetry test, next examination step should be performed i.e., a mobilization test of the affected side. Patricks' test was originally described as the side on which pain was detected. [0046] In the context of the present invention Patrick's test is performed by a health care provider to assess if the underlying cause of LBP is sacroiliitis (inflammation of the sacroiliac joint.). The knee is flexed to ninety degrees on the affected side and the foot is rested on the unaffected knee. Holding the pelvis firm against the examination table, the affected-side knee is pushed towards the examination table, a maneuver which provides external rotation of the leg at the hip and sacroiliac joints. If pain results, this is considered a positive Patrick's test and sacroiliitis is more likely. However, Patrick's test does not prove that sacroiliitis is causing the back pain, just increases the likelihood. A severely restricted and painful Patrick's test can be found in patients suffering from a degenerative disease of the hip or in traumatic injury to the hip. Patients having a positive outcome of Patricks' test are further subjected to the mobilization test, described in figure 2. [0047] The mobilization test (Figure 2) of the side affected by MET (muscular energy technique) as seen above with symmetry by a slight pressure from the knee perpendicular to the horizontal level upward and then lift to maximum fist height of the affected pelvic side for some seconds. Then raise the pelves from the ground. The shoulders and the feet should still be touching the ground and the malleol levels should now be in symmetry, otherwise repeat the test. Provocate to see if asymmetry exists in other planes by raising one or two legs upwards. If asymmetry turns up in either CIPI or malleol level go back to step c) and step d) according to the present invention and try to regain the symmetry.
    11 [0048] Pubic upper level is examined (step f) with two fingers wherein one finger is on respective pubic bone, discrepancy is measurable. Apply a MET tension in the part to be stretched and rotate the pelvic to loosen the muscular tension. Provocate again and control the hip movement in the same phase of investigation. Mobilize the side affected (positive in Patricks' test) positioned upward as described in figure 3. The pubic level, on the positive side, decides the route of rotation for symmetry of pelves after MET. [0049] Test malleoli level, if discrepancy, raise the pelves from the ground and symmetry are obtained in malleoli and CIPI level and the two planes studied. [0050] Another way in this last mobilization is to rotate both clockwise and anticlockwise, with both legs in opposite directions. This will give symmetry without raising the pelves (Figure 3). [0051] Control of malleoli-, CIPI- and pubic levels should show symmetry, if not go back to the modified Patricks' test again and try to obtain expected symmetry. [0052] It is of first choice to use both the CIPI- and malleoli-tests for easier discrimination in obese or fractured individuals. [0053] The present invention provides a scheme in order to show the mechanism behind non-specific low back pain. Some orientation steps including Patrick's modified test demonstrate the mechanisms of incongruence behind non-specific low back pain. Patrick's test is conducted, pubic in the frontal plane.The mobilization step 1 is done by raising the pelves (or pelvices); the malleolar level is equal after that. The provocation of the sagittal plane by raising a leg makes incongruence in the malleolar level again, showing dependence or coupling to the sagittal plane. Working in the sagittal plane - now lying sideways by rotating legs/pelvises forth and back in opposite direction fulfills the second mobilization. Or if you work on just one position rectifying the positive restrictive pelvis in the modified Patrick's test, you have to raise the pelves once more to get full symmetry in the crests, pubices and malleoli. The two planes are obligatorily coupled to each other, but independent in what order they are conducted! Thus, unless the second step is conducted, the first mobilization step and apparent symmetry is lost momentarily. That is on all the reference points of lower crests of iliac bone, malleoli and pubic levels 12 [0054] The mechanical procedure provided is a plain bed side technique, involving load and power. [0055] In figure 4 the predetermined reference points (x) for measuring level differences by using marked-free or marked-based methods are marked. Commercial software programs are used for image analysis of the obtained images. By marking a reference point in the image and compare the level of the first marked reference point with the level of the other reference point (e.g., points A with point B in figure 4) a value will be obtained. The value shows if the reference points are in symmetry or not. The value will be documented and used for comparison with earlier or later images of the same person or for other purposes, such as research. [0001] See the warnings written by NICE, UK, not to use radiology, electric devices or any injections without having examined properly if these treatments are necessary. [0002] A skilled physiatrist will manage to analyze, treat and inform about LBP. The muscular derived affection is of a plastic nature and will easily revert into incongruence. If nothing else is defined, any terms and scientific terminology used herein are intended to have the meanings commonly understood by those of skill in the art to which this invention pertains.
    13 References Wadell G. Volvo award in clinical sciences. A new clinical model for the treatment of low back pain. Spine 1987; 12(7):632-644. Nachemson A. Jonsson E. Neck and back pain. The scientific evidence of causes, diagnosis and treatment. New York: Lippincott Williams & Wilkins; 2000. Slipman CW, et al. eds. Interventional spine, an algorithmic approach. Saunders, Elsevier USA: 2008, 1453pp.
    权利要求:
    Claims (9)
    [1] 1. A method of diagnosing a patient suffering from mechanical low back pain (LBP) for treatment by physiotherapy or for a radiological examination for analysis of an underlying complication, said method comprising: a) examining the gait and posture of the patient to determine any abnormality thereof, b) examining the hip height symmetry of the patient in both a standing position and a sitting position to determine any asymmetry thereof, c) examining the crista iliaca posterior inferior (CIPI) level of the patient by observing the associated bone prominences during forward bending movement of the patient in a sitting position to determine structure and function and any asymmetry thereof, d) examining the malleoli level of the patient in a lying position by observing the associated bone prominences to determine any asymmetry thereof; e) performing a modified Patricks' test in a lying position by flexing the patient's knee to ninety degrees, resting the associated foot on the other knee, holding the pelvis firm against an underlying surface, and pushing the flexed knee toward the underlying surface to determine if pain results and the degree of outward rotation and not if pain is obtained , and f) examining the pubic level by observing the associated bone prominences to determine any asymmetry of the pubic bone, wherein the method is conducted by performing each of the examination steps a) to f), wherein the patient is diagnosed for physiotherapy if an abnormality is determined in step a) - f), If no asymmetry is found the patient is diagnosed for a radiological examination for analysis of an underlying complication.
    [2] 2. The method according to claim 1, wherein each examination step and predetermined examination point(s) in the process are documented by using a video camera or a digital camera, to subsequently be able to perform precise measurements of length and/or level differences between two examination points in the images obtained using marked-based or marked free image analysis.
    [3] 3. The method according to claim 1, wherein each examination step and examination point(s) in the process are documented by using a video and/or a digital camera, to subsequently be able to perform precise measurements 15 and comparisons of the obtained images using image analysis and store the data and images for later comparison between two or more examinations of the same patient.
    [4] 4. The method of claim 1, wherein steps a)-f) are performed in the recited sequence.
    [5] 5. The method of claim 1, wherein the method is performed in less than 5 minutes.
    [6] 6. The method of claim 1, wherein, when pain results in step e), the method further comprises mobilization test to diagnose muscular causes of such pain, wherein the mobilization test comprises: i) applying pressure to a knee of the patient in a lying position in a direction perpendicular to an underlying surface and then lifting the associated pelvis to a fists' distance for five seconds and returning the leg and pelvis to the underlying surface; and ii) raising the pelvis of the patient from the underlying surface while maintaining the feet and shoulders of the patient on the underlying surface; and iii) examining the malleoli level of the patient by observing the associated bone prominences to determine any asymmetry thereof in back position, wherein asymmetry indicates an associated muscular disorder.
    [7] 7. The method of claim 3, wherein the mobilization test is repeated using the other knee and associated leg of the patient, wherein asymmetry indicates an associated muscular disorder.
    [8] 8. The method of claim 1, wherein, when asymmetry of the pubic bone in step f) is determined, the method further comprises a pubic bone mobilization test to diagnose muscular causes of such asymmetry, wherein the pubic bone mobilization test comprises: i) rotating the pelvic bone to loosen muscular tension, ii) examining the malleoli level of the patient by observing the associated bone prominences to determine any asymmetry thereof after said rotation, iii) raising the pelvis of the patient from the underlying surface while maintaining the feet and shoulders of the patient on the underlying surface; and 16 iv) examining the malleoli level of the patient by observing the associated bone prominences to determine any asymmetry thereof after the pelvis is in the raised position, wherein asymmetry indicates an associated muscular disorder.
    [9] 9. The method of claim 8, wherein, after step iv), the method further comprises examining the crista iliaca posterior inferior (CIPI) level of the patient again by observing the associated bone prominences during forward bending movement of the patient in a sitting position to determine structure and function and any asymmetry thereof, wherein asymmetry indicates an associated muscular disorder.
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    公开号 | 公开日
    AU2013200977B2|2015-03-12|
    引用文献:
    公开号 | 申请日 | 公开日 | 申请人 | 专利标题
    法律状态:
    2015-07-09| FGA| Letters patent sealed or granted (standard patent)|
    优先权:
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    US201261602790P| true| 2012-02-24|2012-02-24||
    US61/602,790||2012-02-24||
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