Condition monitoring

If you go to a dictionary for a definition of physiotherapy, you'll discover the word relates to the treatment of disease and injury through a combination of massage, heat and exercise. The practise has a long history; ancient Greeks such as Hippocrates and Galenus are believed to have been the first to advocate that physical therapy could be a valid treatment. But the technique appears to have fallen by the wayside until the beginning of the 19th Century, when the Swedish Royal Central Institute of Gymnastics was founded in 1813 for 'massage, manipulation and exercise'. However, physiotherapy as a recognisable technique didn't arrive in the UK until 1894, when four nurses formed the Chartered Society of Physiotherapy. Because physiotherapy is a manual technique, there has been little, if any, use of technology. However, a renowned sports physiotherapist has collaborated with a leading technology company to bring physiotherapy bang up to date. The Gatherer Partnership, created by Don Gatherer and motorsport engineering expert John Bailey, is developing a range of innovative products and support packages that will offer physiotherapists accurate and objective data for the management of neuromusculoskeletal conditions. Data such as peak force and fatigue rating of voluntary muscle contraction will enable physiotherapists to assess the patient's true condition, determining whether there is the need for surgery, as well as providing the ability to create and administer bespoke conditioning and rehabilitation programmes. "Physiotherapy often relies on subjective data that can affect recovery levels and times," says Gatherer. "Our equipment will provide information on what the patient really can achieve and how their condition is developing over time. Extensive work undertaken with rugby players suggests we can improve recovery times too." To acquire such objective data, The Gatherer Partnership is incorporating electronic measurement devices that have typically been found in F1 racing cars. "Using loadcells and associated telemetry will introduce previously unseen levels of accuracy, repeatability and quality data to the physiotherapy profession," asserted John Bailey. "It genuinely can revolutionise the role of the physiotherapist." The Gatherer Partnership is working closely with neurosurgeons, orthopaedic surgeons and research institutions in an attempt to set new standards in the field of clinical evaluation. It believes the introduction into physical medicine of technology capable of objective data collection, analysis and rehabilitation monitoring will have a ground breaking impact for clinical management of the neuromusculoskeletal system. Analysis of data is paramount to clinical evaluation, says the Partnership, especially concerning nerve root lesions and the design of safe pre and post operative lesions and rehabilitation programming. Gatherer is a research physiotherapist whose 40 years of experience have given him an unrivalled reputation in sports and research physiotherapy. A rugby international for Singapore, Gatherer has provided physiotherapy services to the British Lions and England rugby teams. He was also chief physiotherapist to the Great Britain Olympic Team at the 1980 Moscow Olympics, where his charges included Steve Ovett and Sebastian Coe. He has also worked with footballers, F1 drivers, skiers, boxers, horse riders, rowers and field athletes providing conditioning and rehabilitation programmes and support. Gatherer has focused on proprietary research, specialising in cervical and lumbar analysis through the use of design and development of objective data logging. Projects include G force tolerance, motor function testing and working closely with neurosurgeons to provide analysis as a diagnostic aid for surgical intervention decisions. He believes this knowledge offers benefits outside of sport and, in 2010, set up The Gatherer Partnership to provide the tools and skills necessary to allow objective analysis in sport, leisure, defence and other sectors. Along with partnering with Gatherer, Bailey is managing director of Beru f1systems. Beru is a specialist supplier of performance engineering solutions – such as motorsport wiring harnesses, load cells, tyre pressure and temperature monitoring systems – to a range of motorsports categories. Its approach to component design incorporates lightweight and highly accurate solutions that perform for sustained periods in harsh environments. Physiotherapy would appear to be quite removed from the cut and thrust of, say, Formula 1, but there are links between the two environments. Bailey explained: "The Gatherer Partnership is using Formula 1 technology to allow force measurement data to be collected, then transmitted wirelessly to be analysed using bespoke software." Bailey said he met Gatherer in 2009. "He has been collecting and measuring human performance using force measurement and software, but the technology he was using was 'untidy'; the data was not as clean as it could be and the software was an arbitrary analysis package. He needed someone to sort this out." Bailey outlined the approach in physiotherapy. "If you look at physiotherapy, it provides a subjective analysis. The process is carried out by the physiotherapist, who will establish a condition solely by feel. What we have developed in The Gatherer Partnership is a system that will provide an objective measurement of the patient's condition. In particular, the system can provide information about the performance of particular muscle groups." Gatherer's work over the recent past has focused on the collection of data relating to cervical injuries; something common amongst rugby players. Assessing these injuries requires a delicate approach. "By taking force measurements, analysing the data and displaying it specifically," said Bailey, "the physiotherapist can establish the patient's condition and where their spinal problems are." In the first application of the technology, The Gatherer Partnership has developed what Bailey describes as 'a complex harness'. "It's a combination of things," he noted, "but the most important aspect is the interface between the patient and the load cell." Noting the importance of not exacerbating a spinal condition, Bailey said: "We have to be careful when applying force to the neck. The harness – the link between the physiotherapist and the patient – needs to remain straight in order to avoid imposing any lateral forces. If the link deviates, then the harness must break away." The whole system comprises the load cell, analysis software and a host pc. "Because the load cell can be controlled remotely," Bailey explained, "it means the physiotherapist is free to conduct exercises without having to enter keystrokes on the host computer." Beru's contribution to the project is a continuation of the work which it has done for the Formula 1 community. "Specifically," Bailey noted, "it's all about the accuracy of the load cell." Previously, Gatherer was using a beam cell to collect data. "But this was heavy and over specified," Bailey commented. "The load cell used in this harness has been designed specifically to be lightweight yet to have the ability to cope with forces of up to 250kg." The load cell is based on a strain gauge. "We selected that technology for its accuracy," Bailey pointed out. "It gives a resolution of grams and supports high sampling rates." High sampling rates may not seem to be a top line requirement for such a device, but Bailey disagreed. "With sampling rates in the order of 250Hz, the physiotherapist can collect data which would highlight such problems as muscle spasms." The system can also be used to monitor progress towards the patient's recovery. "Assessment tests can be used to review the patient's progress," Bailey said. "By comparing the patient's performance against a database, the physiotherapist can determine how well they are doing." It's an approach that may well prove attractive to those involved with professional rugby players. Now top level players are receiving high salaries, team directors are keen to get them back on the field as soon as possible. "If the player is, for example, within the top 10% of the database," Bailey explained, "he may well be ready to get back in the side." As far as work with professional athletes is concerned, Bailey said the opinion so far is that it gives them more confidence to get back to playing. This confidence boost is important for front row rugby players, who experience substantial loading on their necks during scrums. "It's a way of making sure they are in condition and showing that it is safe for them to play," Bailey believed. "It's something that hasn't been available before." Professional rugby aside, the system may find application in gyms, where it would provide a way for gym goers to determine how their fitness regimes are progressing. "And it would also allow those operating gyms to make sure people can use the equipment safely. But this is only one of the many potential applications for the technology," Bailey believed. One of these applications lies in Beru's 'home ground' – Formula 1. Bailey believes the approach will have useful application in G force training for drivers. As cars corner faster and brake more severely, the G forces imposed on the driver's neck are increasing. Although technology has been applied to this problem in the form of HANS, the head and neck support, drivers still need to develop the necessary muscular performance. "We can create exercise programmes from G maps, which use data collected from Formula 1 races. Using this data, complete race distances can be simulated in a 15minute exercise programme," Bailey suggested. A further application at the leading edge may lie with fighter pilots. "Pilots don't fly as much as they used to," Bailey contended. Now, The Gatherer Partnership is looking to develop the approach further. "One avenue which is being explored," said Bailey, "is to create a body area network to provide a 3d map of body loading." The system currently uses what Bailey called 'a 2.4GHz wireless protocol' to transmit data from the load cell to the host pc. "We're now looking to use a Bluetooth network and to add in more sensors," he said. Using Beru's Formula 1 expertise to ensure an optimised design, the first products are ready for commercialisation. "The experience we now have has allowed us to create a more compact unit, that is easier to use in a clinic," said Gatherer. "Using components originally specified for the harsh motorsport environment, we have been able to incorporate higher levels of accuracy, delivering better repeatability for the end user." In collaboration with the Royal Bucks Hospital, The Gatherer Partnership is actively designing, testing and analysing systems specific to spinal injuries and their rehabilitation. The Gatherer Partnership is now refining loadcell and sensor options to accommodate a range of exercise routines and levels of patient effort. "We envisage developing sensors that will provide a complete picture of patient effort and position in relation to specific exercise," Gatherer concluded.