METHOD FOR RECORDING THE SPINE DURING PHYSICAL EXAMINATION
Where, when and why was the SpinalMouse® system created?
What innovations does the SpinalMouse® bring for diagnosis and evaluation?
What are the benefits of the SpinalMouse® compared to other diagnostic methods?
ADVANTAGES FOR PATIENTS AND CLINICIANS
What kind of information does a recording provide?
The output comprises important clinical information that is needed and can be used by the physician and the therapist in order to formulate the best treatment, therapy or overall care-plan for the patient, and to accurately assess the results or outcomes of any treatments or interventions.
Just some of the clinical information or data include:
- Posture (sagittal and frontal shape of the spine)
- Sagittal and frontal curvature of thoracic and lumbar spine
- Angle of inclination relative to the perpendicular
- Segmental kyphotic/lordotic angles
- Pelvic tilt
- Total back length
Mobility, range of motion (ROM)
- ROM of the thoracic and lumbar spine
- Segmental mobility for all segments starting from T1/2 to L5/S1
- Inclination (total ROM)
- Flexion and extension mobility of hip joints
Postural competence (stability of the trunk)
- Postural reaction when loaded in functional tests (Matthiass test)
Furthermore, the SpinalMouse® software provides the physician with indications for spinal dysfunctional posture or mobility.
Indications for non-harmonic curvature (posture)
- Angle differences of kyphotic or lordotic relation from one segment to the next of > 7°
- Assessment of segment integrity
- Kyphosis instead of lordosis in the lumbar spine in upright position
(“+” instead of “-” values)
- Lordosis instead of kyphosis in the thoracic spine in upright position
(“-” instead of “+” values)
- Lordotic segments in flexed position
- Kyphotic segments in the lumbar spine in extended position
Indications for non-harmonic mobility (ROM)
- Differences in motion from one segment to the next of > 7°
- Dorsal motion of segments when moving from upright to flexed position
- Segmental ROM values of +1°, 0° or -1° (segmental hypomobility)
- 0° of ROM of subsequent segments (regional hypomobility)
- 0° of ROM of one segment in both flexion and extension (rigid segment)
What is the benefit for patients?
SpinalMouse® assessments made during treatment or therapy can document the progress of the patient and provide much-needed quality assurance. Ultimately, this will lead to better rehabilitation results for the patient, medical and healthcare providers, together with lower costs with less time lost for employers and insurance companies.
Could someone without specific back pain benefit from a Spinal Mouse® assessment?
HOW IT WORKS
What does the SpinalMouse® do?
The SpinalMouse® is a computer-assisted medical device that can be used to determine the shape and mobility of the spinal column by simply gliding the device manually down the back.
There is a strong relationship between the surface line on which the recording is done and the midline of the spine in terms of alignment, range of motion, performance and its functions. The Spinal Mouse® device has two wheels arranged on a mobile support that allows the contour of the spine to be tracked. This shape is recorded by sensors that transmit the data to a computer program through a Bluetooth connection.
From the superficial shape, an intelligent recursive algorithm computes information concerning the relative position of the vertebral bodies of the thoracic and lumbar spine, while taking into account the local curvature (kyphotic or lordotic). The final result is an accurate segmental localization of all vertebral bodies as the projection of their midpoints on the superficial contour of the back.
What is the operating principle?
How does the SpinalMouse® detect each vertebral body?
Important: The vertebrae are not actually detected; a recursive calculation is carried out. However, data comparisons with X-ray measurements demonstrated good reliability and validity (see Seichert 1999). The detailed assessment principle is part of our industrial secret.
PRACTICE - HANDLING
How to ensure both C7 and S3 are palpated? Additional anatomical points of reference?
S3 can be palpated; however this is somewhat difficult and not always possible. This is why recording must be stopped at the beginning of the anal crest.
Should I push very hard on the SpinalMouse®? Does the pressure affect the result?
Are the markers on the skin just used for demonstration and are not necessary during the actual test?
How can I clean the markers off the client’s skin – taking sensitive skin into consideration?
Must the orange mark and the incision on the housing be lined-up during the test?
Does the fluency with which the SpinalMouse® is run along the spine affect the result?
The most important issue is to maintain the same pace you start with during the whole process of recording the spine from C7 to S3. The conditions for achieving accurate recordings are:
- Exact identification of landmarks as starting and stopping points
(this was a problem that arose, but was recognised in Mannion’s study in 2004)
- Slow and constant speed
- Both wheels of the SpinalMouse® need to stay in contact with the skin at all times
- Apply a constant, very light pressure
How can I clean the SpinalMouse® after contact with a patient’s skin during the assessment?
- Use only water and soap when cleaning the plastic surfaces
- Detergents that contain certain ingredients (e.g. alcohol) will tarnish the material or make it brittle
- DO NOT use corrosive or abrasive detergents, sponges or cloths
Do the following when cleaning:
- Be sure the SpinalMouse® “power” is OFF
- Make sure NO liquids run into the SpinalMouse®, this can cause corrosion or internal damage
- Use a lint free cloth moistened only with soap and water
- The docking station should be cleaned after each 50 uses, but at least once a month
- The SpinalMouse® should be cleaned frequently and as required
- Clean both wheels of the SpinalMouse® after each 50 uses, but at least once every two months:
1. Pull the small wheel carefully from its attachment.
2. Clean the small wheel, the axle and the attachment.
3. Press the small wheel carefully into the attachment until it latches.
4. Be sure the small wheel can move freely.
How can I disinfect the SpinalMouse®?
A disinfectant should be used to clean the SpinalMouse®, its surfaces and equipment.
The SpinalMouse® wheels and the patient’s back should be disinfected before commencing the test.
- Switch the device “OFF” before disinfecting
- The SpinalMouse® and docking station may only be disinfected by wiping them
- The use of sprays is not recommended because disinfectants could enter the interior of the device
- Never use corrosive or abrasive disinfectants
- Never use disinfectants containing high-strength alcohols
- Do not use Toluol based resolvents
- Never sterilize or expose the SpinalMouse® or the docking station to high temperatures
- Never expose the SpinalMouse® or docking station to any disinfectants that contain alcohol for longer than 5 minutes
- DO NOT wash or submerse the SpinalMouse® or docking station in any liq¬uids or disinfectants
- Use a lint free cloth moistened only with disinfectant
- Use a disinfectant specifically suited for plastics or synthetics
PRACTICE – TESTING
When would you assess the spinal posture paravertebrally?
Do the markers on the spinal processes move away when the patient flexes laterally?
How can I instruct a patient in a seated position?
In order to generate comparable data, try to instruct patients to always adopt the same position. This is basically the key to reliability.
What is the Matthiass Test for?
What is the Spine-check Score© for?
How can I detect axial rotation and therefore scoliosis?
Patients bend forward until the most pronounced hump of the costal arch is reached. Two assessments in the sagittal plane are conducted in this position, at approx. 1-2cm left and right of the spine (see figure 1). A difference in the two assessments shows rotations within a certain region of the back, but cannot indicate axial rotations of a single vertebral body. The assessed rotation is a first indication for scoliosis, further examination for a clear diagnosis might be required.
How to assess if the standard posture contradicts with a patient’s habitual posture?
- Stand with the feet about hip-width apart
- Feet are parallel
- Distribute bodyweight evenly on both feet
- Knees should be straight
- The patient should adopt his habitual posture
- The arms should be allowed to hang relaxed at the sides of the body
- Look straight ahead (horizontally).
What to consider when interpreting data of an overweight patient?
Are there age limitations?
The gap between 12 and 17 years is a tricky issue because it is well known that during this time, substantial morphological changes to vertebral dimensions occur in the spine. Actually, because the SpinalMouse® System assumes constant vertebra dimensions, reference values for this age group are not as valid as those for patients aged below 12 and above 17. For the group between 12-17 years however, reference values for the age band 18-35 are shown. However, it based on practical experience, that these references values are interlinked with the age group of 12-17 years.
Analysis of the data and explanation of the figures (i.e. data table)
Sac/Hip J: Designates the “sacral angle”. This is defined as the angle between the superficial contour line via the sacrum in comparison to the plumb line. Because the connection of the sacrum to the pelvis via the sacroiliac joint is relatively immobile, the sacral angle is an assessment of the position of the pelvis in space (pelvis and sacrum move synchronously). Large positive sacral angles signify pelvic tilting, small positive or even negative sacral angles signify an upright position of the pelvis (pelvic tilting means ventral lowering of the pelvis, an upright pelvis signifies the opposite movement). The change in the sacral angle in the last three columns corresponds to the associated movement in the hip joints.
Thoracic spine: Represents the posture or mobility of the entire dorsal spinal column from Th1 to Th12. Positive angles signify kyphotic posture or flexion, negative angles lordotic posture or extension. The value corresponds to the sum of the 11 segmental angles from Th1/2 to Th11/12. The software adds up the raw data which can result in a minimal difference between the manually calculated sum and the automatically generated sum.
Lumbar spine: Represents the posture or mobility of the entire lumbar spinal column from Th12/L1 to L5/S1. It starts at Th12/L5 because this angle has a generally high mobility. Positive angles signify kyphotic posture or flexion, negative angles lordotic shape or extension. The value corresponds to the sum of the 6 segmental angles from Th12/L1 to L5/S1. The software adds up the raw data which can result in a minimal difference between the manually calculated sum and the automatically generated sum.
Incl.: The connection between Th1 and S1 is referred to as the line of inclination. The angle between this line of inclination and the plumb line is called the angle of inclination or for short, inclination. This has a very graphic meaning; in a “military-upright posture” one is “in the plumb line”. That means that a plumb line dropped from Th1 bisects the trochanter major and runs through the middle of the supporting area of the feet. In this case the inclination is zero degrees. In the usual posture, healthy volunteers often stand bent somewhat forward, so that the inclination is between 5° and 10°. A negative inclination signifies a total bending backwards or a reclination.
What are the reference zones related to?
The reference ranges for patients were provided through standardized assessments on healthy persons without back problems. Reference ranges are matched to gender and age categories. The reference ranges can be defined in the software as 1 or 2 standard deviations from the arithmetical mean of the study population.
Age groups (yrs.)
m / f
m / f
m / f
m / f
Sagittal standing, sagittal sitting, MatthiassTest
Diploma Thesis, Marina Thuma, 2007, Institut Bewegtes Lernen-Gesundheitsförderung, Vienna (A)
Dissertation, Stephanie Steinbeis, 1999, Ludwig-Maximilians-Universität, Munich (D)
Why use angles of >7° or <1° for investigations with the SpinalMouse®?
First of all, let us clarify an important but often misunderstood term: A motional or functional segment consists of two adjacent vertebrae with the corresponding intervertebral disk. The angle between the two vertebrae is usually termed the segmental angle.
The respective software tool is designed to mark jumps in segmental angles from one segment to the other of more than 7°. If you look at the reference values there is a mean standard deviation, depending on the segment, of approximately 2-6°. This is therefore deemed the “normal” variability. The values based on practical experience showed that this statistically “normal” variability and therefore the deviations of angles >7° and <1° are appropriate for practical application. Therefore jumps from one segment to the other that are greater than this variability (e.g. 7°) may be an indication of e.g. hypermobility.
The 1° tool is empirically determined too. If within a segment (between one vertebra and the adjacent vertebra), there is an angle equal or smaller than 1°, then it is marked. This may be an indication of hypomobility of the respective segment.
Important: The SpinalMouse® data must be used solely as a guideline towards achieving a correct diagnosis. As for all other clinical instruments, the SpinalMouse® must not be used blindly in the sense of an "expert system", where deviations from the reference values are uncritically interpreted as signs of pathology. In an individual case, only the complete clinical information available, together with the physician's individual experience, is capable of allowing a reliable clinical assessment to be made. Neither the technical device nor the software is able to interpret the results – only an expert can be responsible and capable of making the most reliable interpretation of the data.
Does the SpinalMouse® detect the Cobb angle as well?
The validity and reliability of "Spinal Mouse" assessment of spinal curvatures in the frontal plane in pediatric adolescent idiopathic thoraco-lumbar curves
Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Hacettepe University, Ankara, Turkey
Eur Spine J, [Epub ahead of print] Apr 22, 2015
In the Matthiass Test, why 30 seconds?
Predictive value of Matthiass' arm-raising test. A. Klee. Article in German
What do signs like ")" or "(" mean in viewing results of frontal assessments?
) = convex to the right
( = convex to the left
This is similar to the sagittal plane where you have an inclination forwards and backwards. The arrows in the range of motion column (3 columns on the right hand side) indicate whether there is a net angular change to the right “►” or to the left “◄”.
What is the acceptable range of error if I test the same patient several times consecutively?
What does it mean if the value of the angle between the sacrum and the hip is out of range (less than min or more than max) in the upright position?
Can the thoracic or lumbar spine (in the expert report of the Spine-check Score©) be hypomobile when some segments are hypermobile (red)?
Is there a standardised approach for assessing one test position?
Are there any special requirements for an interval period between two tests on the same person?
What is the degree of data comparability if participants are tested at different times of day?
How can I detect underlying pathologies?
Would an abnormally thick spinal disc or a spinal disc extrusion patient affect the accuracy?
If all discs are abnormally thick, then the system will compensate for that with the predicted dimension of each vertebral body and accuracy will not be affected.
EMPIRICAL VIEW &
Is there relevant research which indicates the scientific and diagnostic value of an assessment?
How good is validity in the lumbar region?
Which file format is the most appropriate for backing-up my recorded data?
The file which you currently use with the software must be located in the folder C:\MM60\Data with the name Data60.mdb.
If you want to use a backup version of your database with the software you must rename it back to Data60.mdb and replace it into the folder C:\MM60\Data.